Separating intentional inhibition of prepotent responses and resistance to proactive interference in alcohol-dependent individuals

Background

Impulsivity is a hallmark of addictive behaviors. Addicts’ weakened inhibition of irrelevant prepotent responses is commonly thought to explain this association. However, inhibition is not a unitary mechanism. This study investigated the efficiency of overcoming competition due to irrelevant responses (i.e., inhibition of a prepotent response) and overcoming competition in memory (i.e., resistance to proactive interference) in sober and recently detoxified alcohol-dependent individuals.

Methods

Three cognitive tasks assessing the inhibition of a prepotent response (Hayling task, anti-saccade task and Stroop task) and two tasks tapping into the capacity to resist proactive interference (cued recall, Brown-Peterson variant) were administered to 30 non-amnesic recently detoxified alcohol-dependent individuals and 30 matched healthy participants without alcohol dependency. In addition, possible confounds such as verbal updating in working memory was assessed.

Results

Alcohol-dependent subjects performed worse than healthy participants on the three cognitive tasks assessing the inhibition of irrelevant prepotent responses but group performance was similar in the tasks assessing overcoming proactive interference in memory, updating of working memory and abstract reasoning.

Conclusions

These findings suggest that alcohol-dependence is mainly associated with impaired capacity to intentionally suppress irrelevant prepotent response information. Control of proactive interference from memory is preserved. Theoretical and clinical implications are discussed.     

Personality disorders in alcoholics: a comparative pilot study between the IPDE and the MCMI-II

In this paper, the most frequent personality disorders (PDs) related to alcoholism are described. 105 participants took part in the study (50 consecutively recruited treatment-seeking alcoholics and 55 subjects from the general population). All subjects were assessed with the IPDE and the MCMI-II. According to the results in the IPDE, 22% of alcoholics, versus 7.27% of the normal sample, showed at least one PD. The most prevalent PDs were the Avoidance personality disorder (10%), followed by the Non-specified (8%) and Borderline (6%). When the MCMI-II was used a significantly higher prevalence of PDs was observed (52% in alcoholics and 18.1% in the normal sample), without coincidence in the kind of PDs diagnosed. This lack of consistency is probably related to the assessment tools, mainly the IPDE, which is more accurate and conservative than self-report inventories, which present a tendency for over-diagnosis.     

Assessment reactivity to follow-up in a study of women's treatment for alcohol dependence

Little research has been conducted on symptom reductions in response to assessments in clinical trials, despite the impact such reactivity may have on interpretation of outcomes. Reactivity to data collection procedures during post-treatment follow-up may obscure treatment effects. The current study examined whether female participants (n=102) in a trial of cognitive-behavioral treatment for alcohol dependence had lower drinking quantity and frequency immediately after participating in follow-up assessments. Repeated measures ANOVAs were used to compare each participant's drinking among two-week time periods immediately before the follow-up, directly after the follow-up, and between follow-ups. No assessment reactivity was found for 9 or 15 month follow-up interviews, but was suggested at a 12 month in-person interview.     

Depression among alcoholics in a Turkish sample

The aim of the present study was to identify the predictor variables of depression among alcoholics in a Turkish mental hospital. A questionnaire and the Beck Depression Inventory (BDI) were utilized to collect data from 71 male alcoholics. A stepwise multiple regression analysis between the BDI scores and demographic and health-related variables resulted in the identification of marital problems and physical problems due to alcohol as the risk factors. The findings are discussed within the context of the findings from Western countries and the similarities are pointed out.     

Attachment, fear of intimacy and differentiation of self among clients in substance disorder treatment facilities

Attachment, fear of intimacy and differentiation of self were examined by means of self-report questionnaires in 158 volunteers, including 99 clients enrolled in addiction treatment programs. As expected, clients (who were undergoing treatment for alcoholism, heroin addiction, amphetamine/cocaine addiction or cannabis abuse) reported higher levels of insecure attachment and fear of intimacy, and lower levels of secure attachment and differentiation of self, compared to controls. Insecure attachment, high fear of intimacy and low self-differentiation appear to characterize clients enrolled in addiction treatment programs. Such characteristics may reflect a predisposition to substance problems, an effect of chronic substance problems, or conceivably both.     

