Psychological expectancy as mediator of vulnerability to alcoholism

Association between polymorphism in gene related to the dopamine circuit and motivations for drinking in patients with alcohol use disorder

The development of alcohol use disorder (AUD) is influenced by genetic, psychological, and social factors. However, the identification of the load of each of these factors and the association between them is still debatable. This study aimed to explore the load of the association between AUD and polymorphisms in genes of the dopaminergic system, as well as with drinking triggers. The study comprised 227 inpatients with AUD and 174 controls. The pattern and motivations for drinking were evaluated using the Alcohol Use Disorders Identification Test (AUDIT) and the Inventory of Drinking Situations (IDS). Analyses of genetic variation in genes encoding dopaminergic were performed using next generation sequencing. We observed an significant association between a polymorphism in DDC (rs11575457) and AUD. Positive reinforcement factors as urges/temptations to drink and pleasant emotion, in isolation, were the significantly related elements to drinking. In addition, negative (physical discomfort) and positive reinforcement factors (testing personal control; pleasant time with others) significantly reinforced the interaction with DDC genetic variant for increased odds of an individual presenting AUD. These results indicated a complex relationship between the dopaminergic system and the drug-seeking behavior profiles.

Alvanzo AA, Mojtabai R, Pacek LR, Cullen BA, Reboussin BA. Transitions through stages of alcohol involvement: The potential role of mood disorders

INTRODUCTION

Although prior clinical and population-based studies have demonstrated comorbidity between mood and alcohol use disorders (AUD), there is a paucity of research assessing whether mood disorders predict transition across stages of alcohol involvement.

METHOD

Hypothesizing that mood disorders predict transition across sex-specific alcohol involvement stages, we used prospective data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of US adults, which included male (n = 14,564) and female (n = 20,089) participants surveyed in 2001-2 and re-interviewed in 2004-5. Latent class (LCA) and latent transition analyses (LTA) were used to assess patterns of alcohol involvement in the US and the association of lifetime mood disorders at baseline with transition across stages of alcohol involvement during follow-up.

RESULTS

A three-class model of AUD criteria was identified (No problems, Moderate problems and Severe problems) for both sexes. Positive cross-sectional associations between mood disorder and problem classes of alcohol involvement were found among both sexes, as were positive longitudinal associations. Propensity score adjustment mitigated the associations of baseline mood disorder with progressive transition for both sexes. However, among females, baseline mood disorder was consistently associated with reduction in remission from Severe to Moderate alcohol problems (aOR = 0.30, CI = 0.09-0.99, p = .048) over time.

DISCUSSION

Our study provides evidence that mood disorders impact transition through stages of alcohol involvement and are most strongly associated with hindering remission among females. Findings advance our understanding of these comorbid relationships and have clinical implications for ongoing assessment of drinking patterns among individuals with mood disorders.

Early life predictors of alcohol-related attitudes among 11-year-old never drinkers

Alcohol-related attitudes are evident before children have personal experience drinking alcohol and represent key proximal predictors of alcohol use, but relatively little is known about how early life characteristics predict these attitudes. Among late childhood lifetime alcohol abstainers (M_age=10.67years; 51% girls), we examine predictors of positive alcohol expectancies and perceived risk of alcohol use. Data from the Millennium Cohort Study, an ongoing nationally representative longitudinal study of children born in the UK, were available from 11,097 children who completed the self-report survey at modal age 11 and reported never drinking alcohol. A sequential structural model suggested that sociodemographic factors were distal predictors of age 11 alcohol attitudes that operated, in part, through family and child risk factors (measured at ages 3 to 7). Alcohol attitudes varied by sociodemographics; for example, boys had higher positive expectancies than girls and White British children had higher positive expectancies and lower perceived risk than Black British and Asian British children. In terms of family factors, parent alcohol problems predicted children's lower perceived risk, and higher parent-child conflict predicted more positive expectancies. For child factors, children's greater cognitive skills predicted higher perceived risk, and internalizing problems predicted more positive expectancies. Indirect effects from sociodemographics through parent-child conflict and internalizing problems predicted positive expectancies; indirect effects through parent alcohol problems and cognitive skills predicted perceived risk. Future research should delve further into mechanisms underlying the development of alcohol attitudes and their potential as malleable targets for prevention.

