Stress-response-dampening effects of alcohol: attention as a mediator and moderator

Alcohol dose effects on stress response to cued threat vary by threat intensity

RATIONALE

Clarification of alcohol's effect on stress response during threat is critical to understand motivation for alcohol use and related alcohol-use disorders. Evaluation of stress response dampening (SRD) effects of alcohol has been limited by nonsystematic use of varied experimental methods and measures.

OBJECTIVES

This experiment parametrically varied alcohol dose and shock threat intensity among social drinkers to examine their effects on startle potentiation, a physiological measure of the affective component of the stress response.

METHODS

Ninety-six participants were assigned to one of four beverage groups: placebo and target blood alcohol concentration (BAC) groups of 0.04%, 0.075%, and 0.11%. Participants viewed colored cues presented in shock and no-shock blocks. Distinct colored cues predicted imminent low, moderate, or high intensity electric shock administration. Startle potentiation during shock threat relative to no-shock cues indexed affective response.

RESULTS

High threat increased startle potentiation relative to moderate/low intensity threat. Startle potentiation decreased as BAC increased. Threat intensity moderated this BAC effect with the strongest BAC effect observed during high threat. Analysis of individual difference moderators revealed reduced effect of BAC among heavier, more problematic drinkers.

CONCLUSIONS

Clear alcohol SRD effects were observed. These SRD effects were greatest at higher BACs and during more potent threat. Failure to account for these factors may partially explain inconsistent findings in past laboratory SRD research. Furthermore, they suggest greater reinforcement from alcohol at higher doses and among individuals with greater stress. Moderation of SRD effects by alcohol consumption and problems point to possible important risk factors.

Alcohol effects on performance monitoring and adjustment: affect modulation and impairment of evaluative cognitive control

Alcohol is known to impair self-regulatory control of behavior, though mechanisms for this effect remain unclear. Here, we tested the hypothesis that alcohol's reduction of negative affect (NA) is a key mechanism for such impairment. This hypothesis was tested by measuring the amplitude of the error-related negativity (ERN), a component of the event-related brain potential (ERP) posited to reflect the extent to which behavioral control failures are experienced as distressing, while participants completed a laboratory task requiring self-regulatory control. Alcohol reduced both the ERN and error positivity (Pe) components of the ERP following errors and impaired typical posterror behavioral adjustment. Structural equation modeling indicated that effects of alcohol on both the ERN and posterror adjustment were significantly mediated by reductions in NA. Effects of alcohol on Pe amplitude were unrelated to posterror adjustment, however. These findings indicate a role for affect modulation in understanding alcohol's effects on self-regulatory impairment and more generally support theories linking the ERN with a distress-related response to control failures.

Targeting cognitive-affective risk mechanisms in stress-precipitated alcohol dependence: an integrated, biopsychosocial model of automaticity, allostasis, and addiction

This paper proposes a novel hypothetical model integrating formerly discrete theories of stress appraisal, neurobiological allostasis, automatic cognitive processing, and addictive behavior to elucidate how alcohol misuse and dependence are maintained and re-activated by stress. We outline a risk chain in which psychosocial stress initiates physiological arousal, perseverative cognition, and negative affect that, in turn, triggers automatized schema to compel alcohol consumption. This implicit cognitive process then leads to attentional biases toward alcohol, subjective experiences of craving, paradoxical increases in arousal and alcohol-related cognitions due to urge suppression, and palliative coping through drinking. When palliative coping relieves distress, it results in negative reinforcement conditioning that perpetuates the cycle by further sensitizing the system to future stressful encounters. This model has implications for development and implementation of innovative behavioral interventions (such as mindfulness training) that disrupt cognitive-affective mechanisms underpinning stress-precipitated dependence on alcohol.

Effects of alcohol on brain responses to social signals of threat in humans

Alcohol is a known exogenous modulator of negative affect (anxiety, tension) in both animals and humans. It has been proposed that the anxiolytic effects of alcohol are mediated via the amygdala, an area critical to fear perception and responding. However, little is known about the acute effects of alcohol on amygdala reactivity to threatening information in humans. We used functional magnetic resonance imaging and a validated task to probe amygdala responses to social signals of threat in 12 healthy, social drinkers after a double-blind crossover administration of alcohol or placebo. We found that alcohol significantly reduced amygdala reactivity to threat signals. The current findings fit well with the notion that alcohol may attenuate threat-based responding and provide a potential brain-based mechanism for the link between alcohol and anxiety and/or social threat perception.

