Do trauma cue exposure and/or PTSD symptom severity intensify selective approach bias toward cannabis cues in regular cannabis users with trauma histories?

Trauma cue-elicited activation of automatic cannabis-related cognitive biases are theorized to contribute to comorbid posttraumatic stress disorder and cannabis use disorder. This phenomenon can be studied experimentally by combining the trauma cue reactivity paradigm (CRP) with cannabis-related cognitive processing tasks. In this study, we used a computerized cannabis approach-avoidance task (AAT) to assess automatic cannabis (vs. neutral) approach bias following personalized trauma (vs. neutral) CRP exposure. We hypothesized that selective cannabis (vs. neutral) approach biases on the AAT would be larger among participants with higher PTSD symptom severity, particularly following trauma (vs. neutral) cue exposure. We used a within-subjects experimental design with a continuous between-subjects moderator (PTSD symptom severity). Participants were exposed to both a trauma and neutral CRP in random order, completing a cannabis AAT (cannabis vs. neutral stimuli) following each cue exposure. Current cannabis users with histories of psychological trauma (n = 50; 34% male; mean age = 37.8 years) described their most traumatic lifetime event, and a similarly-detailed neutral event, according to an established interview protocol that served as the CRP. As hypothesized, an AAT stimulus type x PTSD symptom severity interaction emerged (p = .042) with approach bias greater to cannabis than neutral stimuli for participants with higher (p = .006), but not lower (p = .36), PTSD symptom severity. Contrasting expectations, the stimulus type x PTSD symptoms effect was not intensified by trauma cue exposure (p = .19). Selective cannabis approach bias may be chronically activated in cannabis users with higher PTSD symptom severity and may serve as an automatic cognitive mechanism to help explain PTSD-CUD co-morbidity.

Context matters: The role of subjective arousal during Attentional Bias Modification targeting socially anxious students

BACKGROUND AND OBJECTIVES

Attentional Bias Modification (ABM) paradigms targeting anxiety aim to reduce attentional biases for threatening stimuli and thereby reduce anxiety. Based on cognitive theories of performance and learning, elevated levels of arousal during ABM might enhance its effectiveness by making training more engaging and activating fear schemas. This study investigated whether elevated levels of arousal during ABM would increase its effectiveness in reducing attentional bias, stress reactivity, and post-event processing.

METHOD

We randomly assigned 79 high socially anxious students to a session of ABM or control training preceded by either a social stress or control induction to manipulate arousal. Training outcomes were attentional bias, stress reactivity, and post-event processing. Subjective arousal was assessed before, during, and after training.

RESULTS

Results indicated that ABM was not successful in reducing attentional bias, stress reactivity or post-event processing, and that the effects of ABM were not moderated by subjective arousal. There was a trend towards ABM being more effective than control training in reducing attentional bias directly after training when participants were more aroused. However, this effect was not maintained one day after the training.

LIMITATIONS

The arousal manipulation did not result in significant between-group differences in subjective arousal.

CONCLUSIONS

This study did not provide support for the moderating role of arousal in ABM training effects. Replications with more effective mood induction procedures and more power are needed as a trend finding was observed suggesting that higher levels of arousal improved the direct ABM effects on attentional bias.

The relation between gray matter volume and the use of alcohol, tobacco, cocaine and cannabis in male polysubstance users

BACKGROUND

Neuroimaging studies have demonstrated gray matter (GM) volume abnormalities in substance users. While the majority of substance users are polysubstance users, very little is known about the relation between GM volume abnormalities and polysubstance use.

METHODS

In this study we assessed the relation between GM volume, and the use of alcohol, tobacco, cocaine and cannabis as well as the total number of substances used, in a sample of 169 males: 15 non-substance users, 89 moderate drinkers, 27 moderate drinkers who also smoke tobacco, 13 moderate drinkers who also smoke tobacco and use cocaine, 10 heavy drinkers who smoke tobacco and use cocaine and 15 heavy drinkers who smoke tobacco, cannabis and use cocaine.

