Presentation 2

Alcohol Expectancies and ALDH2*2 in Korea

Benjamin Mahoney, Dr. Deborah Graham & Dr. David Cottrell

South Korea

Archeological findings date Korean civilization as early as

2333 BC

Civil war 1950 to 1953

South Korea is today the 15th biggest economy in the world

Soju

Made from rice

Typically sold in 375ml

bottles

Most frequently al-cohol

content is 20%

Usually drank neat

Alcohol Consumption Rates

South Koreans consume 90 bottles of soju a year

Global Position Country Liters per Year1st Luxemburg 15.62nd France 14.83rd Ireland 13.5---------------------- --------------------------- -------------------14th Australia 9.815th Netherlands 9.716th South Korea 9.3

5th highest for unrecorded alcohol consumption (est. 7 liters)

Korean Alcohol Dependence Rates

Liters of Alc. per capita Lifetime Dependence (%)0

5

10

15

20

25

Male

Female

Men are drinking far more than women, with allavailable data indicating huge gender splits

The recent lifetime alcohol dependence rate has been reported as high as 11.7% (W.H.O, 2004)

In 2001, up to 22% of males suffered lifetime dependence, and only 1-4% of women (W.H.O., 2004)

Different Definition of Alcoholic

South Korean Sample French Sample Belgium Sample0

10

20

30

40

50

60

Alcohol Abstainence on Acamprosate

% A

bsta

ined

Korean sample may be more representa-tive of acute alcoholism

Alcoholism is effected by higher social tolerance of heavy drinking.

ALDH2*2

ALDH2 mutations (2/1 & 2/2) fail to break down alcohol as effectively

Occurs in high amounts in East Asian coun-tries(China, Korea, Japan)

Those with the mutation suffer far greaternegative physical effects when drinking

Alcohol Metabolism

AcetateAcetalde-hydeEthanol

Alcohol Dehydroge-

naise(ADH)

Aldehyde Dehydrogenaise 2

(ALDH2)

If not processed, negativephysical effects occur

ALDH2*2 Facial Flush

Alcoholism RatesFor review, see Quertemont and Didone (2000)

ALDH2 (1/1)

ALDH2 (2/2)

ALDH2 (2/1)

Those with ALDH2 (1/1) can maintain normal drinking rates

Those with ALDH2 (2/1) are 4 times less likely to develop alcohol dependenceThose with ALDH2 (2/2) are 7 times less likely to developalcohol dependence

Placebo and Expecta-tions

Lang et.al., 1975

Behavior changes when people think they are consuming alcohol

Outcome expectancies are believed to mediate the changed behavior

Alcohol expectancies vary according to peoples experience with the drug

Sociable!RelaxedSick

Alcohol Makes Me….

Alcohol Free Association (Reich and Goldman, 2005)

0 1 2 3 4 5 6_8 >80

0.02

0.04

0.06

0.08

0.1

0.12Sick

Happy

Pro

bab

ility

of

Rec

all

Drinks Per Ocassion

Significantly Higher Tension Reduction Expectancies

Tension Reduction Social Assertive Physical and Social Pleasure0

2

4

6

8

10

12

ALDH2 (1/1)

ALDH2 (2/1)

Lev

el o

f E

xpec

tan

cy

Expectancy Type

ALDH2*2 Heavy Drinkers:

Expectancy Challenges

Research has shown that if you challenge expectancies you can change behavior

Expectancy challenges involve modified placebo exercises and expectancy information

Expectancy ChallengesDarkes and Goldman (1993)

Pre Post13

14

15

16

17

18

19

20

21

Control

Tradiction

Expectancy

Mea

n D

rin

ks

per

Wee

k

Period

Implicit Expectancy Ac-tivation

Alcohol expectancy words can also increase consumption levels

Participants presented with a neutral video, positive alcohol expectancies, and a video related to alcohol consumption, and com-binations of the three

Cheers Video

Happy

Stroop Task

Stroop Task

Confident

Stroop Task

Sociable

Roerich & Goldman (1995)

Series10

50

100

150

200

250

300

350

Cheers/Expectancy

Cheers/Control

Newhart/Expectancy

Newhart/Control

Mill

s D

ran

k

Condition

ALDH2*2 Facial Flush

•Facial Flush-ing

•Dizziness

•Nausea

•Headaches

•Drowsiness

ALDH2*2

How can they drink on?

