Paternal alcoholism predicts the occurrence but not the remission of alcoholic drinking: a 40-year follow-up

OBJECTIVE: To test the effects of father's alcoholism on the development and remission from alcoholic drinking by age 40. METHOD: Subjects were selected from a Danish birth cohort that included 223 sons of alcoholic fathers (high risk; HR) and 106 matched controls (low risk; LR). Clinical examinations were performed at age 40 (n = 202) by a psychiatrist using structured interviews and DSM-III-R diagnostic criteria. RESULTS: HR subjects were significantly more likely than LR subjects to develop alcohol dependence (31% vs. 16%), but not alcohol abuse (17% vs. 15%). More subjects with alcohol abuse were in remission at age 40 than subjects with alcohol dependence. Risk did not predict remission from either alcohol abuse or alcohol dependence. CONCLUSION: Familial influences may play a stronger role in the development of alcoholism than in the remission or recovery from alcoholism.     

Increased tryptophan hydroxylase immunoreactivity in the dorsal raphe nucleus of alcohol-dependent, depressed suicide subjects is restricted to the dorsal subnucleus

Considerable evidence suggests that alcoholics with co-occurring depressive disorder are at greater risk for developing psychosocial problems particularly suicidal behavior. Moreover, dysfunction in serotonin (5-HT) neurotransmission has been implicated in depression, suicide and alcoholism. In the present study, we measured the levels of tryptophan hydroxylase (TPH), the main synthetic enzyme of 5-HT synthesis, in specific nuclei of the dorsal raphe (DR) in depressed suicide victims with alcohol dependence and matched psychiatrically normal controls. TPH immunoreactivity (IR) was quantified in frozen tissue sections containing the DR from 8 suicide victims with a diagnosis of major depression and alcohol dependence, and 8 psychiatrically normal control subjects by using immunoautoradiographic methods. We found that the levels of TPH-IR were significantly increased by 46% in the dorsal subnucleus of the DR in depressed suicide victims with alcohol dependence when compared with controls. In contrast, TPH-IR levels did not significantly differ in the other DR subnuclei between depressed, alcoholic suicide subjects, and controls. Our results indicate that abnormalities in 5-HT biosynthesis in the brain of depressed alcoholic suicide subjects are restricted within distinct regions of the DR.     

Mortality among patients in psychiatric hospitals in Germany

Data from 7 psychiatric hospitals with defined catchment areas were analyzed; 14,195 episodes of treatment in acute psychiatry wards were recorded within 30 months. During their stay in hospital 196 patients died, 174 from natural causes and 22 by suicide, compared to the expected 32 deaths. Standardized mortality ratios (SMRs) were calculated for the different diagnostic and age groups, mortality risk being highest in organic mental disorder (SMR 7.59, followed by functional psychoses (SMR 4.55) and the “other disorders” (alcoholism, neurotic and related disorders, SMR 3.25). Roughly one half of the 196 deaths were due to cardiovascular disorders and pneumonia. In patients with nonorganic psychiatric syndromes, suicide was the most frequent cause of death (21 of 58 fatalities). With regard to the elevated mortality risk of patients with acute mental illness, a reduction of fatality rates from natural and unnatural causes should remain a major objective of hospital care in psychiatry.     

Predictors and correlates of suicide attempts over 5 years in 1,237 alcohol-dependent men and women

OBJECTIVE: In previous studies, factors related to a history of suicide attempts in persons with alcohol dependence have included sociodemographic variables, a more severe course of alcoholism, additional substance use disorders, and psychiatric comorbidity. This 5-year prospective study evaluated attributes associated with suicide attempts in a group of treatment-seeking persons with alcohol dependence. Psychiatric comorbidity was examined in terms of a distinction between substance-induced and independent psychiatric disorders. METHOD: Semistructured interviews were conducted with 1,237 alcohol-dependent subjects from the Collaborative Study on the Genetics of Alcoholism both at an initial evaluation and at a 5-year follow-up. Clinically relevant information was gathered at baseline, and suicidal behavior, aspects of alcohol dependence, and drug use were evaluated at the follow-up interview. RESULTS: Alcohol-dependent subjects (N=56) with suicide attempts during the follow-up period were more likely than subjects with no suicide attempts (N=1,181) to have made prior attempts. Other factors related to future suicide attempts in univariate analyses included younger age, being separated or divorced, other drug dependence, substance-induced psychiatric disorders, and indicators of a more severe course of alcoholism. Gender did not predict future attempts. CONCLUSIONS: A 5-year prospective evaluation of attributes associated with suicide attempts among alcohol-dependent persons identified factors that contributed to a small but significant proportion of the variance for future suicidal behavior.     

