Recent developments in life-event research and their relevance for the study of addictions

On the Road to Damascus? A Qualitative Study of Life Events and Decreased Drinking

This article presents a qualitative exploration of the relationship between life events and reduction in drinking. The 17 participants were all heavy drinkers who had experienced a life event in the previous two years and who had decreased their alcohol consumption. They were selected from a cohort of 500 untreated heavy drinkers in the English West Midlands. Data were obtained through in-depth interviews and subjected to thematic analysis. Participants discussed the decision to decrease in terms of: “needing to” decrease in order to prevent harm, “having to” decrease because of responsibilities, and “being able to” cut down as a by-product of other changes. It is argued that drinking change may occur for diverse reasons, and needs to be seen, not only as an individual decision-making process, but in relation to the discursive, social and environmental context in which drinking is embedded.

Life Cycles and Changes in Alcoholic Beverage Consumption: Research Project & Theoretical Framework

In order to understand the micro-sociological explanations behind the decline in alcoholic beverage consumption, particularly wine, in Italy during the last 30 years, we studied social mechanisms affecting the behavior of individuals. Alcohol consumption patterns, context, time of day, people with whom it was consumed, regularity and quantity consumed, all vary over the course of a person's life. One of the approaches adopted in analyzing changes in consumption patterns was the sociological “approach to the lifecourse” that focused its attention on the transitions from one phase of life to the next and looked at the paths characterizing the lives of individuals.

The complex study of alcoholic beverage consumption was addressed with interviews that combined completely standardized techniques (questionnaires with fixed questions and answers) and partially standardized approaches (semi-structured interviews). Altogether, 117 men of two cohorts (40–45 years and 65–70 years) were interviewed, all of whom had reduced their alcohol consumption over the course of their lives. Two focus groups were also organized and conducted.

The age groups were designed to record the consumption habits in the initial phase of the period of interest—that is the early 1970s—of two important social groups. The first one was young and in their adolescent years during the 1970s, while the second group was made up of people already in their adult years.

Positional Role Changes and Drinking Patterns: Results of a Longitudinal Study

This study of heavily drinking males in the general population assesses the effect of positional role changes on drinking behaviors. The data are derived from a longitudinal study over a three-year period (1992–1995) of a representative sample of 617 male heavy drinkers from the Quebec (Canada) adult population. Three types of positional roles have been examined: employment, marital, and parental status. This study examined two dimensions of the drinking pattern: the annual frequency of drinking and the annual frequency of five drinks or more on a single occasion. Standard multiple regression analyses were conducted independently for each dimension of the drinking patterns. Results indicated that baseline annual frequency and baseline annual frequency of five drinks or more per occasion were the main predictors of both drinking patterns under study. Furthermore, positional role changes contributed to explain the Δ1992–1995 annual frequency of drinking, but marginally. Men who reported a child's birth between 1992 and 1995 reduced their annual frequency of drinking, while men who reported being unemployed in 1992 and in 1995 increased their annual frequency of drinking. Further research should take into account the qualitative aspects of positional roles.

Is alcohol dependence best viewed as a chronic relapsing disorder?

This 'For Debate' paper starts by recognizing the growing trend towards considering alcohol dependence as a chronic relapsing disorder. We argue that the adoption of this model results from focusing on those in treatment for alcohol dependence rather than considering the larger number of people in the general population who meet criteria for alcohol dependence at some point in their lives. The majority of the general population who ever experience alcohol dependence do not behave as though they have a chronic relapsing disorder: they do not seek treatment, resolve their dependence themselves and do not relapse repeatedly. We suggest that caution is therefore needed in using the chronic relapsing disorder label. Our primary concerns are that this formulation privileges biological aspects of dependence to the detriment of psychological and social contributions, it inhibits much-needed developments in understanding alcohol dependence and leads to inefficient distributions of public health and clinical care resources for alcohol dependence. We invite debate on this issue.

The importance of glucocorticoids in alcohol dependence and neurotoxicity

Alterations in hypothalamo-pituitary adrenal (HPA) function have been described in alcoholics and in rodents after chronic alcohol consumption but the role of glucocorticoids in alcohol consumption, and the mechanisms involved, has received little attention until recently. Both alcohol consumption and withdrawal from chronic alcohol intake raise circulating glucocorticoid levels, and prolonged high concentrations of glucocorticoids are known to have detrimental effects on neuronal function and cognition. This minireview covers the ways in which glucocorticoids may be involved in drinking behavior, from social drinking to dependence, and the negative consequences of alcohol consumption seen during withdrawal which may have a detrimental effect on treatment outcome. Research shows prolonged increases in brain glucocorticoid concentrations and decreased brain glucocorticoid receptor availability (consistent with increased levels of endogenous ligand) after withdrawal from chronic alcohol treatment. Evidence suggests that increased glucocorticoid levels in the brain after chronic alcohol treatment are associated with the cognitive deficits seen during abstinence which impact on treatment efficacy and quality of life. Studies on organotypic cultures also demonstrate the importance of glucocorticoids in the neuropathological consequences of alcohol dependence.