Alcoholics Anonymous attendance following 12-step treatment participation as a link between alcohol-dependent fathers' treatment involvement and their children's externalizing problems

We investigated longitudinal associations between alcohol-dependent fathers' 12-step treatment involvement and their children's internalizing and externalizing problems (N = 125, M(age) = 9.8 +/- 3.1), testing the hypotheses that fathers' greater treatment involvement would benefit later child behavior and that this effect would be mediated by fathers' posttreatment behaviors. The initial association was established between fathers' treatment involvement and children's externalizing problems only, whereas Structural Equation Modeling (SEM) results supported mediating hypotheses. Fathers' greater treatment involvement predicted children's lower externalizing problems 12 months later, and fathers' posttreatment behaviors mediated this association: Greater treatment involvement predicted greater posttreatment Alcoholics Anonymous attendance, which in turn predicted greater abstinence. Finally, fathers' abstinence was associated with lower externalizing problems in children. Theoretical and practical implications of these findings are discussed.     

Alcohol expectancies, self-efficacy and coping in an alcohol-dependent sample

This study expanded earlier work conducted by this laboratory by examining the independent and interactive effects of avoidant coping strategies, positive and negative alcohol expectancies and self-efficacy, in predicting volume and frequency of alcohol consumption in a sample dependent on alcohol (n=296). Coping strategies were found to be salient predictors of frequency of drinking, while venting emotion interacted with negative expectancies to predict both volume and frequency of drinking. Venting emotion was also found to interact with drinking refusal self-efficacy in predicting volume of alcohol consumed. These interactions are discussed in terms of the cognitive and behavioural mechanisms thought to underlie drinking behaviour.     

Gender differences in early maladaptive schemas in a treatment-seeking sample of alcohol-dependent adults

The current study examined early maladaptive schemas among alcohol-dependent men and women and sought to determine whether men and women differed in their early maladaptive schemas. Using preexisting patient records of adults diagnosed with alcohol dependence from a residential treatment center in the Southeastern United States, from 2005 to 2010 (N = 854), results showed that women scored significantly higher than men on 14 of the 18 early maladaptive schemas assessed. Both women and men endorsed having a number of early maladaptive schemas, with four schemas being particularly prevalent across gender. Study limitations are noted and implications of these findings for treatment and future research are discussed.     

The structure of positive alcohol expectancies in alcohol-dependent inpatients

Alcohol expectancies, i.e. the immediate effects of alcohol anticipated by an individual, have been shown to predict initiation of drinking during adolescence as well as transition from nonproblem to problem drinking. Moreover, cross-sectional studies have revealed that alcohol expectancies are related to both frequency and quantity of alcohol use. However, research has focused almost exclusively on nonclinical samples. While numerous studies have examined alcohol expectancies in college samples, little is known about the expectancies of alcohol-dependent individuals. The present study aimed to expand the research on alcohol expectancies by establishing the factor structure of the Alcohol Expectancy Questionnaire (AEQ), the most frequently used expectancy scale, in a large sample of alcoholism treatment clients (N = 685). Furthermore, gender differences and the relationship between expectancies and alcohol consumption were examined. Exploratory factor analysis identified two dimensions of alcohol expectancies. Factor one represented alcohol expectancies regarding social assertiveness, self-confidence, and mood management. With two exceptions all items loading on the second factor described alcohol-induced enhancement of sexual feelings. Comparing the findings of the present study with the results of previous expectancy research based on the responses of college students and other nonclinical samples revealed that these factors appear to be relatively uniform across studies. However, item statistics suggested that the structure derived from factor analysis may have been influenced by rate of endorsement. Women scored lower on factor one and the total score than men. Inclusion of the total score in regression analysis added to the prediction of alcohol consumption. The present results suggest that the findings of previous research should be interpreted with caution, since AEQ scores are not comparable across groups.     

An attempt to improve the identification of alcohol-dependent patients in a teaching general hospital

The information on drinking habits contained in medical records with that obtained through the CAGE alcoholism screening test was compared for 124 inpatients of a teaching general hospital. This survey was followed by testing the possibility of introducing the CAGE test into the routine clinical interview. A second analysis of 110 medical records performed 2 months later indicated the failure of this attempt, as the general pattern of information on drinking habits remained unaltered and characterized by either no information at all or information that was too ambiguous to be of clinical value. Among the different hypotheses that could account for the negative results is the possibility that physicians are not sufficiently informed on the wide spectrum of clinical disorders associated to alcohol abuse. Another important factor is the lack of motivation shown by attending physicians to detect less obvious cases of alcohol dependence as they feel pessimistic about dealing with this condition.     

