Alcohol Addiction ETIOLOGIES Biological Etiologies Alcohol addiction - Biological Basis Alcohol...

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Transcript of Alcohol Addiction ETIOLOGIES Biological Etiologies Alcohol addiction - Biological Basis Alcohol...

Alcohol Addiction

ETIOLOGIES

Biological EtiologiesAlcohol

addiction - Biological Basis

Alcohol addiction is frequently formed due to the pleasurable aspects of drinking alcohol. This is associated with the changes in the balance of chemicals in the brain. Long term drinking can cause the body to crave alcohol and alcohol dependence.

Alcohol Dependence Study (Biomedical)

Pickens et al. (1988) studied 169 same-sex pairs of twins, both males and females, at least one of which had sought treatment for alcoholism. The researchers found greater concordance of alcohol dependence in identical twins than in fraternal twins.They also found greater concordance of alcohol abuse (defined by DSM-III--Diagnostic and Statistical Manual of Mental Disorders, Third Edition, of the American Psychiatric Association) in identical male twins but not in identical female twins. Other twin studies have produced more detailed information; for example, Partanen et al. (1966), in studying 902 male Finnish twins, found that less severe drinking patterns were less heritable, and more severe drinking patterns were more heritable. Among the difficulties in designing twin studies is accounting for unequal environmental conditions. Early studies assumed that the environments of two fraternal twins were as similar to each other as were the environments of two identical twins. Later studies showed that the environments of identical twins are more alike than are the environments of fraternal twins, and recent twin studies have taken this difference into account (McGue, 1991)The results of twin studies are useful and have suggested the possibility of a genetic component in inheritance (Kendler, 1973); however, because focuses of the studies have varied, the results are difficult to interpret.

Kendler et al. 1999Biomedical/Socio-cultural Study

Background: There are substantial sex differences in all levels of alcohol involvement among U.S. adults. The goal of this study was to test whether the magnitude and sources of genetic and environmental influences on liability for alcohol abuse and dependence differ for men and women.Methods: Structured personal interviews were used to assess DSM-III-R- and DSM-IV-defined alcohol abuse and dependence among 5091 male and 4168 female twins (including 1546 identical, 1128 same-sex fraternal, and 1423 opposite-sex pairs) born in Virginia between 1934 and 1974. Twin correlations were analyzed using structural equation modeling.Results: The magnitude of twin-pair resemblance was similar across several definitions of alcoholism and was substantially higher among identical than fraternal pairs. The proportion of population variation in liability attributed to genetic factors was substantial among both women (55-66%) and men (51-56%), and we found little evidence of a role of environmental factors shared by family members. In all definitions studied, we could reject a model that the genetic sources of liability in the two sexes overlap completely.Conclusion: In this first population-based study of alcoholism among male and female twins from the U.S., we found that genetic factors play a major role in the development of alcoholism in both sexes, that the magnitudes of genetic influence were equally high for men and women, and that the genetic sources of vulnerability are partially, but not completely, overlapping in men and women.http://onlinelibrary.wiley.com/doi/10.1111/j.1530-0277.1999.tb04270.x/abstract

Cloninger 1987Neurogenetic adaptive mechanisms in alcoholism.

AbstractClinical, genetic, and neuropsycho-pharmacological studies of developmental factors in alcoholism are providing a better understanding of the neurobiological bases of personality and learning. Studies of th e adopted-away children of alcoholics show that the predisposition to initiate alcohol-seeking behavior is genetically different from susceptibility to loss of control after drinking begins. Alcohol-seeking behavior is a special case of exploratory appetitive behavior and involves different neurogenetic processes than do susceptibility to behavioral tolerance and dependence on the antianxiety or sedative effects of alcohol. Three dimensions of personality have been described that may reflect individual differences in brain systems modulating the activation, maintenance, and inhibition of behavioral responses to the effects of alcohol and other environmental stimuli. These personality traits distinguish alcoholics with different patterns of behavioral, neurophysiological, and neuropharmacological responses to alcohol.