Impact of self-reported life events on the profile of opioid dependence syndrome

AIM

The aim of this work was to investigate the impact of life events on the profile of opioid dependent patients.

METHOD

Recruitment was achieved through outpatient drug treatment clinic in Birmingham, UK, and data were collected through semistructured interviews. One-hundred and twenty subjects with opioid dependence syndrome were interviewed, and 100 controls of non-drug-using family members and friends.

RESULT

The mean age of the opioid group was 33.3 years, SD = 8.8. The majority individuals of the sample were White British (80.8%), unemployed (69.2%), and male (75%). The mean severity of dependence as measured by two scales indicated severe level of dependence according to the authors of each scale. The mean number of traumatic events for the opioid dependence group was 4.8, SD = 3.57 vs. 3.55; SD = 3.65 in control group with significant difference (t = 2.56, df = 218, p = .01). Significant predictors of severe opioid dependency were age of second exposure to events, change of residence, break-up with boy/girlfriend, and conflict with father.

CONCLUSION

The data presented indicate that a significant group of opioid dependent patients experience adverse life events in both childhood and adulthood. It is by attending to and addressing these issues that health care workers can alleviate ongoing distress and promote confidence.

Measuring factors that influence the response of medical practitioners and social workers to problem drinkers: a pilot study

It is increasingly recognized that factors such as professionals' empathy, willingness to intervene, self-efficacy and role legitimacy influence the initial engagement of clients into treatment and the nature of any subsequent therapeutic relationship. These factors are difficult to measure using questionnaires, and for this reason qualitative research techniques are frequently used in this field of inquiry. The present methodological study is based on in-depth interviews conducted with 16 medical practitioners and 12 social workers, and attempts to overcome one of the main limitations associated with qualitative data-that is, the difficulty of reducing such complex material to a numerical value suitable for quantitative analysis. The interview technique and rating system described were most successful in achieving this in the case of self-efficacy and least successful in the case of empathy. Possible reasons for this are discussed. It is concluded that the technique described has the potential to elicit detailed data concerning the interactions of medical practitioners and social workers with problem drinkers, and that this material can be reliably rated in a manner that is not unduly time-consuming and burdensome to researchers.

The impact of moderate daily alcohol consumption on aggression and the formation of dominance hierarchies in rats

RATIONALE AND OBJECTIVE

Group-housed male rats form social hierarchies, and under these conditions, it has been reported that subordinate (SUB) rats consume more alcohol than dominant (DOM) rats. We tested the hypothesis that a history of drinking alcohol would cause SUB rats to consume even greater amounts of alcohol.

METHODS

Male Long-Evans rats were trained to drink 10% alcohol or a sucrose/quinine solution equal in calories for 1 h/day using a sucrose-fading procedure. Subsequently, rats were housed in colonies (four males, two females) in a visible burrow system (VBS) for 14 days. Individual control male rats were housed in a tub cage with one female. Rats were removed from the VBS (or control environment) daily and given 1 h to drink alcohol or sucrose/quinine.

RESULTS

Colonies given daily access to sucrose/quinine formed clear DOM/SUB relationships in all measured parameters. Alcohol-drinking colonies failed to establish a dominance hierarchy and displayed little aggression, with an average of 14.6 +/- 6.1 offensive attacks compared with 58.5 +/- 12.3 attacks carried out by DOM sucrose/quinine rats. During VBS housing, alcohol and sucrose/quinine intake decreased independent of housing environment or social status.

CONCLUSIONS

Contrary to prior reports of the effect of alcohol on aggressive behavior, moderate daily alcohol intake before and during VBS housing reduced aggression and precluded the formation of a dominance hierarchy in rats.

Adolescence, glucocorticoids and alcohol

This review examines the evidence that glucocorticoids are involved, during both adolescence and adulthood, in the cognitive deficits caused by long-term alcohol consumption and in the mechanism(s) of alcohol dependence. During adolescence, the hypothalamopituitary-adrenal (HPA) axis undergoes well-characterized changes in basal activity and many of these are influenced by alcohol consumption. While the former have been fairly well studied, there is little information about whether alcohol effects on the HPA in adolescents differ from those in adults. The means by which glucocorticoids may influence alcohol-related neurotoxicity are presented, and potential differences between adolescence and adults in this regard noted. The substantial evidence for involvement of glucocorticoids in alcohol-induced cognitive deficits is described, with particular reference to the consequences of alcohol withdrawal. The use of immature organotypic cultures of rodent brain in the study of alcohol neurotoxicity is considered in detail, and the information obtained from this methodology concerning the role of glucocorticoid receptors and excitable membrane proteins in this neurotoxicity. The influence of glucocorticoids on alcohol consumption and possible contributions to alcohol dependence are then considered. In conclusion, more information concerning the effects of glucocorticoids on plasticity and alcohol neurotoxicity during the adolescent period is needed.