Grays’ (1987)Reward and Punish-ment Model

Behavioral Activation System (BAS) Regulates approach action,

and is sensitive to cues of reward (SR)

Behavioral Inhibition System (BIS) Regulates evasive action,

and is sensitive to cues of punishment (SP)

SPSR

While SR is a good predictor of heavy alcohol consumption, SP is not

It has been shown that those high in SR, low in SP and high in expectancies, are heavy consumers (Simons & Arens, 2007)

Simons and Arens (2007)

High SR

Low SP

High PositiveExpectancies

Heavy Drinking

Hypothesized ALDH2 (2/1) Heavy Drinker Model

ALDH2 (2/1)High Tension

Reduction Expectancies

Tension reductionexpectancies are constantly associated with problematic drinking

High SR and lowSP high and alcohol expectancies mediate problem consumption

ALDH2 (2/1) is the genetic muta-tion of interest due to higher drinking rates and preva-lence

High SR/Low SP Heavy Drinking

ALDH2 (2/1) high in tension reduction, low in SP and High in SR.

Implicit Expectancy Ac-tivation

237 Korean participants answered the ques-tion:

Alcohol makes me….

Also filled out a survey with alcohol questions embedded

Korean Alcohol Expectancies

1 to 3 4 to 6 7 to 9 >9 0.00

0.02

0.04

0.06

0.08

0.10

0.12

0.14

0.16

0.18

Feel Good

Dizzy

Drinks per Occassion

Rec

all P

rob

abili

ty

Figure 1. Recall probability of the highest Korean alcohol associates.

Expectancy Categories

8 Dimensions of expectancy Multi Dimensional Scaling

Aroused

Positive Aroused

Positive

Positive Sedated

Sedated

Negative Sedated

Negative

Negative Aroused

RelaxedSick

Aggressive

HornyAwake

Dizzy Sleepy

Happy

Heavy Drinkers

Lighter Drinker


Positive Aroused Positive Positive Aroused Positive0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