RESULTS

Regression analyses showed that there was a negative relation between the number of substances used and volume of the dorsal medial prefrontal cortex (mPFC) and the ventral mPFC. Without controlling for the use of other substances, the volume of the dorsal mPFC was negatively associated with the use of alcohol, tobacco, and cocaine. After controlling for the use of other substances, a negative relation was found between tobacco and cocaine and volume of the thalami and ventrolateral PFC, respectively.

CONCLUSION

These findings indicate that mPFC alterations may not be substance-specific, but rather related to the number of substances used, whereas, thalamic and ventrolateral PFC pathology is specifically associated with tobacco and cocaine use, respectively. These findings are important, as the differential alterations in GM volume may underlie different cognitive deficits associated with substance use disorders.

The effect of N-acetylcysteine on brain glutamate and gamma-aminobutyric acid concentrations and on smoking cessation: A randomized, double-blind, placebo-controlled trial

Using data form a 14-day double-blind trial with 48 smokers randomized to either N-acetylcysteine (2400 mg) or placebo, we tested the effect of N-acetylcysteine on glutamate and gamma-aminobutyric acid concentrations in the dorsal anterior cingulate cortex and on smoking cessation. Smoking related behaviors and neurotransmitter concentrations in the dorsal anterior cingulate cortex were assessed before and after treatment. Forty-seven non-smoking males served as baseline controls. Smokers showed higher baseline glutamate but similar gamma-aminobutyric acid concentrations than non-smokers. There were no treatment effects on dorsal anterior cingulate cortex neurotransmitter concentrations, smoking cessation, craving, or withdrawal symptoms. These results confirm glutamate disbalance in smokers, but not efficacy of N-acetylcysteine.

Longitudinal study of hippocampal volumes in heavy cannabis users

BACKGROUND

Cannabis exposure, particularly heavy cannabis use, has been associated with neuroanatomical alterations in regions rich with cannabinoid receptors such as the hippocampus in some but not in other (mainly cross-sectional) studies. However, it remains unclear whether continued heavy cannabis use alters hippocampal volume, and whether an earlier age of onset and/or a higher dosage exacerbate these changes.

METHODS

Twenty heavy cannabis users (mean age 21 years, range 18-24 years) and 23 matched non-cannabis using healthy controls were submitted to a comprehensive psychological assessment and magnetic resonance imaging scan at baseline and at follow-up (average of 39 months post-baseline; standard deviation=2.4). Cannabis users started smoking around 16 years and smoked on average five days per week. A novel aspect of the current study is that hippocampal volume estimates were obtained from manual tracing the hippocampus on T1-weighted anatomical magnetic resonance imaging scans, using a previously validated protocol.

RESULTS

Compared to controls, cannabis users did not show hippocampal volume alterations at either baseline or follow-up. Hippocampal volumes increased over time in both cannabis users and controls, following similar trajectories of increase. Cannabis dose and age of onset of cannabis use did not affect hippocampal volumes.

CONCLUSIONS

Continued heavy cannabis use did not affect hippocampal neuroanatomical changes in early adulthood. This contrasts with prior evidence on alterations in this region in samples of older adult cannabis users. In young adults using cannabis at this level, cannabis use may not be heavy enough to affect hippocampal neuroanatomy.

E-Mental Health Interventions for the Treatment of Gambling

Gambling Disorder (GD) is a complex psychopathological phenomenon, characterized by the interaction of multiple etiological factors and a very heterogeneous symptomatological expression. Currently many questions remain concerning the best way of treating GD. Indeed, the traditional used (cognitive) behavioral interventions have at best a modest effect size. In addiction, there remains a large treatment gap, i.e. less than 10% of pathological gamblers ever seek help and enter treatment. E-health interventions could potentially help to close this gap. Cognitive bias modification (CBM) refers to a class of cognitive training paradigms that target specific automatic attentional, behavioral or evaluative biases triggered by addiction-related cues. These biases have repeatedly been shown to play an important role in addiction. Recently a number of studies have shown that modifying these biases has been effective in the treatment of different types of addictions, e.g. alcohol use disorders. An online Approach Bias Modification program, testing both Attention Bias Modification (ABM) and Approach Bias Modification (AppBM), is currently tested with Belgian and Dutch problem and disordered gamblers. Personalized motivational feedback has been added to the training program, to increase training adherence and prevent dropout. The same research group is also launching a second web-based study combining online AppBM with an online standard, protocoled, cognitive behavioral Therapy (CBT) program with guidance of a trained therapist. Participants receive nine CBT sessions through online chat with the therapist and, concurrently, nine sessions of AppBM. Preliminary results will be discussed.

