Effects of social drinking and familial alcoholism risk on cognitive functioning: null findings

Does family history of alcohol problems influence college and university drinking or substance use? A meta-analytical review

AIMS

Family history of alcohol use problems is a reliable determinant of alcohol use and problems in the population at large, but findings are inconsistent when this issue is examined in college and university students. No quantitative summary of this literature has been reported to date. The purpose of this study was to conduct a meta-analysis on the effects of family history on substance use and abuse in college and university students.

METHODS

A two-group contrast meta-analysis was conducted to evaluate the differences in substance use and abuse between family history-positive and -negative students pursuing higher education. The studies that contributed data to this meta-analysis were conducted in five countries, with the majority of studies from the United States. A total of 65 published papers (53 samples) contributed data from 89 766 participants attending university or college. Effect sizes were coded for alcohol consumption, problems and use disorder symptoms, as well as other illegal drug use and abuse. Two independent coders calculated effect sizes and coded descriptive content about the papers, and discrepancies were reconciled. Family history was used as the grouping variable.

RESULTS

Family history had a minimal effect on alcohol consumption, with stronger effects on alcohol consequences (Cohen's d: 0.21-0.25), alcohol use disorder symptoms (Cohen's d: 0.24) and other drug involvement (Cohen's d: 0.37-0.86).

CONCLUSIONS

Relative to students without a family history of alcohol problems, students with positive family histories do not drink more, but may be at greater risk for difficulties with alcohol and drugs.

An evidence based review of acute and long-term effects of cannabis use on executive cognitive functions

Cannabis use has been shown to impair cognitive functions on a number of levels-from basic motor coordination to more complex executive function tasks, such as the ability to plan, organize, solve problems, make decisions, remember, and control emotions and behavior. These deficits differ in severity depending on the quantity, recency, age of onset and duration of marijuana use. Understanding how cannabis use impairs executive function is important. Individuals with cannabis-related impairment in executive functions have been found to have trouble learning and applying the skills required for successful recovery, putting them at increased risk for relapse to cannabis use. Here we review the research on the acute, residual, and long-term effects of cannabis use on executive functions, and discuss the implications for treatment.

Coping styles predict responsiveness to cognitive behaviour therapy in psychosis

The study aimed to determine the clinical and neuropsychological predictors of responsiveness to cognitive behavioural therapy for psychosis (CBTp). Sixty patients with schizophrenia or schizoaffective disorder and 25 healthy individuals took part in the study. Thirty patients (25 protocol completers) received CBTp in addition to standard care (SC); 30 patients (18 protocol completers) received SC only. All patients were assessed on symptoms using the Positive and Negative Syndrome Scale (PANSS) and clinical and neuropsychological function before and after CBTp. Symptoms and self-esteem improved to a greater extent in the CBTp+SC than SC control group. Greater pre-therapy coping ability and the self-reflectiveness dimension of cognitive insight at baseline predicted improvement in symptoms in the CBTp+SC group, but not the SC control group, explaining up to 21% of the variance in symptom improvement. Pre-therapy neuropsychological function, duration of illness, clinical insight and gender did not predict CBTp responsiveness. Being able to have a range of coping strategies and reflect on one's experiences while refraining from overconfidence in one's interpretations before therapy is conducive to better CBTp responsiveness.