Attention to social threat as a vulnerability to the development of comorbid social anxiety disorder and alcohol use disorders: an avoidance-coping cognitive model

Despite the frequent comorbidity of social anxiety disorder and alcohol use disorders, no theoretical model currently exists to explain the specific mechanisms underlying the comorbidity between these two disorders. An integration of existing theoretical models and empirical evidence across the social anxiety and alcohol use literatures is presented as the Avoidance-Coping Cognitive Model, which proposes that socially anxious individuals may be particularly vulnerable to the anxiolytic effects of alcohol through reductions in attention biases to social threat. The disproportionate reduction in anxiety may then make alcohol an attractive method of avoidance coping. Gaps in the empirical literature are reviewed in light of this model as future directions are suggested.

The other side of the curve: examining the relationship between pre-stressor physiological responses and stress reactivity

There is widespread consensus that stress induces dramatic physiological changes, but no agreement on the quantitative parameters that are appropriate to measure these responses. More importantly, the interpretation of various stress measurements, and how individual responses should be evaluated, has not been properly addressed. Even the definition of baseline, against which stress responses must be measured, is not clearly established. The current experiment sought to address these shortcomings by comparing the predictive value of different calculated parameters for psychosocial and physiological measures of stress across individuals. Subjects were 29 male and 59 female healthy undergraduate students with saliva samples collected over a 3-h interval that included a Trier Social Stress Test. Salivary cortisol and alpha-amylase response were analyzed using the absolute concentration, the percent change in concentration, the area under the curve (Pruessner et al., 2003), and the arrival index (change from arrival to 1h after arrival). The arrival index correlated with the subsequent stress response for both cortisol (r=0.76, p<0.01) and alpha-amylase (r=0.86, p<0.01). The arrival index for both cortisol and alpha-amylase was also related to subjective ratings of anxiety following the psychosocial stressor. A subset of individuals with high self-reported anxiety also displayed higher reactivity in response to the psychosocial stressor. Thus, the magnitude of the difference in cortisol and alpha-amylase between arrival and 1h after arrival was a predictor of subsequent stress reactivity. These findings suggest that different psychosocial profiles may be reflected in cortisol and alpha-amylase changes. For this reason: (1) a recovery period after arrival is essential to establish a baseline, (2) the difference between arrival and post-recovery period baseline should be included in experimental designs as a predictive variable, and (3) transformation of individual measures into proportional changes relative to the arrival sample is very likely to obscure important underlying individual differences.

An Examination of the Mediational Effects of Cognitive and Attitudinal Factors of a Parent Intervention to Reduce College Drinking

As part of a parent intervention to reduce heavy-drinking, college freshmen were assessed for their attitudes toward drinking and reasonable alternatives to drinking on the weekends, as well as cognitive variables underlying attitudinal variables. Intervention parents received a handbook the summer prior to college entrance with information about college drinking and best practices for parent-teen communication. Results revealed that the association between intervention condition and drinking outcomes was mediated by attitudes favorable to drinking and reasonable alternatives to drinking, as well as beliefs about alcohol related behavior. This parent program was shown to be efficacious for changing high-risk drinking in college. Findings are discussed regarding the further development of college drinking prevention programs involving parents.

Impulsivity, impulsive and reflective processes and the development of alcohol use and misuse in adolescents and young adults

This paper contrasts dual-process and personality approaches in the prediction of addictive behaviors and related risk behaviors. In dual-process models, behavior is described as the joint outcome of qualitatively different “impulsive” (or associative) and “reflective” processes. There are important individual differences regarding both types of processes, and the relative strength of both in a specific situation is influenced by prior behavior and state variables (e.g., fatigue, alcohol use). From this perspective, a specific behavior (e.g., alcohol misuse) can be predicted by the combined indices of the behavior-related impulsive processes (e.g., associations with alcohol), and reflective processes, including the ability to refrain from a motivationally salient action. Personality approaches have reported that general traits such as impulsivity predict addictive behaviors. Here we contrast these two approaches, with supplementary analyses on four datasets. We hypothesized that trait impulsivity can predict specific risky behaviors, but that its predictive power disappears once specific behavior-related associations, indicators of executive functioning, and their interaction are entered into the equation. In all four studies the observed interaction between specific associations and executive control (EC) was robust: trait impulsivity did not diminish the prediction of alcohol use by the interaction. Trait impulsivity was not always related to alcohol use, and when it was, the predictive power disappeared after entering the interaction between behavior-specific associations and EC in one study, but not in the other. These findings are interpreted in relation to the validity of the measurements used, which leads to a more refined hypothesis.