Disclosure of interest

Member Advisory board Lundbeck-Belgium.

Received grant from LOTTO- Belgium to conduct behavioural study that will be discussed in presentation

Online visual search attentional bias modification for adolescents with heightened anxiety and depressive symptoms: A randomized controlled trial

Anxiety and depression, which are highly prevalent in adolescence, are both characterized by a negative attentional bias. As Attentional Bias Modification (ABM) can reduce such a bias, and might also affect emotional reactivity, it could be a promising early intervention. However, a growing number of studies also report comparable improvements in both active and placebo groups. The current study investigated the effects of eight online sessions of visual search (VS) ABM compared to both a VS placebo-training and a no-training control group in adolescents with heightened symptoms of anxiety and/or depression (n = 108). Attention bias, interpretation bias, and stress-reactivity were assessed pre- and post-training. Primary outcomes of anxiety and depressive symptoms, and secondary measures of emotional resilience were assessed pre- and post-training and at three and six months follow-up. Results revealed that VS training reduced attentional bias compared to both control groups, with stronger effects for participants who completed more training sessions. Irrespective of training condition, an overall reduction in symptoms of anxiety and depression and an increase in emotional resilience were observed up to six months later. The training was evaluated relatively negatively. Results suggest that online ABM as employed in the current study has no added value as an early intervention in adolescents with heightened symptoms.

Cue-induced striatal activity in frequent cannabis users independently predicts cannabis problem severity three years later

Cannabis is the most frequently used illicit drug worldwide, but little is known about the mechanisms underlying continued cannabis use. Cue-reactivity (the physical, psychological, behavioural and neural reaction to substance-related cues) might be related to continued cannabis use. In this 3-year prospective neuroimaging study we investigated whether cannabis cue-induced brain activity predicted continued cannabis use and associated problem severity 3 years later. In addition, baseline brain activations were compared between dependent and non-dependent cannabis users at follow-up. Analyses were focussed on brain areas known to be important in cannabis cue-reactivity: anterior cingulate cortex, orbitofrontal cortex, ventral tegmental area, amygdala and striatum. At baseline, 31 treatment-naive frequent cannabis users performed a cue-reactivity functional magnetic resonance imaging task. Of these participants, 23 completed the 3-year follow-up. None of the cue-induced region of interest activations predicted the amount of cannabis use at follow-up. However, cue-induced activation in the left striatum (putamen) significantly and independently predicted problem severity at follow-up (p < 0.001) as assessed with the Cannabis Use Disorder Identification Test. Also, clinically dependent cannabis users at follow-up showed higher baseline activation at trend level in the left striatum compared with non-dependent users. This indicates that neural cue-reactivity in the dorsal striatum is an independent predictor of cannabis use-related problems. Given the relatively small sample size, these results are preliminary and should be replicated in larger samples of cannabis users.

Visual search attentional bias modification reduced social phobia in adolescents

BACKGROUND AND OBJECTIVES

An attentional bias for negative information plays an important role in the development and maintenance of (social) anxiety and depression, which are highly prevalent in adolescence. Attention Bias Modification (ABM) might be an interesting tool in the prevention of emotional disorders. The current study investigated whether visual search ABM might affect attentional bias and emotional functioning in adolescents.