Moderate alcohol consumption and cognitive risk

We reviewed 143 papers that described the relationship between moderate drinking of alcohol and some aspect of cognition. Two types of papers were found: (1) those that provided ratios of risk between drinkers and nondrinkers (74 papers in total) and (2) those that, although they did not provide such ratios, allowed cognition in drinkers to be rated as "better," "no different," or "worse" than cognition in nondrinkers (69 papers in total). The history of research on moderate drinking and cognition can be divided into two eras: 1977-1997 and 1998-present. Phase I (1977-1997) was the era of neuropsychological evaluation involving mostly young to middle-aged (18-50 years old) subjects. Although initial studies indicated moderate drinking impaired cognition, many later studies failed to confirm this, instead finding no difference in cognition between drinkers and nondrinkers. Phase II (1998-present) was and is the era of mental status exam evaluation involving mostly older (≥55 years old) subjects. These studies overwhelmingly found that moderate drinking either reduced or had no effect on the risk of dementia or cognitive impairment. When all the ratios of risk from all the studies in phase II providing such ratios are entered into a comprehensive meta-analysis, the average ratio of risk for cognitive risk (dementia or cognitive impairment/decline) associated with moderate "social" (not alcoholic) drinking of alcohol is 0.77, with nondrinkers as the reference group. The benefit of moderate drinking applied to all forms of dementia (dementia unspecified, Alzheimer's disease, and vascular dementia) and to cognitive impairment (low test scores), but no significant benefit against cognitive decline (rate of decline in test scores) was found. Both light and moderate drinking provided a similar benefit, but heavy drinking was associated with nonsignificantly higher cognitive risk for dementia and cognitive impairment. Although the meta-analysis also indicated that wine was better than beer or spirits, this was based on a relatively small number of studies because most studies did not distinguish among these different types of alcohol. Furthermore, a number of the studies that did make the distinction reported no difference among the effects of these different types of alcohol. Therefore, at present this question remains unanswered. Analysis also showed that the presence of the apolipoprotein E epsilon 4 allele eliminated the benefit of moderate drinking. However, this was based on a relatively small number of studies and several other studies have found a beneficial effect of the epsilon e4 allele. Further studies are necessary to settle this question. The benefit of moderate alcohol for cognition was seen in both men and women, although the amount and pattern of drinking is very different between the two sexes. Lastly, the finding of unaffected or significantly reduced cognitive risk in light to moderate drinkers was seen in 14/19 countries for which country-specific ratio data were available, with three of the five remaining countries showing nonsignificant reductions as well. Overall, light to moderate drinking does not appear to impair cognition in younger subjects and actually seems to reduce the risk of dementia and cognitive decline in older subjects.

Binge drinking in young adults: Data, definitions, and determinants

Binge drinking is an increasingly important topic in alcohol research, but the field lacks empirical cohesion and definitional precision. The present review summarizes findings and viewpoints from the scientific binge-drinking literature. Epidemiological studies quantify the seriousness of alcohol-related problems arising from binge drinking, with a growing incidence reported in college-age men over the last 2 years. Experimental studies have found neurocognitive deficits for frontal lobe processing and working memory operations in binge-drinking compared with nonbinge alcohol drinkers. The findings are organized with the goals of providing a useful binge-drinking definition in the context of the empirical results. Theoretical implications are discussed on how binge drinking may alter neurophysiological and neurocognitive function.

The underlying role of aggressivity in the relation between executive functioning and alcohol consumption

The research literature on the relation between cognitive functioning and alcohol consumption is inconsistent and difficult to interpret. The purpose of this study was to test a causal model that might help reconcile some of these conflicts. The model specifies that aggressivity is an important intermediary mechanism underlying the relation between executive functioning (EF) and alcohol consumption. Participants were 310 (152 men and 158 women) healthy social drinkers between 21 and 35 years of age tested in a laboratory setting. EF was measured with a battery of neuropsychological tests. Aggressivity and alcohol consumption (as well as cigarette and drug use frequency) were measured with self-report and interview formats. Aggressivity played a mechanistic role in the relation between EF and alcohol/drug use for men but not for women. Women evinced some unexpected positive relations between EF and alcohol use. This study serves as a first step in trying to reconcile previous inconsistent findings regarding the relation between cognitive functioning and alcohol use by demonstrating that a better understanding of this relation involves considering aggressivity as an intermediary variable.