Increases in B-type natriuretic peptide after acute mental stress in heart failure patients are associated with alcohol consumption

OBJECTIVE

The aim of this study was to investigate in heart failure (HF) patients whether acute mental stress induces increases in the HF-severity biomarker B-type natriuretic peptide (BNP) and if alcohol consumption is associated with such stress-induced increases.

METHOD

Twenty-one male HF patients and 19 male non-HF controls (M = 56 years, SEM = 2) underwent a 15-minute acute mental stress test combining public speaking and mental arithmetic. Plasma levels of BNP were determined immediately before as well as 2 hours after the stress test. Alcohol consumption was assessed by self-reported number of drinks per month and history of use.

RESULTS

HF patients had higher BNP levels before and after stress, F(1, 38) = 23.42, p < .001, and showed greater stress-induced increases in BNP levels, F(1, 38) = 4.52, p = .04, compared with controls. HF status (beta = .32, p = .015, deltaR(2) = .10) and higher alcohol consumption ((beta = .61, p< .001, deltaR(2) = .37) were independently associated with higher BNP stress increases. Moreover, higher alcohol consumption moderated the greater BNP stress increases in HF patients but not in controls (p = .49, p < .001, delta(2) = .20), although alcohol consumption did not differ between groups.

CONCLUSIONS

For individuals with HF, particularly those who drink moderate to more substantial amounts of alcohol, exposure to acute psychological stress leads to increases in circulating levels of BNP, a biomarker which is associated with increased morbidity and mortality in HF.

Executive functioning, irritability, and alcohol-related aggression

The purpose of this investigation was to examine (a) whether irritability mediates the relation between executive functioning (EF) and alcohol-related aggression and (b) whether the alcohol-aggression relation is better explained by the interactive effects of EF and irritability above and beyond the effects of either variable alone. EF was measured using seven well-established neuropsychological tests. Irritability was assessed with the Caprara Irritability Scale. Participants were 313 male and female social drinkers between 21 and 35 years of age. Following the consumption of an alcohol or a placebo beverage, participants were tested on a laboratory aggression task in which electric shocks were given to and received from a fictitious opponent under the guise of a competitive reaction-time task. Aggression was operationalized as the shock intensities administered to the fictitious opponent. Results indicated that irritability successfully mediated the relation between EF and intoxicated aggression for men only. Despite the fact that irritability and EF both independently moderated the alcohol-aggression relation in previous studies, no significant interaction for their combined effect was detected here. The findings are discussed, in part, within a cognitive neoassociationistic framework for aggressive behavior.

Catching the alcohol buzz: an examination of the latent factor structure of subjective intoxication

BACKGROUND

The goal of this study was to examine the latent structure among measures of alcohol-induced subjective feelings of intoxication from a behavioral pharmacology perspective.

METHODS

Data on subjective intoxication, measured concomitantly by the Subjective High Assessment Scale, Biphasic Alcohol Effect Scale, and the Short Version of the Profile of Mood States, were collected at 3 levels of breath alcohol concentration during an alcohol administration study in a sample of heavy drinkers (n = 135).

RESULTS

Results of exploratory factor analyses supported a 3-factor model which captured the following dimensions of subjective intoxication: (1) stimulation and other pleasant effects, (2) sedative and unpleasant effects, and (3) alleviation of tension and negative mood. The tension-reduction factor was most consistently associated with more frequent drinking and alcohol problems in this sample.

CONCLUSIONS

These findings support the notion that the neuropharmacological and behavioral effects of alcohol are multifaceted and cannot be simply defined as either positive or negative. Rather, moderate levels of intoxication appear to have concomitant dimensions of positive reinforcement, negative reinforcement, and punishment. This study also suggests that factor scores may be useful in future alcohol administration studies to reduce the number of comparisons and perhaps increase statistical power to detect meaningful effects.