Limitations of lifetime alcohol use disorder assessments: A criterion-validation study

The goal of the present study was to compare etiologically and clinically relevant correlates of lifetime AUD (e.g., alcohol consumption, personality traits, psychiatric disorders) based on a single assessment compared to a cumulative, prospective assessment of lifetime AUD. Data were drawn from the Alcohol, Health and Behavior (AHB; baseline N=489) study, which consisted of a prospective cohort of college students assessed seven times over a 16-year period ([M(SD) age at baseline=18.56 (.97)] and [M(SD) age at final assessment=34.33 (.82)]). The participants were assessed using the Diagnostic Interview Schedule (DIS) for DSM-III at Waves 1-7 and for DSM-IV at Waves 6-7. A single assessment and cumulative assessments of DSM-III lifetime AUD at Wave 6 (M[SD] age=28.98 [1.03]) were used to predict past-year alcohol related variables (e.g., alcohol consumption, drinking motives, drinking expectancies), personality variables, general functioning, lifetime substance use, and lifetime psychiatric disorders at Wave 7. Significantly larger correlations were found between the cumulative assessment and eight of the 25 etiologically relevant correlates of AUD compared to the single assessment. Further, significant incremental validity of cumulative assessment over single, retrospective assessment was observed for 16 of the 25 covariates. Overall, this study provides further support for the value of using prospective data with multiple assessments when determining lifetime history of disorder.

Less drinking, yet more problems: understanding African American drinking and related problems

Researchers have found that, compared to European Americans, African Americans report later initiation of drinking, lower rates of use, and lower levels of use across almost all age groups. Nevertheless, African Americans also have higher levels of alcohol problems than European Americans. After reviewing current data regarding these trends, we provide a theory to understand this apparent paradox as well as to understand variability in risk among African Americans. Certain factors appear to operate as both protective factors against heavy use and risk factors for negative consequences from use. For example, African American culture is characterized by norms against heavy alcohol use or intoxication, which protects against heavy use but also provides within-group social disapproval when use does occur. African Americans are more likely to encounter legal problems from drinking than European Americans, even at the same levels of consumption, perhaps thus resulting in reduced consumption but more problems from consumption. There appears to be one particular group of African Americans, low-income African American men, who are at the highest risk for alcoholism and related problems. We theorize that this effect is due to the complex interaction of residential discrimination, racism, age of drinking, and lack of available standard life reinforcers (e.g., stable employment and financial stability). Further empirical research will be needed to test our theories and otherwise move this important field forward. A focus on within-group variation in drinking patterns and problems is necessary. We suggest several new avenues of inquiry.

A framework for the specificity of addictions

Research over the last two decades suggests that a wide range of substance and behavioral addictions may serve similar functions. Yet, co-occurrence of addictions has only been reported among a minority of addicts. "Addiction specificity" pertains to a phenomenon in which one pattern of addictive behaviors may be acquired whereas another is not. This paper presents the PACE model as a framework which might help explain addiction specificity. Pragmatics, attraction, communication, and expectation (PACE) variables are described, which may help give some direction to future research needs in this arena.

Longitudinal validation of the acquired preparedness model of drinking risk

This paper reports on the first longitudinal test of the Acquired Preparedness (AP) model of alcoholism risk, which holds that individual differences in key personality traits influence drinking behavior by influencing alcohol-related learning (Smith and Anderson, 2001). We studied 418 individuals making the transition to the independence of college across 3 longitudinal waves. Each of 2 longitudinal models predicting typical drinking quantity provided support for the AP process. In the first, drinking quantity at the end of the first year of college was predicted by positive urgency (the tendency to act rashly when experiencing extremely positive affect) at the start of college, and that predictive relationship appeared to have been mediated by expectancies that alcohol provides positive, arousing effects. In the second, drinking quantity was predicted by negative urgency (the tendency to act rashly when experiencing extremely negative affect) at the start of college, and that relationship appeared to have been mediated by the motive to drink alcohol to cope with subjective distress.