Effects of tetrabamate and of diazepam on sleep polygraphy during subacute withdrawal in alcohol-dependent patients

We have studied the effects of two anxiolytic drugs frequently prescribed in alcohol withdrawal, diazepam and tetrabamate, on sleep polygraphy of alcohol-dependent patients hospitalized for alcohol detoxification. Twenty-three inpatients (16 M and 7F) fulfilling the DSM 3R alcohol-dependence criteria were included. Twelve patients were treated with tetrabamate and the other 11 with diazepam. Sleep polygraphy was carried out on average 15 days after alcohol withdrawal. The sleep of tetrabamate-treated patients differs from that of diazepam-treated patients in having a much longer duration of stage 4, at the expense mainly of stage 2. The two groups of patients had a greater total sleep time and duration of delta sleep than comparable untreated patients. These results suggest that the delta sleep deficit of abstinent alcoholics is paradoxically corrected by anxiolytic treatment. Tetrabamate seems to induce the production of delta waves during the sleep of abstinent alcoholics.     

Psychometric validation of the Leeds Dependence Questionnaire (LDQ) in a young adult clinical sample

Objective

Measures of substance dependence severity that are both clinically efficient and sensitive to change can facilitate assessment of clinical innovation necessary for improving current evidence-based practices. The Leeds Dependence Questionnaire (LDQ) is a 10-item, continuous, self-report measure of dependence that is not specific to any particular substance and has shown promise in preliminary psychometric research. The present study investigates its psychometric properties in a large clinical sample of young adults.

Method

Young adults (N = 300) were enrolled in a naturalistic treatment process and outcome study of residential substance dependence treatment (mean age 20.4 [1.6], range 18–25; 27% female; 95% White). Dependence severity by demographic and diagnostic groupings, factor structure and internal consistency, and criterion- and construct-related validity were examined.

Results

Dependence severity in this cohort of youth overall was high (M = 18.65 [8.65]). LDQ scores were highest among opiate and stimulant users, and there was a trend for higher scores among women compared to men (t = 1.869, p = .063). Factor analysis using a robust alpha factoring extraction revealed a single factor accounting for 63% of the variance in reported dependence severity. The internal consistency was also very high (alpha = .93). Concurrent and convergent validity with dependence criteria, substance use frequency, and general symptom severity, respectively, were also acceptable.

Conclusions

The LDQ shows considerable promise as a brief, psychometrically sound, measure of substance dependence useful across a variety of substances, that has clinical and research utility. This study supports its use among young adults.     

Predictors of alcohol dependence in a sample of women

Predictors of alcohol dependence were investigated in a clinical sample of 59 women in inpatient alcohol treatment in Adelaide and in a similar number of matched controls. The strongest statistical predictors of alcohol dependence were high depression, smoking, sex-role identity conflict and non-positive perception of mother's personality.     

Negative Mood Regulation (NMR) expectancies, mood, and affect intensity among clients in substance disorder treatment facilities

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.     

Female substance abuse: characteristics and correlates in a sample of inpatient clients

This article reports on a study of 64 female substance abusers in residential treatment for chemical dependency. This study was conducted with the purpose of describing the associations between: (a) demographic characteristics, (b) presence and severity of addiction, (c) depression, and (d) self-esteem. All participants were drawn from inpatient females, and were administered questionnaires that included the following instruments: (a) Screening/Intake Assessment, (b) the Michigan Alcohol Screening Test, (c) the Addiction Presence and Severity Index, (d) the Provision of Social Relations Scale, (e) the Rosenberg Self-Esteem Scale, and (f) the Costello-Comrey Depression Scale. Multivariate analyses revealed that levels of self-esteem were related to detoxification status and social support. Depression levels were associated with social support, and severity of addiction was more pronounced for White clients than Black clients in this study. Implications for program development are discussed.     

76例腭部恶性肿瘤治疗临床分析

目的探讨腭部恶性肿瘤的治疗方法及其疗效。方法回顾性分析76例腭部恶性肿瘤经手术、放疗及手术和放疗联合治疗的临床疗效。结果鳞状上皮癌患者行单纯手术、单纯放疗、放疗联合手术治疗的5年生存率分别为40．0％、25．0％、57．9％。腺上皮癌患者行单纯手术、单纯放疗、放疗联合手术治疗的5年生存率分别为36．4％、30．0％、73．3％。结论腭部恶性肿瘤通过根治性手术治疗预后较好,手术配合放疗明显优于其他治疗方式。     

Gender differences at admission and follow-up in a sample of methadone maintenance clients.

