Family history of alcoholism does not predict neuropsychological performance in alcoholics

Executive dysfunction as a risk marker for substance abuse: the role of impulsive personality traits

The relationships between family history of substance use, executive functions, impaired decision making, and current substance dependence are the focus of this study. Thirty-eight substance-dependent inpatients were compared with 30 community controls on performance on the Wisconsin Card Sorting Test, Trail-Making Test-B, the Stroop Color Word Test, the Wais-II Digit Span, and the Iowa Gambling Task. Recent alcohol use, depressive symptoms, and impulsivity were also assessed. As hypothesized, individuals with substance dependence exhibited poorer executive functioning. Family history status was modestly related to impaired performance on tests designed to measure the integrity of the dorsolateral prefrontal cortex. In particular, substance-dependent, family history positive individuals performed less well on the Wisconsin Card Sorting Test than substance-dependent individuals without a family history. Digit Span performances were worse among family history positive controls when compared with family history negative controls. Impulsive personality traits--specifically, difficulty thinking before acting (Urgency)--were related, as hypothesized, to executive functioning. Results indicate that family history status confers an increased risk of impairment beyond that conferred by recent substance abuse, and that impulsive personality traits are related to performance on tests of executive functions. Implications for criminality are discussed.

Cognitive ability and risk for alcoholism: short-term memory capacity and intelligence moderate personality risk for alcohol problems

This study tested the hypothesis that short-term memory (STM) capacity moderates the effect of social deviance on alcohol problems. Personality, cognitive ability, and alcohol use and abuse were assessed in the adult offspring of alcoholics (FHPs; n = 153) and the adult offspring of nonalcoholics (FHNs; n = 150). The results revealed that STM capacity moderated the effect of social deviance on alcohol problems, independent of intelligence. High social deviance and high-STM participants had fewer alcohol problems than did high social deviance and low-STM participants. Intelligence also moderated the effect of social deviance on alcohol problems in the same way, independent of STM capacity. FHPs had lower IQs, lower verbal ability, and more response perseveration than FHNs. The results suggest that working memory capacity moderates the risk for alcoholism associated with disinhibited traits.

Executive cognitive functioning in alcohol use disorders

Executive cognitive functioning (ECF) has been identified as an important determinant in the etiology of alcoholism. ECF represents a "higher-order" cognitive construct involved in the self-regulation of goal-directed behavior. The prefrontal cortex and its subcortical connections represent the primary neurological substrate that subserves ECF. Both alcoholics and individuals at high risk for alcoholism exhibit a mild dysfunction in ECF. However, this deficit appears to be significantly stronger in alcoholics with a comorbid diagnosis of an antisocial personality disorder. Individuals with other disorders that are also highly comorbid with alcoholism, such as attention deficit hyperactivity disorder and conduct disorder, also demonstrate deficits in ECF. As such, compromised ECF may not be specific to alcoholism, but instead, might be a potential underlying etiologic substrate for a number of disorders of behavioral excess-disinhibition. Subsequent to reviewing the literature implicating ECF deficits in alcoholism and comorbid disorders, the authors present a heuristic cognitive-neurobehavioral model of alcoholism implicating the frontostriatal system. Finally, recommendations for the prevention and treatment of alcoholism, based on this model, are discussed.

Severity of alcohol dependence and its relationship to neurological soft signs, neuropsychological impairment and family history

We examined the relationship between severity of alcohol dependence, subtle neurological impairment, neuropsychological deficits and genetic vulnerability among 36 day hospital attenders who satisfied the DSM-III-R criteria for alcohol dependence. Severity of alcohol dependence was unrelated to the presence of a family history, but was correlated with neurological soft signs and neuropsychological impairment. Neurological soft signs were correlated with neuropsychological impairment on both Trail A and Trail B. Patients with an affected first-degree relative exhibited more neurological soft signs. These data indicate that severity of alcohol dependence is related not only to neuropsychological impairment, but also to subtle neurological deficits which may not be apparent on conventional neurological examination. Patients with a positive family history of alcohol dependence may be particularly susceptible to the neurological sequelae of alcohol dependence, or may have neurological deficits which antedate their alcohol dependence.

Risk for alcoholism, antisocial behavior, and response perseveration

Numerous studies have demonstrated the existence of an association between alcoholism and antisocial personality (ASP). The present study tested two hypotheses: First, that nonalcoholic men with a multigenerational familial history (MGH) of alcoholism would play more cards on a card task that has been shown previously to differentiate antisocial populations from normals and, second, that MGH subjects would display more evidence of ASP on two personality questionnaires: The Self-Report Psychopathy scale and the Socialization scale of the California Psychological Inventory. A total of 28 subjects (14 MGH and 14 family history negative for alcoholism [FH-]) were employed in this study. MGH subjects played significantly more cards during the card task than did FH- subjects. However, the two groups did not differ on the ASP questionnaires. The possibility that a subtle frontal-lobe deficit, rather than ASP per se, underlies the poorer performance of the MGH males is discussed.