1to3 drinks

4to6 drinks

7to9 drinks

>9 drinks

Rec

all P

rob

abili

ty

Males Females


Negative Sedated Negative Negative Sedated Negative0.0

0.1

0.2

0.3

0.4

0.5

1to3 drinks

4to6 drinks

7to9 drinks

>9 drinks

Rec

all P

rob

abili

ty

Males Females

Back Translation

Item Number

Questionnaire Statement Item Total Corre-lations

Original Factor Score

Ex-pectan

cy Score

EXPECTANCY I

16 술을 마신 뒤엔 좀더 창의적인 생각이 떠오른다 .525 .542

91 술을 마시면 성욕이 생기게 된다 .585 .685

20 음주는 기분 좋은 순간들을 유지시키는데 더

용이하게 작용한다

.520 .617

30 어떤 식으로든 답답한 느낌을 받을 때 몇 잔의

음주는 기분을 나아지게 만든다

.563 .691

Item Number

Questionnaire Statement Item Total Corre-lations

Original Factor Score

Ex-pectan

cy Score

EXPECTANCY I

16 I have creative thoughts after drinking alcohol .525 .542

91 I get a desire for sex after drinking .585 .685

20 I use drinking to sustain a good time. .520 .617

30 A few drinks alleviate any stifling feelings I

might have

.563 .691

31 Guys become friendlier after drinking .444 .565

32 It’s easier to meet new people after drinking .584 .694

38 Dinking allows me to feel less conscious of

the people around me

.552 .624

Original English Version Korean Version

Back Translation

Item Nu

mber

Questionnaire Statement Item Total Cor-relations

Origi-nal

Factor Score

Ex-pectan

cy Score

EXPECTANCY I

16 술을 마신 뒤엔 좀더 창의적인 생각이

떠오른다

.525 .542


20 음주는 기분 좋은 순간들을 유지시키는데

더 용이하게 작용한다

.520 .617

30 어떤 식으로든 답답한 느낌을 받을 때 몇

잔의 음주는 기분을 나아지게 만든다

.563 .691

Item Nu

mber


Origi-nal

Factor Score

Ex-pectan

cy Score

EXPECTANCY I

16 I have creative thoughts after drinking al-

cohol

.525 .542




might have

.563 .691


32 It’s easier to meet new people after drink-

ing

.584 .694

Back TranslatedEnglish Version

Korean Version

Back Translation

Item Nu

mber


Origi-nal

Factor Score

Ex-pectan

cy Score

EXPECTANCY I


cohol

.525 .542




might have

.563 .691



ing

.584 .694

Back Translated English Version

Item Nu

mber


Origi-nal

Factor Score

Ex-pectan

cy Score

EXPECTANCY I


cohol

.525 .542




might have

.563 .691



ing

.584 .694

Original English Version

Back Translation

Item Nu

mber


Origi-nal

Factor Score

Ex-pectan

cy Score

EXPECTANCY I

16 술 을 마 신 뒤 엔 좀 더 창 의 적 인 생 각 이

떠오른다

.525 .542


20 음주는 기분 좋은 순간들을 유지시키는데 더

용이하게 작용한다

.520 .617

30 어떤 식으로든 답답한 느낌을 받을 때 몇

잔의 음주는 기분을 나아지게 만든다

.563 .691

31 남성들은 술을 마시면 더 상냥해 진다 .444 .565

32 술을 마시면 새로운 사람들을 만나는 것이

더 쉬워진다

.584 .694

38 알코올은 평소 때 보다 다른 사람들에 대한

주의를 덜 갖게 만든다

.552 .624

Korean Version

Method Outline

461 participants

Measures:-A demographic Survey-Alcohol Expectancy Questionnaire-SPSRQ (S)-Buccal Swap

Buccal Sawb

Average Drinks per Oc-casion

ALDH2 (1/1) ALDH2 (2/1) ALDH2 (2/2)0

1

2

3

4

5

6

7

8

9

Dri

nk

s p

er O

ccas

ion

ALDH2 Type

Gender and Global Positive Expectancy Moderating ALDH2 (1/1) Drinks per Occa-sion

Low Med High0

1

2

3

4

5

6

7

8

9

Female

Male

Dri

nk

s p

er O

ccas

sion

Global Poitive Expectancy

Tension Reduction Expectancy and SP Moderating ALDH2 (2/1) Drinks per Occa-sion

Low Medium High0

1

2

3

4

5

6

7

8

9

High SP

Medium SP

Low SP

Dri

nk

s p

er O

ccas

sion

Relaxation and Tension Reuction Expectancy

Implicit Expectancy Ac-tivationDo Korean expectancy words affect

cognition?

Memory network can be activated by associated cues

Reich, Noll and Goldman (2005) demonstrated activation of alcohol memory network

Implicit Expectancy Ac-tivation 30 word memory test

Two word categories embedded:• grocery items (e.g. bread, cheese)• alcohol expectancy words (e.g. happy confident)

Two condition: • those who saw ‘milk’ first word • those who saw ‘beer’ first word

Implicit Alcohol Cue

Beer


Bread


Happy


Sociable


Cheese

Memory Test (Reich, Noll & Goldman, 2005)

Non Lighter Heavier0

1

2

3

4

5

6

7

8

Milk

Beer

Exp

ecta

ncy

Wor

ds

Rec

alle

d

Drinker Type

Implicit Expectancy Ac-tivation 30 word memory test

Two word categories embedded:• grocery items (e.g. bread, cheese)• alcohol expectancy words (e.g. happy confident)

Two condition: • those who saw ‘kim chi’ first word • those who saw ‘soju’ first word

Memory Test

Kim Chi Soju0

1

2

3

4

5

6

7

8

9 Grocer words

Alcohol Expectancy Words

Ave

rage

Rec

alle

d

Major Findings

Free association tests show higher levels of

negative expectancy

Genetic testing shows that ALDH2*2 drinking levels are mediated by and tension reduction expectancy SP

Memory test failed to show activation of alcohol memory network

Gender a big mediator

Postulation

Tension reduction expectancy may aid ALDH 2*2 drinkers tolerate the nega-tive effects

SP appears to play a moderating role in this

toleration of the punishing effects of alcohol

ALDH2*2 may be moderating the high levels

of negative expectancy and failure to see

activation of a memory network

Theoretical Questions

Does acetaldehyde have stress re-lief

properties?

How is ALDH2*2 impacting the larger than

usual gender difference in alco-hol

consumption?

Conclusion

Results lend support to research showing

ALDH2*2 report higher tension reduction

expectancy

Results do not support research suggesting

SR is a moderator of drinker level

Results suggest that ALDH2*2 drinks per

occasion is moderated by SP

Conclusion

Results suggest that Koreans have higher

levels of negative expectancy

Memory network activation may be more

difficult in a Korean population, which may be mediated by higher levels of negative

expectancy

Practical Aplications

South Korean Sample French Sample Belgium Sample0

10

20

30

40

50

60

Alcohol Abstanence on Acamprosate

% A

bsta

ined

Intervention programs not working a well

Identifying ALDH2 may help better target motivation

Korean Expectancy Challenges

Pre Post13

14

15

16

17

18

19

20

21

Control

Tradiction

Expectancy

Mea

n D

rin

ks

per

Wee

k

Period

Focus on disrupting tension reduction expectancy may help.

Focusing on negative effects to heighten SP

Presentation 2

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