Cognitive deficits predict low treatment retention in cocaine dependent patients

Previously, we found that impaired cognition predicted treatment dropout from cognitive behavioral therapy (CBT) in a small sample of cocaine dependent patients. To further address the role of impaired cognition in retention and treatment outcome of cocaine-dependent patients in CBT, we expanded a previous investigation to a larger sample, added depressed cocaine patients, and added an additional cognitive assessment. Fifty-six cocaine dependent patients receiving CBT in outpatient clinical trials were assessed for cognitive performance at treatment entry with the computerized MicroCog (MC) and the Wisconsin Card Sort Test (WCST). Treatment completion was defined as 12 or more weeks. Treatment dropouts had significantly lower MC scores (poorer cognitive functioning) than completers on attention, memory, spatial ability, speed, accuracy, global functioning, and cognitive proficiency, with effect sizes in the moderate to large range. These findings were not affected by depression, demographics (age, gender, race, sex, marital status) or drug use (years of cocaine use or average weekly cocaine expenditure in the prior 30 days). In contrast, patients' performance on the WCST was in the average or near-average range, and WCST scores did not differentiate between completers and dropouts. Consistent with previous research, results suggest that mild cognitive impairments (< or =1 S.D. below the mean) negatively affect retention in outpatient CBT treatment for cocaine dependence. Future studies should examine whether there are specific effects of different executive functioning abilities on treatment outcome. Modified behavioral and pharmacologic interventions should be considered to target mild cognitive impairments to improve substance treatment outcome.

Intelligence in relation to later beverage preference and alcohol intake

AIMS

The health effects of drinking may be related to psychological characteristics influencing both health and drinking habits. This study aims to examine the relationship between intelligence, later beverage preference and alcohol intake.

DESIGN

Prospective cohort study.

SETTING

Zealand, Denmark.

PARTICIPANTS

A total of 900 obese men and a random population sample of 899 young men.

MEASUREMENTS

Intelligence testing at the draft board examinations over a 22-year period between 1956 and 1977. Percentage of wine of total alcohol intake (wine pct), preference for wine (wine pct >50), heavy drinking (>21 drinks per week) and non-drinking (<1 drink per week), and vocational education from follow-ups of the initial study sample in 1981-83 and 1992-94.

FINDINGS

A strong dose-response-like association was found between intelligence quotient (IQ) in young adulthood and beverage preferences later in life in both the obese and the random population sample. At the first follow-up a 30-point advantage in IQ [2 standard deviations (SD)] was found to be associated with an odds ratio (OR) for preferring wine over beer and spirits of 1.7 (1.3-2.4). At the second follow-up the corresponding OR was 2.8 (2.0-3.9). A 30-point advantage in IQ was found to be associated with an OR for being a non-drinker of 0.5 (0.3-0.8) at the first follow-up and second follow-up. We examined whether, at the second follow-up, the association between IQ, beverage preferences and non-drinking could be explained by socio-economic position (SEP). The association between IQ and non-drinking disappeared when controlling for SEP. The association between IQ and beverage preferences was attenuated, but remained statistically significant. IQ was not associated with heavy drinking.

CONCLUSION

Irrespective of socio-economic position, a high IQ was associated with preference for wine to other beverages, but IQ was not related similarly to alcohol consumption.

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.

The effects of alcohol hangover on cognitive functions in healthy subjects

A hangover is characterized by the constellation of unpleasant physical and mental symptoms that occur between 8 and 16 h after drinking alcohol. We evaluated the effects of experimentally-induced alcohol hangover on cognitive functions using the Luria-Nebraska Neuropsychological Battery. A total of 13 normal adult males participated in this study. They did not have any previous histories of psychiatric or medical disorders. We defined the experimentally-induced hangover condition at 13 h after drinking a high dose of alcohol (1.5 g/kg of body weight). We evaluated the changes of cognitive functions before drinking alcohol and during experimentally-induced hangover state. The Luria-Nebraska Neuropsychological Battery was administrated in order to examine the changes of cognitive functions. Cognitive functions, such as visual, memory, and intellectual process functions, were decreased during the hangover state. Among summary scales, the profile elevation scale was also increased. Among localization scales, the scores of left frontal, sensorimotor, parietal-occipital dysfunction, and right parietal-occipital scales were increased during the hangover state. These results indicate that alcohol hangovers have a negative effect on cognitive functions, particularly on the higher cortical and visual functions associated with the left hemisphere and right posterior hemisphere.