METHODS

A visual search task was used as a training paradigm; participants (n = 16 adolescents, aged 13-16) had to repeatedly identify the only smiling face in a 4 × 4 matrix of negative emotional faces, while participants in the control condition (n = 16) were randomly allocated to one of three placebo training versions. An assessment version of the task was developed to directly test whether attentional bias changed due to the training. Self-reported anxiety and depressive symptoms and self-esteem were measured pre- and post-training.

RESULTS

After two sessions of training, the ABM group showed a significant decrease in attentional bias for negative information and self-reported social phobia, while the control group did not. There were no effects of training on depressive mood or self-esteem.

LIMITATIONS

No correlation between attentional bias and social phobia was found, which raises questions about the validity of the attentional bias assessment task. Also, the small sample size precludes strong conclusions.

CONCLUSIONS

Visual search ABM might be beneficial in changing attentional bias and social phobia in adolescents, but further research with larger sample sizes and longer follow-up is needed.

[Motivational processes in addiction: the role of craving, salience and attention]

BACKGROUND

Motivational processes play an important role in addictive behaviours. Craving is mainly an explicit or conscious process that can motivate individuals to continue alcohol, take drugs or smoke cigarettes. Craving also plays a role in relapse; self-reported craving has often been associated with relapse. However, craving cannot explain all addictive behaviours. In addition to craving, implicit cognitive processes play an important part in motivating individuals to become involved in substance use.

AIM

To describe some of these implicit cognitive processes, namely the role of salience, attention bias, automatic memory associations and action tendencies.

METHOD

A description is given of recent research results and the implications of these implicit processes for clinical practice.

RESULTS

Oversensitive/hypersensitive motivational processes and a lack of control over these processes both play an important role in addiction. This can be expressed by an uncontrollable urge to inject the drug or substance again, in spite of the fact that it is unwise for the person in question to do so. Recent research has shown that there are various very promising methods for dealing with these two problems (oversensitive/hypersensitive motivational processes and a lack of control over these processes), either separately or together. The methods involve behavioural training programmes, medication and neural stimulation.

CONCLUSION

The research results are very promising, but more research is needed.

Motivational Mechanisms and Outcome Expectancies Underlying the Approach Bias toward Addictive Substances

Human behavior can be paradoxical, in that actions can be initiated that are seemingly incongruent with an individual’s explicit desires. This is most commonly observed in drug addiction, where maladaptive behavior (i.e., drug seeking) appears to be compulsive, continuing at great personal cost. Approach biases toward addictive substances have been correlated with actual drug-use in a number of studies, suggesting that this measure can, in some cases, index everyday maladaptive tendencies. At present it is unclear whether this bias to drug cues is a Pavlovian conditioned approach response, a habitual response, the result of a Pavlovian-instrumental transfer process, or a goal-directed action in the sense that expectancy of the rewarding effects of drugs controls approach. We consider this question by combining the theoretical framework of associative learning with the available evidence from approach bias research. Although research investigating the relative contributions of these mechanisms to the approach bias is to date relatively limited, we review existing studies and also outline avenues for future research.

Impairment of inhibitory control in response to food-associated cues and attentional bias of obese participants and normal-weight controls

OBJECTIVE

Starting from a model of impaired response inhibition and salience attribution for addictive behaviour we investigated whether obese participants show a greater impairment of inhibitory control in response to food-associated cues compared with neutral stimuli and whether this is seen in normal-weight control subjects. In addition, we questioned whether an attentional bias towards food-associated cues can be observed in an early stage of information processing.

DESIGN

Control-group study including the administration of behavioural tasks (that is, go/no-go task with food-associated and neutral words, visual dot probe task with food-associated and neutral pictures) and self-reported measures of eating behaviour and impulsivity.

RESULTS

Although self-reported measures indicated disinhibition of eating behaviour of obese patients, we found that food-associated stimuli induced an impairment of inhibitory control in both obese participants as well as normal-weight controls. Results from the visual dot-probe task indicated that food-associated cues did not modulate attention allocation in a very early stage of information processing, which suggests that the incentive salience of food-associated stimuli might be lower than that of drug-associated cues.