Cloninger 2002The genetic and environmental

relationship between Cloninger's dimensions of temperament and

character Abstract

The purpose of this study was to determine whether Cloninger’s revised 7-factor model of personality showed incremental validity over his four dimensions of temperament. A sample of 2517 Australian twins aged over 50 between 1993 and 1995 returned completed self-reported measures of Self-directedness, Cooperativeness, and Self-transcendence from Cloninger’s Temperament and Character Inventory. Many of these twins had participated in a 1988 study containing Cloninger’s temperament measures of Harm Avoidance, Novelty Seeking, Reward Dependence and Persistence. Contrary to theoretical expectations, univariate analyses revealed that familial aggregation for the character dimensions could be entirely explained by additive gene action alone. Although temperament explained 26, 37 and 10% of additive genetic variance in Self-directedness, Cooperativeness and Self-transcendence, respectively, seven genetic factors were required to explain the genetic variance among the TPQ dimensions, and almost all of the non-shared environmental variance was unique to each dimension of character. Our results indicate that the inclusion of all seven dimensions in a taxonomy of personality is warranted.

Biomedical Approach Info and Study!

• Family history of alcoholism represents one of the best established risk factors for alcohol dependence

• Genetic epidemiological studies indicate a substantial role of heredity• Several specific genes appear to convey risk for alcohol dependence

Family history of alcoholism is, arguably, the most well-established risk factor for the development of alcohol dependence. Across a variety of different studies, children of alcoholics are at 3-10 fold risk for the development of alcohol dependence (Cloninger, 1987). Familial transmission of alcoholism appears to be largely due to genetic factors (McGue, 1999). In addition, there is an emerging consensus that genetic factors are important in both men and women, that multiple genes are responsible for the genetic effect and that the nature of the genetic vulnerability remains to be discovered (McGue, 1999).

Cognitive EtiologiesAffect Regulation – Negative and Positive Mood Regulation- The concept is that people drink alcohol to cope with and diminish negative moods.

A Study relating to Cognitive Etiologies

Negative mood regulation (NMR) expectancies, stress, anxiety, depression and affect intensity were examined by means of self-report questionnaires in 158 volunteers, including 99 clients enrolled in addiction treatment programs. As expected, addicts reported significantly higher levels of stress, anxiety, depression and affect intensity and lower levels of NMR compared to non-addict controls. NMR was negatively correlated with stress, anxiety, depression and affect intensity. The findings indicate that mood self-regulation is impaired in addicts. Low NMR and high affect intensity may predispose to substance abuse and addiction, or alternatively may reflect chronic drug-induced affective dysregulation.

Cognitive Etiology StudyStress, Alcohol-Related Expectancies and Coping Preferences: A Replication with Adolescents of the Cooper et al. (1992) Model Jeff Laurent, Salvatore J. Catanzaro, Maribeth Kuenzi Callan Objective: The present study attempted to replicate with adolescents the stressor vulnerability model of adult drinking proposed by Cooper et al. (J. Abnorm. Psychol. 101: 139-152, 1992). The Cooper et al. model simultaneously assesses the stress-moderating effects of gender, expectancies and coping on alcohol use and abuse. Method: Adolescents in Grades 7-12 (N = 184, 59% female) completed the Alcohol Expectancy Questionnaire-Adolescent form, the COPE, the Adolescent Perceived Events Scale and the Drinking to Cope scale. Results: The pattern of results was very similar to those of earlier studies using adults or undergraduates. Generally, positive expectancies for alcohol, an avoidant coping preference and stress were predictive of drinking to cope, alcohol use and alcohol-related problems. A number of two-way interactions were also reported. Although gender did not play a prominent role in prediction, as it typically does with adults, grade was a significant predictor; older students reported more alcohol use and alcohol-related problems than younger students. Conclusions: Results were similar to those reported by Cooper et al. with adults and Evans and Dunn (J. Stud. Alcohol 56: 186-193, 1995) with undergraduates, and support the utility of the stressor vulnerability model for understanding alcohol use among adolescents. (J Stud. Alcohol

Etiologies: Socio-Cultural/Cogntive

Stressor vulnerability modelThe socio-cultural idea behind this model that alcoholics are more likely to relapse if exposed to chronic psychological stress. Furthermore, on a cognitive level, individual differences in cognition make them more or less vulnerable to the effect of such stressors.