Serotonin transporter gene polymorphisms, alcoholism, and suicidal behavior.

BACKGROUND: Dysfunction of serotoninergic transmission could predispose to excessive alcohol consumption and dependence. The functional polymorphism of the serotonin transporter gene (5-HTTLPR) has been associated with different disorders, including alcoholism. Considering the likelihood of heterogeneity in the "alcohol dependence" phenotype, 5-HTTLPR may be more specifically implicated in subsamples of patients or in related traits of alcoholism, such as impulsivity. METHODS: We analyzed the role of this functional polymorphism in the risk for suicide attempt in a population of male alcohol-dependent subjects. One hundred ten male alcohol-dependent patients (DSM-III-R criteria), French for at least two generations, were personally interviewed with the Diagnostic Interview for Genetic Studies and compared with 61 unaffected blood donors. RESULTS: The "short" (S) allele of the 5-HTTLPR appeared to be unrelated to alcohol dependence and comorbid depression in our sample, but was found associated with an increased risk for suicide attempts. This association was predominantly observed in severe and repetitive suicide attempts, with a significant dose effect of the S allele (0, 1, or 2) on the number and the severity of suicide attempts. CONCLUSIONS: Mood disorders and alcohol dependence may interact with a genetic (relative) deficiency in serotonin reuptake, thereby increasing the risk for aggressive/impulsive behaviors such as suicide attempts.     

Mental Disorders in Suicide and Undetermined Death in the Lundby Study. The Contribution of Severe Depression and Alcohol Dependence

To evaluate the role of severe depression, i.e., depression with melancholic and/or psychotic features and alcohol dependence in suicide and undetermined death. The Lundby Study is a prospective, longitudinal study of a population consisting of 3563 subjects. In a long-term follow up 1947–2006 there were 66 suicide cases, including 19 undetermined deaths. Depression and alcoholism were as expected the major contributors to suicide (44% and 23% respectively). Severe depression with psychotic and/or melancholic features was diagnosed in 66% of all depressions and in 29% of all suicide cases, as compared to 15% for major depression only. Alcohol dependence was related to undetermined death. Major depressive disorder with melancholic and/or psychotic features appears to be an important contributor to accomplished suicide in the depression group, and alcohol dependence appears to be related to undetermined death.     

The use of antidepressants in alcohol-dependent veterans

BACKGROUND: Although some research reports suggest antidepressants may be an effective treatment for alcohol dependence, their clinical use has been controversial. METHOD: By using comprehensive national administrative data from the Department of Veterans Affairs (VA) documenting psychiatric diagnoses and care under natural conditions in both mental health and non-mental health settings, the use of antidepressants was compared in alcoholic and non-alcoholic veterans. Data were collected from April 1, 2000, to Sept. 30, 2000. RESULTS: Overall, patients with alcohol dependence were significantly more likely to be prescribed antidepressants than individuals without alcoholism (38.9% vs. 31.2%), but multivariate analysis showed that this was attributable to the higher rate of comorbid psychiatric diagnoses in this group. After controlling for diagnosis and other potentially confounding factors, alcohol-dependent individuals treated in specialty mental health clinics were in fact less likely to be prescribed antidepressants (odds ratio = 0.95, p <.0001). Of patients treated with antidepressants, those with alcohol dependence were more likely to be prescribed newer antidepressants (odds ratio = 1.22, p <.0001). Among patients treated in non-mental health clinics, there were no significant differences in rate of antidepressant use between alcohol-dependent and non-alcohol-dependent individuals with mental illness after controlling for other factors. CONCLUSION: The principal finding is that a diagnosis of alcoholism, independent of other factors, is associated with a decreased likelihood of receiving antidepressant treatment in VA mental health clinics, suggesting that prescribers have not embraced reports of their efficacy in alcohol dependence. In fact, this may reflect a disinclination to use medications to treat alcoholism in specialty mental health clinics but not in non-mental health clinics.     