Neurocognitive impairment associated with alcohol use disorders: implications for treatment

Between 50% and 80% of individuals with alcohol use disorders experience mild to severe neurocognitive impairment. There is a strong clinical rationale that neurocognitive impairment is an important source of individual difference affecting many aspects of addiction treatment, but empirical tests of the direct influence of impairment on treatment outcome have yielded weak and inconsistent results. The authors address the schism between applied-theoretical perspectives and research evidence by suggesting alternative conceptual models of the relationship between neurocognitive impairment and addiction treatment outcome. Methods to promote neurocognitive recovery and ways in which addiction treatments may be modified to improve psychosocial adaptation are suggested. Specific suggestions for future research that may help clarify the complex relations between neurocognitive impairment and addiction treatment are outlined.

Effects of moderate alcohol consumption on the central nervous system

The concept of moderate consumption of ethanol (beverage alcohol) has evolved over time from considering this level of intake to be nonintoxicating and noninjurious, to encompassing levels defined as "statistically" normal in particular populations, and the public health-driven concepts that define moderate drinking as the level corresponding to the lowest overall rate of morbidity or mortality in a population. The various approaches to defining moderate consumption of ethanol provide for a range of intakes that can result in blood ethanol concentrations ranging from 5 to 6 mg/dl, to levels of over 90 mg/dl (i.e., approximately 20 mM). This review summarizes available information regarding the effects of moderate consumption of ethanol on the adult and the developing nervous systems. The metabolism of ethanol in the human is reviewed to allow for proper appreciation of the important variables that interact to influence the level of exposure of the brain to ethanol once ethanol is orally consumed. At the neurochemical level, the moderate consumption of ethanol selectively affects the function of GABA, glutamatergic, serotonergic, dopaminergic, cholinergic, and opioid neuronal systems. Ethanol can affect these systems directly, and/or the interactions between and among these systems become important in the expression of ethanol's actions. The behavioral consequences of ethanol's actions on brain neurochemistry, and the neurochemical effects themselves, are very much dose- and time-related, and the collage of ethanol's actions can change significantly even on the rising and falling phases of the blood ethanol curve. The behavioral effects of moderate ethanol intake can encompass events that the human or other animal can perceive as reinforcing through either positive (e.g., pleasurable, activating) or negative (e.g., anxiolysis, stress reduction) reinforcement mechanisms. Genetic factors and gender play an important role in the metabolism and behavioral actions of ethanol, and doses of ethanol producing pleasurable feelings, activation, and reduction of anxiety in some humans/animals can have aversive, sedative, or no effect in others. Research on the cognitive effects of acute and chronic moderate intake of ethanol is reviewed, and although a number of studies have noted a measurable diminution in neuropsychologic parameters in habitual consumers of moderate amounts of ethanol, others have not found such changes. Recent studies have also noted some positive effects of moderate ethanol consumption on cognitive performance in the aging human. The moderate consumption of ethanol by pregnant women can have significant consequences on the developing nervous system of the fetus. Consumption of ethanol during pregnancy at levels considered to be in the moderate range can generate fetal alcohol effects (behavioral, cognitive anomalies) in the offspring. A number of factors--including gestational period, the periodicity of the mother's drinking, genetic factors, etc.--play important roles in determining the effect of ethanol on the developing central nervous system. A series of recommendations for future research endeavors, at all levels, is included with this review as part of the assessment of the effects of moderate ethanol consumption on the central nervous system.

Alcohol related dementia: proposed clinical criteria

Current diagnostic criteria for Alcohol Related Dementia (ARD) are based almost exclusively on clinical judgment. Moreover, there are no guidelines available to assist the clinician or the researcher in distinguishing Alcohol Related Dementia from other causes of dementia such as Alzheimer's Disease (AD). However, this distinction may have implications for the prognosis and treatment of patients. In this article, provisional diagnostic criteria for establishing a diagnosis of Alcohol Related Dementia are proposed for further study. The criteria are based on the available literature on the relationship between alcohol consumption and dementia and were modeled after existing diagnostic criteria for AD and Vascular Dementia. Validity of these criteria for distinguishing AD from ARD will require further study.