CONCLUSION

These findings are not in line with hypotheses derived from models of addictive behaviour and call into question that an impairment of inhibitory control in response to food-associated cues and salience attribution might be at the core of obesity. Future studies using larger sample sizes and refined experimental procedures are warranted to further investigate mechanisms controlling food intake in obesity.

The role of self-efficacy, recovery self-efficacy, and preparatory planning in predicting short-term smoking relapse

OBJECTIVES

This study aims to identify the role of self-efficacy, recovery self-efficacy, and preparatory planning with regard to short-term smoking relapse. We also assessed whether the importance of these variables differed for smokers quitting individually and without help (self-quitters) and smokers quitting with the help of a smoking cessation course (group quitters).

DESIGN

A longitudinal quasi-experimental study with follow-ups at 1 and 3 months after the quit attempt was conducted in order to assess the role of baseline self-efficacy, recovery self-efficacy, and preparatory planning on short-term relapse.

METHODS

The recruitment included adult daily smokers (N= 121), quitting in a smoking cessation course (N= 57) and self-quitters (N= 64). Respondents received internet-based questionnaires 2 weeks before quitting (baseline) and 1 and 3 months after the quit attempt. Predictors of relapse were analysed using logistic regression analyses.

RESULTS

Relapse at 1 and 3 months after the quit attempt was predicted by low levels of baseline self-efficacy. Simple slope analyses revealed that less preparatory planning significantly predicted relapse at 1 month after the quit attempt among group quitters, but not among self-quitters. Recovery self-efficacy was only predictive of relapse after 1 month when self-efficacy was excluded from the analyses. Moreover, among group quitters, the results indicated a borderline significant curved relation between recovery self-efficacy and relapse after 1 month.

CONCLUSIONS

Our results suggest that more research is needed on the role of preparatory planning and recovery self-efficacy. Moreover, we recommend incorporating self-efficacy increasing techniques in relapse-prevention interventions.

Factors underlying smoking relapse prevention: results of an international Delphi study

No definitive picture of the factors determining smoking relapse exists, and many smoking relapse prevention programmes have only modest behavioural effects. This study aims to identify the level of consensus among and compare the opinions of two groups of experts (researchers and coaches who provide smoking cessation courses) regarding factors already studied in relation to smoking relapse, factors that have not yet been addressed and ideas on how to improve prevention programmes. A three-round Delphi method was employed. In the first round, 15 researchers completed an electronic questionnaire on factors associated with relapse. The results were used to develop a structured questionnaire for the second round, which was completed by 47 researchers and 61 coaches. The second-round results were then presented to the same experts in the third round, enabling them to re-rate their answers. Results revealed high consensus on some factors already identified as predicting relapse (e.g. self-efficacy), new factors (e.g. action planning) and several methods to improve prevention programmes. Generally speaking, the researchers and coaches provided similar suggestions. The results paint a picture of the current state of knowledge on relapse-related factors and point the way to areas for further research.

Implicit and explicit affective associations towards cannabis use in patients with recent-onset schizophrenia and healthy controls

BACKGROUND

Cannabis use is common in patients with recent-onset schizophrenia and this is associated with poor disease outcome. More insight in the cognitive-motivational processes related to cannabis use in schizophrenia may inform treatment strategies. The present study is the first known to compare implicit and explicit cannabis associations in individuals with and without psychotic disorder.

METHOD

Participants consisted of 70 patients with recent-onset psychotic disorder and 61 healthy controls with various levels of cannabis use. Three Single-Category Implicit Association Tests (SC-IAT) were used to assess 'relaxed', 'active' and 'negative' implicit associations towards cannabis use. Explicit expectancies of cannabis use were assessed with a questionnaire using the same words as the SC-IAT.

RESULTS

There were no differences in implicit associations between patients and controls; however, patients scored significantly higher on explicit negative affect expectancies than controls. Both groups demonstrated strong negative implicit associations towards cannabis use. Explicit relaxed expectancies were the strongest predictors of cannabis use and craving. There was a trend for implicit active associations to predict craving.