Clinical and temperamental differences between early- and late-onset alcoholism in Korean men

OBJECTIVES: The aims of this study were to elucidate the clinical and temperamental differences between early- and late-onset alcoholism among Korean men and to ascertain the validity of Cloninger's typology model of alcoholism for Koreans. METHODS: All of the subjects were screened after a detoxification period of at least 2 weeks using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders for diagnosing alcohol dependence and identifying psychiatric comorbidities. The Korean version of the tridimensional personality questionnaire was then administered to 173 male alcoholic inpatients; and information regarding their criminality, family history of alcoholism, and age at the onset of alcohol-related problems was gathered. We divided the patients into 2 groups based on the age at the onset of alcoholism: (1) early onset (n = 80), when they were up to 25 years old at the onset, and (2) late onset (n = 93), when they were older than 25 years at the onset. RESULTS: Early-onset patients exhibited more criminality (chi2 = 15.45, df = 1, P < .001, odds ratio [OR] = 3.84, 95% confidence interval [CI] = 1.93-7.65), suicide attempts (chi2 = 7.92, df = 1, P = .005, OR [95% CI] = 3.14 [1.38-7.15]), and family history of alcoholism (chi2 = 24.75, df = 1, P < .001, OR [95% CI] = 5.27 [2.67-10.37]). With regard to the tridimensional personality questionnaire profile, the early-onset patients exhibited a higher score of novelty seeking (t = 3.42, P = .001), with the difference still being significant after adjusting for age by analysis of covariance (using age as a covariate) (F = 5.928, P = .016). However, harm avoidance (t = -0.13, P = .89), reward dependence (t = -0.19, P = .85), and persistence (t = -0.62, P = .54) did not differ between the 2 groups. CONCLUSIONS: There were several distinct clinical and temperamental differences between early- and late-onset alcoholism among Korean male alcoholic patients. It is suggested that the age at the onset of alcoholism can be used to discriminate alcoholic subtypes. Our data also partly support Cloninger's typology of 2 types of alcoholic individuals.     

Balance and gait deficits in schizophrenia compounded by the comorbidity of alcoholism

OBJECTIVE: Alcoholism carries a liability of balance and gait instability that persists with sobriety. Such deficits are less well documented in schizophrenia and may be compounded by comorbidity with alcoholism, which is prevalent in schizophrenia. METHOD: The authors administered quantitative ataxia tests to 10 patients comorbid for schizophrenia and alcohol dependence/abuse, 10 nonalcoholic patients with schizophrenia, 24 nonschizophrenic patients with alcohol dependence, and 27 age-matched comparison men. RESULTS: All three patient groups were impaired relative to the comparison subjects. The comorbid group was significantly more impaired than the alcoholic group on most tests and was more impaired than the schizophrenia patients, especially when tested with eyes open. CONCLUSIONS: Rigorous quantitative testing revealed gait and balance deficits in schizophrenia, even without alcohol dependence, and exacerbated deficits in schizophrenia comorbid with alcoholism. The enhancement of postural stability expected with visual information was dampened in comorbid patients, implicating compromised sensorimotor integrative abilities.     

Alcohol and aldehyde dehydrogenase polymorphisms in men with type I and Type II alcoholism

OBJECTIVE: The authors examined the genetic polymorphisms of alcohol dehydrogenase 2 and 3 (ADH2 and ADH3) and aldehyde dehydrogenase (ALDH2) in patients diagnosed as having Cloninger's type I or type II alcoholism. METHOD: Seventy-two alcoholic men and 38 nonalcoholic, healthy men were tested for the distribution of genotypes and alleles of ADH2, ADH3, and ALDH2. Forty-eight of the alcoholic men had type I alcoholism, and 24 had type II alcoholism. RESULTS: The frequencies of ADH2*1 and ADH3*2 alleles were significantly higher in men with type II alcoholism than in men with type I alcoholism and healthy men. The frequency of the ALDH2*1 allele was significantly higher in men with alcohol dependence than in healthy men. CONCLUSIONS: The genetic characteristics of alcohol dehydrogenases in men with type I alcoholism were similar to those of healthy men, and the genetic characteristics of aldehyde dehydrogenase in men with type I alcoholism were similar to those of men with type II alcoholism. These findings suggest that the genetic characteristics of alcohol metabolism in type I alcoholism fall between nonalcoholism and type II alcoholism.     