Although one-third of clients enrolled in methadone treatment in the United States are female, few studies have looked at gender differences at admission and follow-up. Using interview data from 435 clients (31% female) collected at admission and approximately 1 year after discharge, females were found to have more dysfunctional families of origin and greater prior and current psychological and medical problems. Both genders improved following treatment, as evidenced by reduced illicit drug, tobacco, and alcohol use, criminal involvement, and HIV/AIDS-risky behaviors. Females were more likely to seek further help for both drug misuse and psychological problems subsequent to discharge.     

A comparison of two depressive symptomatology measures in residential substance abuse treatment clients

Comorbid depression is common among substance abusers, making routine assessment of depression critical for high-quality care. We evaluated two of the most commonly used depressive symptomatology measures in a sample of clients (N = 240) in residential substance abuse treatment settings. The Beck Depression Inventory (BDI-II) has previously been used in clients receiving substance abuse treatment. The Patient Health Questionnaire (PHQ-9), originally developed for primary care settings, has not been used as frequently in substance abuse treatment settings, and it is unknown how it performs in this population. The measures were highly correlated with each other (r = .76) and demonstrated good internal consistency reliability (BDI-II = 0.91, PHQ-9 = 0.87); however, the PHQ-9 classifies more individuals as having “mild” depression symptoms relative to the BDI-II, which tends to suggest these individuals have no depression symptoms. Implications for assessing depression symptoms in individuals receiving substance abuse treatment are discussed.     

Intra-couple communication dynamics of HIV risk behavior among injecting drug users and their sexual partners in Northern Vietnam

This paper elucidates the social context of HIV risk behavior and intra-couple risk communication among injecting drug users (IDUs) and their main sex partner. Data on shared injection equipment, unprotected sex with multiple partners, unprotected sex with a main partner and couples' dynamics and risk communication were gathered through separate in-depth interviews with 11 active male IDUs and 11 of their primary female sex partners in Northern Vietnam. The majority of IDUs' sex partners does not inject drugs and is monogamous. In contrast, most IDUs reported a wide range of risky practices including needle sharing and unprotected sex with multiple, often concurrent, sex partners. Men rarely used condoms with primary partners. Many IDUs worried about their HIV-status, but none disclosed their injecting or sexual practices to their sex partners, leaving their partners unaware of their HIV risk. Among women who worried about HIV/AIDS, the vast majority was unable to influence their partner's needle sharing or extramarital affairs and most would not initiate condom use because they feared their partner's reaction. Couple-based interventions to facilitate risk communication combined with programs to promote condom use among male IDUs, may help to reduce HIV transmission from IDUs to their primary partners.     

Substance-dependent patients with and without social anxiety disorder: occurrence and clinical differences. A study of a consecutive sample of alcohol-dependent and poly-substance-dependent patients treated in two counties in Norway

AIMS: (1) To identify clinically important differences between patients with and without social anxiety disorder (SAD) among alcohol-dependent and poly-substance-dependent patients. (2) To explore if primary SAD is a predictor of alcohol-dependency or poly-substance dependency when controlling for other Axes I and II disorders. METHODS: A consecutive sample of in- and outpatient alcohol-dependent (N = 146) and poly-substance-dependent patients (N = 114) from public treatment programmes in two catchment areas was assessed by personal interview, the Composite International Diagnostic Interview and the Millon Clinical Multiaxial Inventory. RESULTS: The frequency of current SAD was 42%; SAD was significantly more frequent among poly-substance-dependent patients (51%) than among alcohol-dependent patients (34%). Patients with SAD do not represent a distinct clinical subgroup, but the occurrence of SAD is combined with the occurrence of other anxiety disorders, affective disorders and personality disorders in both substance groups. The analysis showed a trend towards primary SAD as a predictor for developing poly-substance dependency. CONCLUSIONS: Patients with SAD in both substance groups exhibited more comorbid Axis I and II disorders. They may need specific psychiatric treatment for such disorders in addition to treatment for SAD. Treatment of primary SAD could be a target for preventing poly-substance dependency in young populations.