CONCLUSIONS

The findings indicate that patients suffering from schizophrenia have associations towards cannabis similar to controls, but they have stronger negative explicit cannabis associations. The strong negative implicit associations towards cannabis could imply that users of cannabis engage in a behaviour they do not implicitly like. Explicit relaxing expectancies of cannabis might be an important mediator in the continuation of cannabis use in patients and controls.

Craving and attentional bias respond differently to alcohol priming: a field study in the pub

BACKGROUND

Several experimental laboratory studies have shown that subjective craving for alcohol increases as a result of low-to-moderate levels of alcohol consumption. Less is known about alcohol prime effects on relatively automatic appetitive motivational processes such as attentional bias (AB). Also, it is not known whether the effects from laboratory studies can be generalized to real-life drinking environments, and whether effects change after higher alcohol doses than those that have been administered in lab studies.

METHOD

In two pubs, we investigated alcohol prime dose effects in self-reported craving and AB, measured by a modified Flicker Paradigm. We included an opportunistic sample of 72 social drinkers who had been drinking various amounts of alcohol.

RESULTS

Self-reported craving was positively predicted by dose of alcohol consumed, from one up to 16 drinks. In contrast, AB was negatively predicted by dose consumed in participants who had been binge drinking.

CONCLUSION

This field study validates earlier experimental research on alcohol prime effects in a real drinking situation. Further, it demonstrates prime effects up to much higher alcohol doses than in previous lab studies.

A randomized clinical trial of a targeted intervention to moderate alcohol use and alcohol-related problems in at-risk adolescents

This study investigated the effectiveness of a targeted intervention program aimed at at-risk adolescents in a randomized clinical trial design (N=107). This program combined intervention methods which have been proven effective in reducing drinking in young adults, such as an expectancy challenge, cognitive behavioral skill training and brief motivational feedback. Additionally, this intervention contained the new element of discussing biological, cognitive and social risk factors for developing alcohol problems. We investigated whether this seven session program was successful in changing cognitive determinants of drinking behavior and consequently in moderating alcohol use and the development of alcohol-related problems in at-risk adolescents. The intervention was effective in changing several of the targeted cognitive determinants. However, despite the changes in these cognitive determinants of drinking, the experimental group did not show a significant difference in decrease of drinking at posttest compared with the control group. The results did not yield support for any differential long term effects of the intervention. We concluded that although the present intervention successfully changed important cognitive determinants of drinking more is needed to change subsequent drinking behavior in at-risk adolescents.

Selective cognitive processing of drug cues in heroin dependence

Previous studies provide evidence for the selective processing of disorder related stimuli on anxiety, depression, and eating disorders. There exist some preliminary indications that selective processing of drug cues may be involved in drug craving and relapse that deserve further investigation. In order to investigate the role of processing bias in an abnormal motivational system, the attentional bias for drug related stimuli was studied in a heroin dependent population. Heroin dependent participants (n = 21) and control participants (n = 30) performed a supra- and subliminal heroin Stroop task and heroin craving was assessed. Heroin dependent participants showed a considerable attentional bias for supraliminally presented heroin cues. However, there was no evidence for a preattentive bias on the subliminal presented cues. Reaction time on heroin cues was significantly predicted by heroin craving-levels. Results indicate that selective processing may be related to motivational induced states in general. The finding are discussed in the context of selective information processing in general psychopathology and in motivational processes as addiction specifically.

Effects of retrieving childhood events on metamemory judgments depend on the questions you ask

OBJECTIVE

The more people retrieve childhood memories, the less favourably they evaluate their own memory. It has been argued that this might play a role in self-reports of amnesia. However, a limitation of previous studies addressing this phenomenon is that participants' judgments about their memory were based on a single item.

DESIGN

Students were randomly assigned to either of two conditions. In one condition, they were asked to retrieve nine negative childhood events, whereas in the other condition, participants were required to recall three events.

METHOD

After recall, students completed measures on memory accessibility and 'repression'.