Comorbidité des troubles anxieux avec l’alcoolisme

Alcohol dependence entrains psychological, physiological and toxic factors. Anxiety, depression and other emotional disorders may be a cause or a consequence of alcohol dependence. Although alcohol is known to have anxiolytic and anti-phobic properties, alcoholic patients have a higher prevalence of developing anxiety disorders. A prevalence of panic disorders is higher in an alcoholic population and similarly alcohol dependence is higher in a population suffering from panic disorders. The association of alcohol dependence with depression in panic disorders increases suicidal risks and ideation. The prevalence of alcohol dependence is also higher in phobias and OCD. Alcohol dependence and anxiety disorders seem to be genetically associated: Anxiety disorders are greater in first degree family members of alcoholic patients. Alcohol dependence can be a cause or a consequence of anxiety disorders; simple, social phobias and agoraphobias usually precede alcoholism, while GAD occurs simultaneously with it. Depending on dose intake alcohol can reduce or increase anxiety by causing a dysfunction of the neurotransmission of GABA, glutamate and noradrenalin receptors. Alcohol intake can have euphoric or depressive effects, depending on dose intake, psychological characteristics and patients’ expectations.     

Hopelessness,impulsiveness and intent among suicide attempters with major depression,alcohol dependence,or both

The present study examined differences in hopelessness, impulsiveness and suicide intent between suicide attempters with either major depression or alcohol dependence, comorbid major depression and alcohol dependence, and those without these disorders. A sample of 114 patients from consecutive cases of attempted suicide referred to a general hospital in Helsinki was interviewed and diagnosed according to DSM-III-R. Suicide intent was measured by the Beck Suicide Intent Scale (SIS) and hopelessness was assessed by the Beck Hopelessness Scale (HS). Impulsiveness of the suicide attempt was measured by two items of the SIS. Suicide attempters with major depression without comorbid alcohol dependence had higher suicide intent and lower impulsiveness than attempters with non-depressive alcohol dependence. Suicide attempts may differ between subjects with major depression, alcoholism or both disorders in terms of impulsiveness and suicide intent.     

Alexithymia in male alcoholics: study in a Turkish sample

The prevalence of alexithymia among male alcoholic cases in a clinical sample from the Turkish population and the relationship between alexithymia and clinical characteristics of alcoholics were studied. Participants were 56 males with alcohol dependence. Alcohol dependence was diagnosed by means of the Structured Clinical Interview for DSM-IV (SCID-I), Turkish version. Alexithymia was screened using the 20-item version of the Toronto Alexithymia Scale (TAS-20). Almost 42% of the patients with alcoholism had a score greater than 60 on the TAS-20, and were therefore considered as alexithymic. The alexithymic patients were found to have a lower level of education and poor economic status. In addition, the severity of alcoholism and duration of alcohol use has been shown to be associated with alexithymia. These results suggest that there was a strong connection between alexithymia and alcoholism. However, the prevalence of alexithymia was not different in Turkish alcoholic men compared with Western alcoholic men.     

Prediction of mortality at age 40 in Danish males at high and low risk for alcoholism

OBJECTIVE: This prospective high-risk study examined the influence of father's alcoholism and other archival-generated measures on premature death. METHOD: Sons of alcoholic fathers (n = 223) and sons of non-alcoholic fathers (n = 106) have been studied from birth to age 40. Archival predictors of premature death included father's alcoholism, childhood developmental data, and diagnostic information obtained from the Psychiatric Register and alcoholism clinics. RESULTS: By age 40, 21 of the 329 subjects had died (6.4%), a rate that is more than two times greater than expected. Sons of alcoholic fathers were not more likely to die by age 40. Premature death was associated with physical immaturity at 1-year of age and psychiatric/alcoholism treatment. No significant interactions were found between risk and archival measures. CONCLUSION: Genetic vulnerability did not independently predict death at age 40. Death was associated with developmental immaturities and treatment for a psychiatric and/or substance abuse problem.     

Management of suicidal behavior in alcoholism

This article will address the problems faced by the clinician in attempting to prevent suicide in alcoholic patients under treatment. It will focus on the clinician's difficult task of assessing suicide potential and initiating interventions to prevent suicide among patients with alcohol dependence. Specifically, the state of the art in identifying, assessing, and treating the suicidal patient with alcohol dependence will be discussed.     

Recent progress in the study of alcoholism

The phenomenon of denial of alcohol dependence prevails not only in a majority of alcoholics, but also in the diagnostic and therapeutic behavior of many physicians. The reasons for this neglect of alcohol abuse are reviewed. In particular, value judgments rather than scientific data seem to lead a number of physicians to share the recent views of the U.S. Supreme Court on primary alcoholism: a "willful misconduct" rather than an illness. This dichotomy between primary and secondary alcoholism, simplistic in itself, is part of current attempts to describe a spectrum of alcoholic disorders, some more social, some more biological. The biological underpinnings of abnormal drinking behaviour include various abnormalities of cerebral neurotransmitters: dopaminergic, serotonergic, GABA and endogenous opiate systems among others. These abnormalities are partly genetically determined, pre-existing to alcohol abuse and explaining why "alcoholism runs in families", and partly secondary to alcohol abuse. Their understanding may open the road to the use of specific pharmacological adjuvants in alcoholism treatment, in conjunction with psychotherapy, rehabilitation and self-help programs.     