Socio-Cultural/Cogntive Stressor vulnerability modelStress, Vulnerability and Adult Alcohol

Relapse (1995) Sandra A. Brown, Peter W. Vik, Thomas L. Patterson, Igor Grant, Marc

A. Schuckit

Objective: Alcoholics experiencing highly threatening or chronic psychosocial stress following treatment are more likely to relapse than abstaining individuals not experiencing such stress. Expanding upon this stress-relapse hypothesis, we predicted that individual risk and protective characteristics would contribute to vulnerability to relapse in alcoholic men confronted with significant life adversity. The present investigation examined the relationship between psychosocial vulnerability and return to drinking. Method: A group of abstinent male alcoholics (N = 67) who experienced marked life adversity that posed a severe and/or chronic threat participated in this study. Men completed a psychosocial assessment first as an inpatient in treatment for alcohol dependence, and again at 3 months and 1 year following discharge. Results: Among alcoholic men exposed to severe psychosocial stressors, those with higher composite psychosocial vulnerability scores were more likely to subsequently relapse than those with lower vulnerability scores. Additionally, men who improved in psychosocial functioning following treatment had better outcomes than men whose vulnerability increased. In particular, coping, self-efficacy and social support most consistently predicted relapse among this sample of severely stressed abstaining alcoholics. Conclusions: These findings supported the stress-vulnerability model of relapse. Results indicated that improvement in psychosocial domains (e.g., coping skills, social networks, perceived ability to tolerate relapse-risk situations) enhanced the ability of these men to remain abstinent despite severe stress. This study highlights the importance of cognitive and behavioral interventions for increasing improvement in these psychosocial domains.

TREATMENTS

Biomedical ApproachThere is a pharmaceutical approach to treating alcoholics. Particulary the drug Antabuse (disulfiram). This works as a deterrent against drinking by making the person sick if they consume any alcohol.

In addition, there is Naltrexone (Revia), which blocks the affects of alcohol in the brain and reduces alcohol craving.

Also, Acamprosate (Campral), which relieves the distress and discomfort alcoholics experience when they stop drinking.

Biomedical Treatment Study (Naltrexone)

A naltrexone treatment study released by the National Institute of Health in February 2008 and published in the Archives of General Psychiatry has shown that alcoholics having a certain variant of the opioid receptor gene (G polymorphism of SNP Rs1799971 in the gene OPRM1) demonstrated strong response to naltrexone and were far more likely to experience success at cutting back or discontinuing their alcohol intake altogether, while in those lacking the gene variant, naltrexone appeared to be no different from placebo. The G allele of OPRM1 is common in individuals of Asian descent, with 60% to 70% of people of Chinese, Japanese, and Indian ancestry having at least one copy, as opposed to 30% of Europeans and very few Africans. In line with this finding, studies found naltrexone to be more efficacious among white subjects than among black subjects, and a 2009 study of naltrexone as an alcohol dependence treatment among African Americans failed to find any statistically significant differences between naltrexone and placebo.

Biomedical Treatment Study (Acamprosate)

Acamprosate has been used in Europe for the treatment of alcohol dependency since 1989. In 2004 it became the third drug to receive approval from the U.S. Food and Drug Administration for this indication, following disulfiram (Antabuse) and naltrexone (ReVia). Acamprosate is a structural analogue of γ-aminobutyric acid (GABA). It is thought to decrease alcohol intake by affecting calcium channels and modifying transmission along GABA and glutamine pathways in the brain, which may result in decreased positive reinforcement of alcohol intake and decreased withdrawal cravings. However, the exact mechanism of action of acamprosate is unknown. MORE: http://www.aafp.org/afp/2006/0815/p645.html

Individual Therapy ApproachCBT: Teaches the person to recognize situations in which they are most likely to drink, avoid these circumstances if possible, and cope with other problems and behaviours which may lead to drinking.

Functional Analysis: Working together, the therapist and the patient try to identify the thoughts, feelings and circumstances of the patient before and after they drank or used drugs. This helps the patient determine the risks that are likely to lead to a relapse. Functional analysis can also give the person insight into why they drink in the first place and identify situations in which the person has coping difficulties.

Skills Training: If someone is at the point where they need professional treatment for their alcohol dependence, chances are they are using alcohol as their main means of coping with their problems. The goal of cognitive behaviour therapy is to get the person to learn or relearn better coping skills. The therapist tries to help the individual unlearn old habits and learn to develop healthier skills and habits. The main goal of cognitive behaviour therapy is to educate the alcohol -dependent person to change the way they think about alcohol and to learn new ways to cope with the situations and circumstances that led to their drinking episodes in the past.

How Effective Is Cognitive Behaviour Therapy?