Alcohol selectively reduces anxiety but not fear: startle response during unpredictable versus predictable threat

Recent theory and empirical research have suggested that fear and anxiety are distinct processes with separable neurobiological substrates. Furthermore, a laboratory procedure has been developed to manipulate fear versus anxiety independently via administration of predictable or unpredictable electric shock, respectively. Benzodiazepines appear to selectively reduce anxiety but not fear in this procedure. The primary aim of this experiment was to determine if alcohol produced a similar selective reduction in anxiety. Intoxicated (target blood alcohol concentration of .08%) and nonintoxicated participants viewed a series of colored squares separated by variable intertrial intervals (ITIs) in 3 conditions. In the predictable shock condition, shocks were administered contingently during every square. In the unpredictable shock condition, shocks were administered noncontingently during both squares and ITIs. In the no-shock condition, no shocks were administered at any time. Alcohol significantly reduced startle potentiation during cues signaling unpredictable but not predictable shock, consistent with the thesis that alcohol selectively reduces anxiety but not fear. In addition, alcohol's effect on startle potentiation during unpredictable shock was mediated by vigilance. This anxiolytic effect may clarify the nature of alcohol's reinforcing effects in social and problem drinkers.

The effects of energy drinks alone and with alcohol on neuropsychological functioning

OBJECTIVE

Caffeinated energy drinks-alone or with alcohol-are heavily marketed to young adults, many of whom believe that caffeine counteracts some negative effects of alcohol intoxication. While the effects of caffeine and alcohol have been widely investigated, few studies have examined neuropsychological performance after consumption of a beverage containing both ingredients.

METHODS

In a double-blind, placebo-controlled design, 27 non-caffeine-deprived female participants were randomly assigned to consume a caffeinated energy drink alone, one containing alcohol, or a non-alcoholic, non-caffeinated control beverage. Pre- and post-test assessments were conducted using alternate forms of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).

RESULTS

Participants who consumed the energy drink plus alcohol evidenced significantly lower post-test performance on a global score of neuropsychological status. Specifically, deficits were found in both visuospatial/constructional and language performance scores. While participants who consumed the caffeinated beverage alone trended toward improved attention scores, neuropsychological status did not show meaningful changes from the pre- to post-test.

CONCLUSIONS

Consumption of an energy drink containing 6% alcohol by volume negatively influenced performance on a global measure of cognitive functioning.

The acute effect of low-dose alcohol on working memory during mental arithmetic: II. Changes of nonlinear and linear EEG-complexity in the theta band, heart rate and electrodermal activity

OBJECTIVE AND HYPOTHESIS

Nonlinear and linear methods of EEG-complexity analysis and autonomic measures were used to characterize processes accompanying performance in a mental arithmetic task challenged by low ("social") alcohol doses. It was expected that alcohol in such doses will dampen changes of task-related EEG-synchronization in the theta band, and those of heart rate and electrodermal activity (EDA).

METHODS

In the mental arithmetic task addition and working memory, effort was required. The EEG, ECG and EDA were recorded in 5 conditions: task, placebo-task, low dose-task (0.2 g/kg alcohol), high dose-task (0.4 g/kg alcohol). Omega-complexity and synchronization likelihood (SL) were computed of the theta band of the EEG.

RESULTS

Task-related decrease of the Omega-complexity and increase of the SL was found in the theta frequency band. Following alcohol consumption, these changes did not develop as seen especially for SL in the anterior area, although the significant effects were elicited by task performance. Conspicuous task-evoked increases were observed for ECG and EDA which were even more enhanced by alcohol.

CONCLUSIONS

Task-induced significant changes of the Omega-complexity and that of SL indicate increased synchrony in the theta band, probably corresponding to working memory effort. Both of these measures proved to be sensitive for the effect of low alcohol dose although these alcohol-elicited changes were not statistically significant. Task-induced heart rate and EDA increases were further intensified by alcohol probably indicating its activating effect on these autonomic measures in the dose range studied.