Social defeat increases alcohol preference of C57BL/10 strain mice; effect prevented by a CCKB antagonist

RATIONALE

In humans, social stress over long and short term can increase alcohol consumption, but the mechanisms involved are not understood.

OBJECTIVES

This study was conducted to examine the effects of social defeat, using the resident/intruder paradigm, on the alcohol preference of "low alcohol drinking" individuals in a colony of C57BL/10 strain mice and the effects of two anxiolytic drugs.

METHODS

Alcohol preference, in a two-bottle choice (8% v/v alcohol or water), was measured, in separate experiments, after either a single experience of social defeat by a resident male mouse, five consecutive daily defeat experiences or one experience per week for 4 weeks. Comparison was made with effects of repeated social defeat on the preference for dilute sucrose. In addition, the actions of the CCKB receptor antagonist, CAM1028, and of diazepam were examined on the effects of repeated defeat experiences.

RESULTS

Five consecutive daily defeat experiences had a slow onset effect in increasing alcohol preference and consumption, compared with five daily exposures to a novel environment. A single defeat, or one defeat per week, did not significantly alter alcohol preference or intake. There were no effects of five daily defeat experiences on sucrose preference or consumption. The effect of repeated defeats on alcohol preference was significantly decreased by administration of the CCKB receptor antagonist, CAM1028, prior to each experience, but not by corresponding administration of diazepam.

CONCLUSION

The results show that social stress increases alcohol intake in low alcohol preference C57BL/10 mice and suggest that CCK transmission may be involved in this effect.

[Prevalence of "bayonet finger": a manifestation of attention-deficit hyperactivity disorder among male alcoholics and psychotics]

The prevalence of Bajonettfinger, a semiologic sign of attention-deficit disorder hyperactivity (ADHD), was determined in male alcoholics and psychotics from a psychiatric hospital. A control group was taken from the hospital staff. The morphologic alteration was observed in 35% of the 200 alcoholics, 45% of the 100 psychotics and 16% of the 50 controls. The difference in prevalence of the sign between the alcoholics and psychotics groups was not significant but the differences between any of these groups and the controls was significant. The observations suggested that: (1) ADHD would be present, as judged through its high correlation with the prevalence of bajonettfinger, in approximately 1/3 of the alcoholics and 1/2 of the psychotics; (2) ADHD would be a vulnerability factor for alcoholism; (3) adolescents with bajonettfinger should deserve special preventive attention with respect to alcoholism.

A longitudinal examination of the relationships among stress, coping strategies, and problems associated with alcohol use

This study examined the longitudinal relationships among family history of alcoholism (FH+), stress levels, utilization of coping methods, and alcohol-related problems. Data used in this study were obtained from a nonclinical sample of subjects who were originally interviewed when they were 12, 15, or 18 years of age and followed-up twice more at 3-year intervals for a longitudinal sample size of 1270. Although a greater percentage of females in this sample reported a FH+ background as well as higher levels of stress, they tended to utilize positive coping strategies more often and reported fewer numbers of alcohol problems than males. In general, younger subjects who reported high levels of stress experienced more alcohol-related problems regardless of coping method chosen. In older subjects, the effect of stress on problems appeared to be buffered when coupled with the use of support seeking. Subjects whose stress preceded problems exhibited no significant difference from subjects whose problems preceded stress and symptom-free and "stressed-only" subjects were not significantly different from each other in number of problems at time 3, suggesting that a direct effect of stress alone on alcohol-related problems is questionable.

Emotional but not physical stress enhances intravenous cocaine self-administration in drug-naive rats

Involvement of stress in the etiology of drug dependence has received little attention. In the present study a number of behavioural manipulations were applied and examined for an effect on intravenous cocaine self-administration in drug-naive rats with no prior training in leverpress responding. Self-administration rate was measured during five consecutive daily sessions. Stress reduction by handling rats daily for two weeks prior to testing for self-administration did not affect cocaine self-administration. Acute physical stress was induced either by a hot plate or by repeated footshocks, and emotional stress was induced by forcing rats to witness another rat being subjected to repeated footshocks. These stressors were applied immediately prior to each cocaine self-administration session. Emotional but not physical stress enhanced the rate of cocaine self-administration. It is concluded that emotional distress may increase the rewarding effects of cocaine and may render an individual more susceptible to development of drug dependence.