RESULTS

Students who retrieved nine events rated their memories as less accessible, but also reported less repression than did students who retrieved three events.

CONCLUSION

The direction of retrieval effects on metamemory judgments depends on the way in which questions are framed.

The assessment of alcohol expectancies in school children: measurement or modification?

AIMS

Earlier research has suggested that measuring children's positive alcohol-related expectancies could have the undesirable side effect of increasing them. This has been reported for an instrument that only measured positive expectancies and used a puppet-reference. The present study investigated whether this increase was still found using an unbiased instrument. Further, it was tested whether the assessment method with puppets influenced children's expectancies.

DESIGN

Children were assigned randomly to respond on an unbiased expectancy questionnaire in one of two assessment conditions: with reference to a puppet (P) or without reference to a puppet (Q). One month later, children were again administered one of the two assessment conditions, resulting in four assessment orders (PP, PQ, QP, QQ).

SETTING AND PARTICIPANTS

Three hundred and ninety-five second- to fifth-graders were administered one of the two methods in their schools and 260 children were measured a second time, 1 month later.

MEASUREMENTS

A questionnaire measuring children's positive and negative expectancies was developed that could be administered with or without a puppet-reference.

FINDINGS

A large direct response-effect was found: in the puppet condition, children scored higher on positive but not on negative expectancies. A smaller indirect measurement-effect was found at borderline significance: children who had used the puppet method 1 month earlier had significantly stronger positive expectancies than children who had used the questionnaire earlier.

CONCLUSIONS

The present results confirm earlier indications that measuring children's positive expectancies may have the undesirable side effect of increasing them. This can be avoided by measuring children's expectancies with an unbiased questionnaire without a puppet-reference.

A confirmatory analysis of the hierarchical structure of positive and negative dose-related alcohol expectancies in alcoholics and the associations with family history of alcoholism

OBJECTIVE

The usefulness of measuring four types of alcohol-outcome expectancies in alcoholics was investigated.

METHOD

The investigation was conducted in three steps. First, a measurement model previously fitted in a general population sample was fitted in the present sample of alcoholics, using confirmative factor analysis. In the hierarchical model tested, four types of expectancies are represented as four second-order factors: positive and negative expectancies for a low and for a high dose of alcohol. The model was compared with competing models. Second, a common measurement model was tested for subgroups of alcoholics categorized by gender and family history of alcoholism. Third, using path analysis, the associations were investigated for the four types of expectancies with variables of potential relevance for treatment. A sample of 451 male and female clinically referred alcoholics volunteered to complete a series of questionnaires, including the expectancy questionnaire.

RESULTS

Following minor modifications, the measurement model was found to fit adequately in the present sample of alcoholics and across the subsamples. Family history of alcoholism was positively associated with positive expectancies, especially for a high dose of alcohol. This association was mediated by cluster-B personality disorders.

CONCLUSIONS

Even though the expectancy questionnaire used here should be refined in several respects, the results demonstrate the usefulness of measuring four types of expectancies in alcoholics.

Is a mild deficit in executive functions in boys related to childhood ADHD or to parental multigenerational alcoholism?

A mild deficit in executive functions has been hypothesized to be associated with attention deficit hyperactivity disorder (ADHD), with externalizing problem behaviors such as conduct disorder (CD) and with the vulnerability to alcoholism in sons of multi-generational alcoholics (SOMGAs). These three categories overlap, which raises concerns about the specificity of the hypothesized associations. In the present study, measures of executive functions (EFs) were tested in seventy-six 7- to 11-year-old boys: boys with ADHD but without a family history of addiction, SOMGAs, and controls. Specific deficits in EFs were found for boys with ADHD but not for SOMGAs. The association between a deficit in EFs and attention problems remained after controlling for externalizing problem behaviors, but not for the reverse. These results suggest that a mild deficit in EFs is specifically related to ADHD and that the deficits reported in boys with CD and in SOMGAs are due to relatively high attentional problems in these groups or due to other factors such as motivation.