Cognitive predictors of alcohol involvement and alcohol consumption-related consequences in a sample of drunk-driving offenders

Motivational theories of alcohol involvement emphasize a wide range of cognitive factors as precursors to "heavy" or high-risk drinking. Central to this consideration has been expectancies, drinking urges, triggers, and situational cues, all of which can synergistically or independently stimulate drinking. Unfortunately, empirical studies have scrutinized low-level or moderate drinkers drawn from the general population, and less is known about the role of cognitive factors as precursors to high-risk drinking. The present study examines the unique contribution of several measures of cognitive motivation to harmful alcohol use in a sample of convicted drunk drivers. Confirmatory factor analysis indicated the psychometric soundness of a model positing four latent predictor constructs assessing drinking urges/triggers, situational cues, positive and negative expectancies and outcome constructs assessing harmful alcohol use and perceived consequences of harmful drinking. A structural equation model indicated that each motivational construct was associated uniquely with both drinking and perceived consequences, with the largest overall effect in both cases associated with situational cues. Results are discussed in terms of identifying prominent cognitive factors that may foster harmful drinking among high-risk populations and their implications for treatment.

Transitions into underage and problem drinking: developmental processes and mechanisms between 10 and 15 years of age

Numerous developmental changes occur across levels of personal organization (eg, changes related to puberty, brain and cognitive-affective structures and functions, and family and peer relationships) in the age period of 10 to 15 years. Furthermore, the onset and escalation of alcohol use commonly occur during this period. This article uses both animal and human studies to characterize these multilevel developmental changes. The timing of and variations in developmental changes are related to individual differences in alcohol use. It is proposed that this integrated developmental perspective serve as the foundation for subsequent efforts to prevent and to treat the causes, problems, and consequences of alcohol consumption.

Adult transition from at-risk drinking to alcohol dependence: the relationship of family history and drinking motives

BACKGROUND

Prospective studies have not previously examined whether a family history of alcoholism and drinking motives conjointly predict a diagnosed DSM-IV alcohol abuse or dependence in adults, despite a large literature that each is associated with alcohol consumption. The focus of this study is the conjoint, prospective examination of these risk factors in a 10-year longitudinal study of adults who were at-risk drinkers at baseline.

METHODS

Prospective, population-based cohort of drinkers aged 18 or older from a Northeastern U.S. area initially evaluated for history of alcohol use disorders and drinking motives in 1991 to 1992. New onset dependence was studied in those who never met the criteria for alcohol dependence at baseline (n = 423), and new onset abuse was studied in those who never met the criteria for alcohol abuse at baseline (n = 301) and who did not develop dependence during the follow-up.

RESULTS

Family history significantly interacted with 2 baseline drinking motives in predicting new onsets of DSM-IV alcohol dependence: drinking to reduce negative affect (OR 3.38; 95% CI 1.05, 10.9) and drinking for social facilitation (OR 3.88; CI 1.21, 12.5). Effects were stronger after conditioning the drinking motives on having a positive family history of alcoholism. In contrast, in predicting new onsets of alcohol abuse, drinking motives did not have direct effects or interact with family history.

CONCLUSIONS

Those who drank to reduce negative affect or for social facilitation at baseline were at greater risk of alcohol dependence 10 years later if they also had a family history of alcoholism. These results suggest an at-risk group that can be identified prior to the development of alcohol dependence. Further, the findings suggest utility in investigating the interaction of drinking motives with measured genetic polymorphisms in predicting alcohol dependence.

The relationship between PROP and ethanol preferences: an evaluation of 4 inbred mouse strains

Ethanol's taste attributes undoubtedly contribute to the development of drug preference. Ethanol's taste is both sweet and bitter. Taster status for bitter 6-n-propylthiouracil (PROP) has been proposed as a genetic marker for alcoholism; however, human results are conflicting. We collected preference scores for both tastants in 4 mouse strains selected on the basis of previously reported taste preference, with the generally accepted idea that inbred mice show minimal within-strain variation. Eighty-eight male mice (22 per strain) participated. The strains were as follows: C57BL/6J, ethanol preferring; BALB/cJ, ethanol avoiding; SWR/J, PROP avoiding; and C3HeB/FeJ, PROP neutral. Using a brief-access (1-min trials) 2-bottle preference test, we assessed the taste response of each strain to PROP and ethanol on separate days. Although PROP avoiding versus neutral mice could be segregated into significantly different populations, this was not the case for ethanol avoiding versus preferring mice, and all strains showed high variability. On average, only BALB/cJ, SWR/J, and C3HeB/FeJ mice conformed to their literature-reported preferences; nonetheless, there were a substantial number of discordant animals. C57BL/6J did not conform to previous results, indicating that they are ethanol preferring. Finally, we did not observe a significant relationship between PROP and ethanol preferences across strains. The high variability per strain and the number of animals in disagreement with their respective literature-reported preference raise concerns regarding their utility for investigations underlying mechanisms of taste-mediated ingestive responses. Absent postingestive consequences, the brief-access results suggest a possible degree of previously masked polymorphisms in taste preferences or a more recent drift in underlying genetic factors. The absence of a relationship between PROP and ethanol indicates that the bitter quality in ethanol may be more highly related to other bitter compounds that are mediated by different genetic influences.