Family history, alcohol use and dependence symptoms among young adults in the United States

Drawing upon data from the National Longitudinal Survey of young adults, this paper examines the effects of family history of alcoholism and current alcohol use by the young adults. A multivariate analysis of the data from the study indicates that there are both main and interaction effects of family history and current alcohol use on dependence symptoms among the young adults.

Treatment compliance after detoxification among highly disadvantaged alcoholics

An outcome study was carried out on a series of 109 highly disadvantaged alcoholics discharged from the detoxification unit of a large municipal hospital in New York City. We examined the impact of a variety of clinical and demographic factors on retention in the initial phases of outpatient and inpatient treatment following discharge. Both high school completion and a history of at least 6 months of employment in the two years preceding admission correlated with frequency of registration for continued aftercare. Measurements of cognitive flexibility correlated with frequency of aftercare completion. An association strongly approaching significance was also found between length of hospital stay and aftercare completion. Some suggestions are made as to the assessment and aftercare planning for highly disadvantaged alcoholics.

Cognitive performance of alcoholics: a longitudinal evaluation of the role of drinking history, depression, liver function, nutrition, and family history

To assess the role of drinking history, depression, liver function, nutrition, and family history on cognitive performance, 171 detoxified male alcoholics were administered a brief neuropsychological examination at admission and discharge from an inpatient treatment program and at a 3-month follow-up evaluation. Regression analyses showed that at admission, depression and liver function were significant predictors of neuropsychological performance, whereas at discharge 3 to 4 weeks later only age and an estimate of premorbid intelligence were significant predictors. At the 3-month follow-up, estimates of drinking following discharge and severity of depressive symptoms were major significant predictors of neuropsychological performance. Indices of drinking prior to admission to the treatment program, nutrition, and family history for alcoholism did not predict performance on any of the three test occasions. These findings indicate that in addition to the chronic neurotoxic effect of alcohol a number of different medical and psychiatric factors, as well as the acute effects of alcohol, contribute to the cognitive scores of patients at various points in the clinical course.

Information processing, neuropsychological function, and the inherited predisposition to alcoholism

Sons of male alcoholics are at particularly heightened risk for the development of alcoholism. This heightened risk frequently appears in association with increased incidence of conduct disorder or hyperactivity, with deficits in abstract thinking and poor school performance, with abnormalities in cued psychophysiological response, and with increased sensitivity to the putatively stress-response-dampening effects of alcohol intoxication. This risk and its associated features are discussed within the context of a neuropsychological theory, predicted on the notions (1) that deficits in cognitive functions theoretically dependent upon the intact functioning of the prefrontal cortex could underlie manifestation of the idiosyncracies commonly attributed to sons of male alcoholics, and (2) that acute alcohol intoxication could relieve the subjective discomfort associated with the consequences of such deficits.

Relationships between neuropsychological test performance and event-related potentials in alcoholic and nonalcoholic samples

Are event-related potentials and nonconcurrently measured neuropsychological test performance correlated? Sober male and female middle-aged alcoholics and peer controls were administered an "oddball" event-related potential (ERP) task and several hours later, a battery of neuropsychological (NP) tests. Alcoholics performed significantly poorer than controls on NP tests. Male alcoholics had significantly altered ERP responses (N1, NdA, and P3 amplitudes) but female alcoholics did not differ on any ERP variables from controls. A number of significant correlations between ERP and NP measures were present. The most consistent findings were positive correlations between perceptual-motor (PM) tests and the P3 amplitude at Pz in both male and female alcoholics and in male alcoholics, a negative correlation between PM tests and P3 latency at Pz, findings similar to those seen in Parkinson patients. Significant correlations were most numerous in family history positive alcoholics. The results lead to two conclusions: first, Grant's postulation that sober alcoholics may manifest an intermediate duration organic mental disorder is supported; second, given the lack of ERP differences in the females, ERP measures should not be considered as being causally related to NP performance.

Abstracting deficits and childhood conduct disorder as a function of familial alcoholism

Using a large sample (n = 515), family history-positive male alcoholics (FH+) performed poorer than family history-negative (FH-) alcoholics on a test of abstracting ability. They also reported an earlier age of onset of alcoholism, more symptoms of childhood conduct disorder, and tended to report more depressive symptoms than FH- alcoholics, however, these variables were not significantly related to abstracting score. FH+ and FH- samples did not differ on average amount of ethanol consumed per day, vocabulary, state anxiety, childhood attentional deficit disorder, and childhood learning disability. The significant differences found in this study between FH+ and FH- alcoholics were minimal. With such weak effects, the inconsistent findings in studies that have investigated differences between FH+ and FH- alcoholics are understandable.