Do young children of alcoholics hold more positive or negative alcohol-related expectancies than controls?

Alcohol-related expectancies and alcohol use were examined in 185 children of alcoholics (COAs) and controls, aged 7 to 18 years. Concerning the expectancies of young COAs, two contrasting hypotheses have been proposed: COAs should hold more negative expectancies than controls due to aversive learning, or hold more positive expectancies due to either social learning or a more favorable response to alcohol. We propose that COAs of elementary school age hold more negative expectancies due to aversive learning, whereas older COAs hold more positive expectancies due to a more favorable response to alcohol. The critical variable with respect to the change from more negative to more positive expectancies is proposed to be the child's own initiation of alcohol use. The results of the present cross-sectional study provide suggestive evidence in favor of this hypothesis. First, elementary school-aged COAs had stronger negative expectancies than controls. Second, the hypothesized interaction between family history and own experience with alcohol was confirmed in the adolescent subsample. The proposed model should be critically tested with longitudinal data. If confirmed, the model may be of importance for prevention of alcohol-related problems in high-risk populations.

High- and low-dose alcohol-related expectancies and the differential associations with drinking in male and female adolescents and young adults

A Dutch questionnaire was developed consisting of positive and negative expectancies relating to low and high doses of alcohol. The associations of these four types of expectancies with current alcohol consumption were investigated in three samples: secondary school pupils of 11-15 years old, secondary school pupils of 16 and older, and university undergraduate students (total n = 554). Using restrictive factor analyses, a common factor-model of the expectancies was shown to fit adequately across subgroups. Which expectancies were associated with current alcohol consumption varied substantially across the subgroups. As expected from previous research, inclusion of high dose expectancies did not substantially improve the prediction of drinking in university students. However, positive and negative high-dose expectancies were found to be powerful predictors of current alcohol consumption in secondary school boys of 16 and older, the subgroup with the highest average alcohol consumption on each occasion. Possible implications are discussed for future research and interventions.

Psychological mechanisms of enhanced risk of addiction in children of alcoholics: a dual pathway?

The background and rationale of a recently started project of the Amsterdam Institute for Addiction Research are outlined. This project is aimed at the psychological mechanisms underlying an enhanced risk of (later) addiction in children of alcoholics and the relationship with childhood psychopathology. A dual pathway mechanism is proposed, in which the type of alcoholism of the parent plays a major role. The child of a multigenerational primary alcoholic parent may suffer from an inherited mild dysfunction of the prefrontal cortex, expressed in neuropsychological and personality characteristics similar to those of the alcoholic parent. These are impulsive, aggressive and reward-seeking behaviour, response perseveration and, in some children, related psychopathology such as conduct disorders. For a child of a secondary alcoholic parent, another mechanism is proposed. In these children, stress and social learning may lead to negative affectivity and repressive coping style, with emotional problems at a later age, and the risk of falling into the "circle of secondary alcoholism". In both pathways, alcohol-related expectancies are suggested to constitute a "final common pathway" between different risk factors and later alcohol abuse. Specific expectancies might be related to different pathways and to gender differences in later drinking patterns.

Children of alcoholics. Predictors for psychopathology and addiction

Children of alcoholics have a higher risk of psychopathology and alcoholism. Therefore, in 1993 the Amsterdam Institute for Addiction Research initiated a study on vulnerability markers and risk factors in children of alcoholics, aimed at identifying predictors for the development of psychopathology and addiction in children of alcoholics. This article provides a summary of the background, rationales and aims of the study. With more specific and sensitive biological vulnerability markers that indicate risk status, more effective preventive interventions might become available. The biochemical part of the study aims at answering the question whether adenylate cyclase is a vulnerability marker for alcoholism. The psychophysiological part is directed at event-related potentials during task performance to clarify the nature of the brain and cognitive functions that may underlie or relate to vulnerability to alcoholism. The third part, the psychological component, aims at possible psychological mechanisms of enhanced risk of addition in children of alcoholics as well as the relationship with childhood psychopathology.