A psycho-economic model of ecstasy consumption and related consequences: a multi-site study with community samples

Becker and Murphy's (1988) theory of rational behavior suggests that economic factors play an influential role in the decision leading to drug consumption and possibly dependence. Psychological models, on the other hand, emphasize internal regulatory cues that motivate drug use and play a contributory role in dependence. Until now, the confluence of both economic and psychological models has not been tested empirically. The present study used latent-variable structural equation modeling (SEM) to examine the influence of both economic (social anomie, unit price, and time spent acquiring drugs) and psychological risk factors (motivation, depression, and sexual risk behaviors) on self-reported ecstasy use. Data were obtained from 612 recreational ecstasy users in the United States and Australia participating in a NIDA-funded epidemiological study examining trends in ecstasy use. The sample was mainly white (61%), male (58%), and young (mean age = 23 yrs [5.25]). All of the hypothesized latent constructs were statistically reliable and correlated in the expected direction. A saturated SEM indicated that monetary and opportunity cost, but not income, significantly predicted ecstasy use. Among the psychological measures, motivational cues were the strongest predictor of both use and dependence. Inclusion of gender, age, race, education, and site variables did not appreciably alter the final model parameters. The implications of incorporating the role of economic factors in shaping a more refined understanding of addiction are discussed. Suggestions for future research and study limitations are also noted.

Alcohol expectancies in relation to personality and aggression among juvenile delinquents in Northern Russia

The relationships between alcohol expectancies, level of alcohol use, alcohol-related problems, aggression, and personality factors in 198 Russian male juvenile delinquents were assessed. A clustering procedure was used in order to establish main patterns of alcohol expectancies, yielding three major clusters. Level of alcohol use, alcohol-related problems, aggression, and personality factors were compared across the identified clusters. It was established that juvenile delinquents with a high level of positive alcohol expectancies and aggression represented a risk-group for higher involvement in drinking behavior as well as problem drinking, which in turn are related to specific personality traits. Implications of these findings for alcohol prevention among the youth are discussed.

Is Risk for Alcoholism Mediated by Individual Differences in Drinking Motivations?

BACKGROUND

Individual differences in motivations to drink have been proposed as a mechanism that mediates risk for alcoholism. We investigated the genetic and environmental sources of variation in motivations for drinking, as assessed by four scales of the Alcohol Use Inventory (AUI), and then examined the extent to which genetic and environmental variations in risk for alcoholism are mediated by individual differences in drinking motives.

METHODS

Data on four AUI scales (assessing drinking to manage mood states, to relieve social anxiety, in social situations, and to improve mental functioning) and lifetime DSM-IV alcohol abuse and/or dependence (AAD) were obtained from 2529 female and 3709 male adult twins, including 2229 complete twin pairs, from the population-based Virginia Twin Registry.

RESULTS

Logistic regression analyses indicated that higher scores on each of the four AUI variables were significantly associated with AAD, with increases in risk for diagnosis of 40% to 141% per standard deviation increase in AUI score. Structural modeling analyses conducted using Mplus indicated that individual differences in AUI scores were in part due to genetic variation, particularly among women. Among males, genetic factors were substantial for drinking to alter mood but small for other measures. A substantial portion of the genetic variation in AAD overlapped with drinking to manage mood states. Results from bivariate twin models of AAD and the AUI scales were consistent with the mediation hypothesis for the social anxiety and social interaction scales but not drinking to manage mood or to enhance mental functioning.