• According to the National Institute on Drug Abuse, more than 24 randomized controlled trials have been conducted among users of tobacco, alcohol, cocaine, marijuana, opiates, and other types of substances, making cognitive-behavioural treatments one of the most frequently evaluated psychosocial approaches to treat substance use disorders. § In these studies, cognitive behaviour therapy has been shown most effective when compared with having no other treatment at all. When compared with other treatment approaches, studies have had mixed results -- some show cognitive behaviour therapy more effective while others show it to be of equal, but not greater, effectiveness than other treatments.

• § As with other treatments for alcoholism and drug abuse, including pharmaceutical treatments, cognitive behaviour therapy works best when combined with other recovery efforts, such as participation in support groups.

• § In short, behaviour cognitive therapy works well for some, but not for everyone, as is the case with all alcoholism and drug treatment approaches.

Type of Individual therapy

• Psychotherapy

• A single psychotherapist meets with a single client or patient one or more times per week for about 50 minutes each meeting. Patients have the therapist's full attention during an individual session, which may help the session to feel more secure and safe. The individual format encourages patients to explore their difficulties in-depth across multiple sessions in a way that is not possible in group format psychotherapy.

Group Therapy ApproachGroup psychotherapy is a special form of therapy in which a small number of people meet together under the guidance of a professionally trained therapist to help themselves and one another. The therapy has been widely used and has been a standard treatment option for over 50 years.

Group therapy helps people learn about themselves and improve their interpersonal relationships. It addresses feelings of isolation, depression or anxiety. And it helps people make significant changes so they feel better about the quality of their lives. Additionally, group therapists can apply the principles of group to other settings and situations such as businesses, schools and community organizations.

Group Therapy for Alcoholics Info

• Group psychotherapy pairs one or more therapists with five to ten patients for 90 minutes or so. Group psychotherapy sessions with a 'teaching of coping skills' agenda are run like classrooms, with the therapist acting as teacher, and the patients acting like students. Usually the therapist will teach some important concept, and then will encourage the patients to give examples of that concept from their own lives. Group therapy is also often run in a 'support' or 'growth' mode, wherein the therapist will guide the patients in a discussion of things they are struggling with in their lives. Without overpowering the discussion itself, the therapist attempts to shape it so that the participants support one another, model effective ways of managing problems, and get relatively equal chances to talk.

• Group therapy formats are cheaper to participate in, and often are just as effective or more effective as individual forms of therapy. Group psychotherapy participants are able to learn from one another in addition to the therapist. Drug and alcohol dependent people often have problems with authority, and may be more able to hear and learn things from their peers than they are from therapist/authority figures.

Group Therapy Study “Alcoholics Anonymous”

Affiliation with Alcoholics Anonymous after treatment: A study of its therapeutic effects and mechanisms of action.

Morgenstern, Jon; Labouvie, Erich; McCrady, Barbara S.; Kahler, Christopher W.; Frey, Ronni M, 1997

Relatively little is known about how substance abuse treatment facilitates positive outcomes. This study examined the therapeutic effects and mechanisms of action of affiliation with Alcoholics Anonymous (AA) after treatment. Patients (N = 100) in intensive 12-step substance abuse treatment were assessed during treatment and at 1- and 6-month follow-ups. Results indicated that increased affiliation with AA predicted better outcomes. The effects of AA affiliation were mediated by a set of common change factors. Affiliation with AA after treatment was related to maintenance of self-efficacy and motivation, as well as to increased active coping efforts. These processes, in turn, were significant predictors of outcome. Findings help to illustrate the value of embedding a test of explanatory models in an evaluation study. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Comparison Study of Individual and Group

• H. Hoffmann, A.A. Noem, D. Petersen (1975)

Thirty-seven successfully and 46 unsuccessfully treated male alcoholics were asked to judge the effectiveness or ineffectiveness of six treatment methods routinely offered by a state hospital. For each treatment method, the total frequencies of judgments of most and least helpful, respectively, were as follows: detoxification (16%, 14%), lectures (16%, 20%), group therapy (54%, 7%), individual counselling (26%, 6%), work therapy (17%, 22%) and family therapy (13%, 14%). The two groups of subjects differed significantly in the frequencies of treatment methods judged to be “least helpful”, but not in the frequencies of “most helpful” treatment. The similarity between the judgements of successfully and unsuccessfully treated alcoholics might reflect the positive effects of previous treatment in the unsuccessful group.