Mu-opioid receptors selectively regulate basal inhibitory transmission in the central amygdala: lack of ethanol interactions

Endogenous opioid systems are implicated in the actions of ethanol. For example, mu-opioid receptor (MOR) knockout (KO) mice self-administer less alcohol than the genetically intact counterpart wild-type (WT) mice (Roberts et al., 2000). MOR KO mice also exhibit less anxiety-like behavior than WT mice (Filliol et al., 2000). To investigate the neurobiological mechanisms underlying these behaviors, we examined the effect of ethanol in brain slices from MOR KO and WT mice using sharp-electrode and whole-cell patch recording techniques. We focused our study in the central nucleus of the amygdala (CeA) because it is implicated in alcohol drinking behavior and stress behavior. We found that the amplitudes of evoked inhibitory postsynaptic currents (IPSCs) or inhibitory postsynaptic potentials (IPSPs) were significantly greater in MOR KO mice than WT mice. In addition, the baseline frequencies of spontaneous and miniature GABA(A) receptor-mediated inhibitory postsynaptic currents were significantly greater in CeA neurons from MOR KO than WT mice. However, ethanol enhancements of evoked IPSP and IPSC amplitudes and the frequency of miniature IPSCs were comparable between WT and MOR KO mice. Baseline spontaneous and miniature excitatory postsynaptic currents (EPSCs) and ethanol effects on EPSCs were not significantly different between MOR KO and WT mice. Based on knowledge of CeA circuitry and projections, we hypothesize that the role of MOR- and GABA receptor-mediated mechanisms in CeA underlying reinforcing effects of ethanol operate independently, possibly through pathway-specific responses within CeA.

Fatty acid ethyl esters in meconium are associated with poorer neurodevelopmental outcomes to two years of age

OBJECTIVE

To determine the relationship between fatty acid ethyl esters (FAEE) in meconium and neurodevelopment in infants exposed to alcohol in utero at 6.5 months, 1 year, and 2 years of age.

STUDY DESIGN

A secondary analysis of a prospective cohort of mothers at high risk and their infants recruited after admission to a labor and delivery unit. Mothers were screened for drug and alcohol use during pregnancy by clinical interview and urine screening. Meconium was analyzed for FAEE in 216 newborn infants. Outcome measures included the Bayley Scales of Infant Development Mental (MDI) and Psychomotor (PDI) Developmental Index scores in infants at 6.5 months, 1 year, and 2 years of age.

RESULTS

After controlling for prenatal visits and maternal factors, increasing concentrations of FAEE were significantly associated with poorer mental and psychomotor development (beta +/- standard error) at all follow-up visits: ethyl myristate (MDI -2.46 +/- 1.24, P = .05; PDI -3.88 +/- 1.67, P = .02), ethyl oleate (MDI -1.94 +/- 0.65, P < .01; PDI -2.60 +/- 0.93, P < .01), ethyl linoleate (MDI -1.92 +/- 0.60, P < .01; PDI -2.28 +/- 0.84, P < .01), ethyl linolenate (MDI -1.99 +/- 0.74, P < .01; PDI -2.98 +/- 1.04, P < .01), and ethyl arachidonate (MDI -2.40 +/- 1.11, P = .03; PDI -3.32 +/- 1.51, P = .03).

CONCLUSION

FAEE in meconium may be a marker for identifying newborns at risk for neurodevelopmental delay from alcohol exposure in utero.

The influence of stress on the transition from drug use to addiction

Stress--that is, any type of stimulus that challenges the organism's normal internal balance--induces a physiologic response involving a variety of hormones and other signaling molecules that act on, among other organs, the brain. This stress response also can influence the progression of alcohol and other drug (AOD) addiction through various stages. For example, AODs can directly activate the stress response. In turn, certain stress hormones (i.e., glucocorticoids and corticotrophin-releasing factor) also act on the brain system that mediates the rewarding experiences associated with AOD use (i.e., the mesocorticolimbic dopamine system). Moreover, elevated glucocorticoid levels and stress increase AOD self-administration in certain animal models. During a later stage of the addiction process, in contrast, excessive and/or prolonged stress may impair the reward system, inducing heavier AOD use to maintain the rewarding experience. During the final stage of addiction, when the addicted person experiences withdrawal symptoms if no drug is consumed, chronic AOD use results in gross impairment of the normal stress response and other signaling mechanisms in the brain, resulting in a state of anxiety and internal stress. At this stage, people continue to use AODs mainly to relieve this negative-affect state.