CONCLUSIONS

Genetic contributions to variation in risk for alcoholism may be mediated in part by individual differences in motivations related to drinking in social settings. Drinking to manage mood indexes genetic risk for alcoholism but does not appear to act as a direct cause of alcoholism.

Alcohol expectancies, alcohol consumption, and problem drinking: the moderating role of family history

The purpose of this investigation was to examine the moderating role of family history (FH) of alcohol use disorders on the association between positive alcohol expectancies and drinking behavior (quantity/frequency of drinking and alcohol-related problems). Lifetime DSM-III-R diagnoses of alcohol abuse/dependence in probands from the Yale Family Study were used to classify FH status of adult relatives, yielding 149 relatives of probands with alcohol abuse/dependence and 110 relatives of controls. Significant main effects were found for FH of alcoholism on problem drinking symptoms and for alcohol expectancies concerning both problem drinking symptoms and quantity/frequency of alcohol use. Regarding moderating effects, there was a significant interaction between alcohol expectancies and FH only for problem drinking symptoms. When familial density of alcoholism was examined as a moderator, significant effects were found for all drinking variables, thus demonstrating that the degree to which alcohol expectancies was associated with the drinking outcomes varied by the extent to which alcohol use disorders clustered in families. The findings are discussed in terms of the interaction of alcohol-related risk factors and the importance of using multiple indicators of familial vulnerability.

A classification of substance-dependent men on temperament and severity variables

This study examined the validity of classifying substance abusers based on temperament and dependence severity, and expanded the scope of typology differences to proximal determinants of use (e.g., expectancies, motives). Patients were interviewed about substance use, depression, and family history of alcohol and drug abuse. Self-report instruments measuring temperament, expectancies, and motives were completed. Participants were 147 male veterans admitted to inpatient substance abuse treatment at a U.S. Department of Veterans Affairs medical center. Cluster analysis identified four types of users with two high substance problem severity and two low substance problem severity groups. Two, high problem severity, early onset groups differed only on the cluster variable of negative affectivity (NA), but showed differences on antisocial personality characteristics, hypochondriasis, and coping motives for alcohol. The two low problem severity groups were distinguished by age of onset and positive affectivity (PA). The late onset, low PA group had a higher incidence of depression, a greater tendency to use substances in solitary contexts, and lower enhancement motives for alcohol compared to the early onset, high PA cluster. The four-cluster solution yielded more distinctions on external criteria than the two-cluster solution. Such temperament variation within both high and low severity substance abusers may be important for treatment planning.

Alcohol expectancies and motives in a substance abusing male treatment sample

Although prior research has demonstrated the utility of both alcohol expectancies and drinking motives in the prediction of alcohol use and problems, the specific relationship between these domains has not been examined in a clinical sample. One-hundred, forty-seven veterans on an inpatient substance abuse unit completed questionnaires measuring alcohol expectancies and alcohol motives and provided information on their alcohol consumption and related problems. Covariance structure modeling was used to test four theoretically competing models. Findings indicated that: (1) motives mediate the effects of expectancies on use and problems and expectancies do not exert an independent influence on consumption and alcohol problems and (2) contrary to past findings, alcohol use only partially mediates the relationship between enhancement motives and alcohol problems.

Validation of cocaine and marijuana effect expectancies in a treatment setting

This study sought to establish the validity of the Cocaine Effect Expectancy Questionnaire (CEEQ), and the Marijuana Effect Expectancy Questionnaire (MEEQ) in discriminating between patterns of drug use in a clinical population. Prior research with these questionnaires has involved primarily nonclinical samples. Expectancy literature has yielded ambiguous results in demonstrating the role of both positive and negative expectancies in regards to drug use patterns. The sample consisted of 149 males on an inpatient V.A. substance abuse unit. On the CEEQ, cocaine users, particularly frequent users, endorsed fewer global positive cocaine expectancies than infrequent or nonusers. Present-infrequent users endorsed greater arousal effects than either present-frequent or nonusers. Nonusers of cocaine endorsed greater relaxation than present users. On the MEEQ, nonusers expected more negative effects from marijuana than users. Present users expected greater relaxation and craving effects than past users or nonusers. These results indicate different roles for positive and negative expectancies in cocaine and marijuana use.