Alcohol hangover and managerial effectiveness

Twenty-one male managers who normally drink moderate amounts of alcohol participated in a placebo-controlled, double-blind, cross-over experiment. Subjects consumed either placebo or alcoholic drinks to attain a breath alcohol level of 0.10 during the evening before participation in Strategic Management Simulations. By the time of arrival at the simultaion laboratory on the following morning, breath alcohol levels were measured at 0.00. Questionnaire responses indicated considerable hangover discomfort. Responses to semantic differential evaluative scales suggested that research participants evaluated their own managerial performance in the simulation setting as impaired. However, multiple (validated) measures of decision-making performance obtained in the simulation task did not show any deterioration of functioning. Previous research had shown considerable performance decrements in the same task setting, while blood/breath alcohol levels ranged from 0.05 through 0.10%. Apparently, complex decision-making competence by persons who normally consume moderate amounts of alcohol may not be impaired by hangover caused by intoxication during the previous evening that remains at or below a blood alcohol level of 0.10.

Moderate alcohol consumption and loss of cerebellar Purkinje cells

OBJECTIVE

To examine the dose-response effect of alcohol consumption on the number of cerebellar Purkinje cells.

DESIGN

A prospective necropsy study combined with detailed reports on use of alcohol from a relative or friend. The number of Purkinje cells was counted in the anterior midsagittal section of the cerebellar vermis, the area of which was measured by computer assisted morphometry.

SETTING

Department of forensic medicine, University of Helsinki.

SUBJECTS

66 men, aged 35 to 69 years, subjected to medicolegal necropsy because of sudden or violent death. The average all year daily alcohol consumption over the year was 0 to 10 g in 17 men, 11 to 80 g in 24 men, and more than 80 g in 25 men.

MAIN OUTCOME MEASURES

Number of Purkinje cells, alcohol consumption.

RESULTS

The numbers and density of Purkinje cells in the cross section of vermis showed a consistent but weak decrease with increasing daily alcohol intake but not with age. A wide variation in the cell counts was observed, especially in men drinking more than 80 g, suggesting differences in the susceptibility to effects of alcohol. Compared with men drinking 40 g or less, a long term moderate consumption of an average of 41 to 80 g daily was associated with a significant average loss of 242 (95% confidence interval 45 to 439) Purkinje cells (15.2%) from a mean of 1583 to 1341 cells. In those drinking 81 to 180 g the average loss was 535 (259 to 811) cells (33.4%) to a mean of 1048 cells. The density of cells in the cross section of vermis also fell significantly by 0.9 cell/mm (0.1 to 1.7) when the daily consumption exceeded 40 g and by 1.4 cell/mm (0.3 to 2.5) when the intake was 81 to 180 g. Only three cases (4.5%) in the series showed macroscopical cerebellar atrophy.

CONCLUSION

Long term intake of moderate doses of alcohol daily for 20-30 years may damage the cerebellum before the onset of macroscopical atrophy. Despite distinct individual differences an all year average daily alcohol intake of 41-80 g results in a risk of significant loss of Purkinje cells.

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.

Alcoholic hangover and performance: a review

The study of alcoholic hangover is reviewed, with particular concern given to its effects upon skills performance. Different models of hangover, and the evidence gathered in their support, are surveyed. Several factors appear to contribute to hangover, and individuals may be differentially susceptible to these influences. The severity of hangover is affected by dose, coproducts of manufacture, and a number of psychological variables. Hangover is differentiated from post-intoxication effects on performance, and the results of a variety of studies on these effects are considered. Post-intoxication effects have been found in a variety of tasks, but no tasks have been consistently affected in a number of studies. This may reflect the fact that few studies have used the same tasks to assess performance. Proposed mechanisms of post-intoxication effects are considered, and the most consistent symptom accompanying impaired performance is found to be fatigue. This notion finds some support in electroencephalographic data collected during the period following intoxication.