Neuroendocrine evaluation of 5-HT1A function in male alcoholic patients

BACKGROUND: Preclinical evidences support the hypothesis of a serotonergic dysfunction in alcohol preference. In human, studies have demonstrated a serotonergic hypoactivity in alcoholism. However, little is known about the role of 5-HT1A receptors. METHODS: We assessed the hormonal (prolactin and cortisol) responses to flesinoxan (a highly potent and selective 5-HT1A agonist) in 12 male inpatients meeting DSM-IV criteria for alcohol dependence, 3 weeks after the last reported use of alcohol and antidepressants. These patients were compared to 10 male controls. RESULTS: There was a highly significant difference between alcoholic patients and controls for the area under the curve relative (AUCr) values of prolactin responses. AUCr values of cortisol responses to flesinoxan showed a trend towards lower values in alcoholics compared to controls. CONCLUSION: These results support the implication of the serotonergic system, and particularly a decreased sensitivity of post-synaptic 5-HT1A receptors, in alcoholism.     

Behavioral symptoms and psychiatric diagnoses among 162 children in nonalcoholic or alcoholic families

OBJECTIVE: People with alcoholic relatives have high rates of alcohol abuse and dependence as adults, but their patterns of problems earlier in life are less clear. Many studies have not controlled for parental disorders other than alcoholism or for parents' socioeconomic status and general life functioning. The authors' goal was to conduct a study controlling for such factors. METHOD: Personal structured interviews and a behavioral checklist were administered to the parents of 162 children 7 years old or older whose fathers had participated in the 15-year follow-up of 453 sons of alcoholics with no history of antisocial personality disorder and sons of nonalcoholic comparison subjects originally selected from a university population. RESULTS: There was no significant relationship between a family history of alcoholism and childhood diagnoses of conduct, oppositional, or attention deficit disorders or with behavioral checklist summary scores. However, children with alcoholic relatives apparently have a slightly higher risk for drug abuse or dependence than those without alcoholic relatives. CONCLUSIONS: Once familial antisocial disorders and familial socioeconomic status are controlled for, a family history of alcoholism does not appear to relate to childhood externalizing disorders.     

RDC alcoholism in patients with major affective syndromes: two-year course

The authors examined the 2-year course of alcoholism as defined by Research Diagnostic Criteria (RDC) in 127 newly admitted patients with major affective syndromes and concurrent alcoholism at intake. The cumulative probability of remission (at least 6 months free of alcohol problems) in these patients was 0.67. Many of the remissions began within a few weeks of intake; the remaining were distributed over the follow-up period. Of the patients without remissions, 17% died, half by suicide. Diagnoses of schizoaffective disorder, indicators of alcohol dependence, and previous chronicity of alcohol problems predicted poor outcome of alcoholism, but none of these variables predicted subsequent relapse.     

Alcoholics in acute medical settings have increased risk for other drug, mood, and personality disorders

OBJECTIVE: Brief medical management and alcohol pharmacotherapy are effective treatments for alcoholic participants enrolled in randomized controlled trials, and this suggests that alcoholism treatment may be delivered successfully in medical settings. However, medical patients may differ from clinical trial participants in ways that suggest a need for more intensive alcoholism treatment. To explore this possibility, this study evaluated the prevalence of mental health disorders in the U.S. population stratified by alcoholism and recent hospitalization or emergency room use. METHODS: Data from the National Epidemiological Survey on Alcohol and Related Conditions were analyzed. Subjects with information on alcohol use disorders, emergency room use, hospitalization, and several mental health diagnoses were included (n = 41,961). Methods appropriate for complex survey data were used to determine the relative risk for mental health diagnoses as a function of a current alcohol use disorder and receipt of acute medical care (hospitalization or emergency room visits) within the past year. RESULTS: Results showed that, relative to alcoholic adults who did not have an emergency room visit or hospitalization, alcoholic adults with use of these services had an increased prevalence of personality disorders, depression, and other drug use disorders. CONCLUSION: Research is needed to evaluate if these and other differences will lead to poorer treatment outcomes for this group relative to the more selected populations included in medical management efficacy trials.