Behavioral Dysfunction and Cognitive Efficiency in Male and Female Alcoholics

This study was conducted to examine the role of childhood behavioral disorders (CBDs) and residual attention deficit disorder (AD-DRT) in alcohol-related cognitive dysfunction in male and female subjects. Alcoholic (n = 44 females, 56 males) and control (n = 40 females, 40 males) subjects completed assessments that included measures of CBDs, ADDRT, and cognitive and psychosocial functioning. Cognitive tests were specifically designed to assess efficiency in function. As expected, alcoholics were inferior to controls in their cognitive efficiency [F(1,171) = 10.43, p = 0.0015]. Alcoholics reported more CBDs [F(1,161) = 12.02, p = 0.0007], regardless of sex. They also reported more ADDRT [F(1,173) = 44.12, p = O.OOOl] than did controls. There were also sex [F(l,173) = 13.31, p = 0.0004] and group by sex effects [F(1,173) = 3.93, p = 0.051. Female alcoholics reported more ADDRT symptoms than any other group. Regression equations conducted to clarify the relation between group, sex, CBDs, ADDRT, and cognitive efficiency indicated that the best predictor of cognitive efficiency was group classification (alcoholic versus control). That is, although symptoms of behavioral disorders were reported significantly more frequently by both male and female alcoholic subjects, these symptoms could not account for the cognitive impairment observed in either sex.     

A Cognitive Typology of Alcoholism: Implications for Treatment Outcome

The present study related patterns of alcohol-related cognitive deficits to the adjustment of the alcoholic at 2-year posttreatment follow-up. Patterns of cognitive control, based on the extent to which the individual utilized information concerning contemplated action (i.e., internal scanning), were studied within a sample of 42 male alcoholics shortly after the beginning of treatment. Adjustment scores at 2-year follow-up were determined by the subject's level of functioning in a variety of life-functioning domains (based on phone interviews with subjects and collateral sources). More effective internal scanning proved to be predictive of better adjustment 2 years following the assessment. In addition, alcoholics less aware of internal cues, defined as narrow internal scanners, more often reported drinking to reduce tension than did broad scanning alcoholics. The narrow internal scanning alcoholics also were slower learners at an electromyographic biofeedback training task than were the broad internal scanning alcoholics. These findings are interpreted in the context of a cognitive typology of alcoholism based on relative skills/ deficits in internal cue processing. Factors relating to differential responsivity to treatment are discussed, and concomitant implications for treatment are noted.     

Sex-role conflicts in alcoholic women

Institutionalized actively alcoholic women (N = 46) were compared to groups of nondrinkers (N = 24), social drinkers (N = 61), and remitted alcoholics (N = 29) (both institutionalized and noninstitutionalized) on scales of sex-role conflict, sex-role ideology, sex-role satisfaction, and depression. When the factors of age, socioeconomic status, and marital status were controlled, alcoholic women scored as more depressed and more sex-role undifferentiated than nonalcoholic women. Alcoholic women were also found to have a relatively traditional sex-role ideology, and remitted alcoholics expressed less satisfaction than other groups with some traditional female roles. Evidence was not found to support the theory that alcoholic women experience a greater degree of sex-role conflict (as measured by the Bem Sex-Role Inventory) than nonalcoholic women.     

Familial transmission of alcoholism among nonalcoholics and mild, severe, and dyssocial subtypes of alcoholism

BACKGROUND: In the field of alcohol studies, there are many typologies attempting to reduce the heterogeneity of expression of this complex disorder to better understand its natural history and etiology. However, few typologies have included empirical assessment of the degree of familial liability. To the extent there is variability in genetic vulnerability to alcoholism, inclusion of measures of this variability in proposed typologies is important to their validity and utility. We test whether the mild, severe, and dyssocial typology distinguished cases of alcohol dependence with high familial liability from those with low familial liability to alcoholism. METHODS: Data came from the National Longitudinal Alcohol Epidemiologic Survey-1992, a household probability sample representative of those 18 years of age and older in the contiguous US Response rate was 92%. Only whites were included here because the typology under study has been successfully applied to this race/ethnic group only. The total number of respondents were 32,447 and included 13,825 men and 18,622 women. Identification of a biological relative as alcoholic was based on the proband's report. All analyses were weighted to adjust for sampling under a multistage stratified design. RESULTS: Familial density of alcoholism (number of alcoholics/number of adult family members) substantially differed by proband alcohol dependence status for both men and women (male probands-nonalcoholics 7%, mild 13%, severe 25%, dyssocial 19%; female probands-nonalcoholics 8%, mild 18%, severe 33%, dyssocial 24%; p <.001). Cross-fostering analysis of the probands with adoptive/stepparents indicated little difference between nonalcoholic and mild alcoholic probands and suggests greater influence of biological parents for severe subtype probands compared to other probands. CONCLUSIONS: These results suggest construct validity for the alcoholism typology as distinguishing subtypes with differing degrees of familial liability to alcoholism. The typology may be useful when employing an extreme comparison strategy in genetic studies of alcohol dependence.     

Family Interactions of Alcoholics as Related to Alcoholism Type and Drinking Condition

BACKGROUND: Several studies have reported that the marital interactions of antisocial and aggressive, versus nonantisocial and nonaggressive, alcoholics exhibit higher rates of aversive-defensive communications and higher levels of negative reciprocity. To extend these findings, we examined the effect of alcoholism type (high- versus low-antisocial alcoholics: HAS, LAS) and drinking condition on family communication patterns. METHODS: Marital and parent-child dyads from 100 alcoholic families were videotaped while they discussed personally relevant issues during drinking and no-drinking sessions (no children were offered any alcohol). All interactions were coded with the Marital Interaction Coding System, and the data were assessed for differences in rate of positive, negative, and problem-solving behaviors, as well as sequential structures. RESULTS: HAS couples were more negative during the drink versus no-drink condition, whereas drinking did not affect negativity for LAS couples. In addition, the negative communications of HAS versus LAS alcoholics were more likely to increase spouse negativity during the drink versus no-drink condition. Group differences for parent-child interactions were few. CONCLUSIONS: The nature of family interactions was related to both alcoholism type and alcohol consumption, and the marital interactions of alcoholism types could be differentiated on the basis of the frequency and sequential structure of negative exchanges. It is most important to note that it is the interactions of the HAS alcoholic that undergo the most change as a function of drinking condition, with little support for the "adaptive consequences" hypothesis that alcohol consumption leads to more effective problem-solving for couples in which the alcoholic exhibits fewer antisocial and more internalizing characteristics. Study limitations and directions for future research are discussed.     

Marital Satisfaction and Personality Traits in Long-Term Marriages: An Exploratory Study

This study explored personality dimensions that contribute to marital satisfaction in older couples in long-term marriages (M = 49.2 years). Each spouse completed the Comprehensive Marital Satisfaction Scale, the Horney-Coolidge Tridimensional Inventory (HCTI), and the NEO-Five Factor Inventory (NEO-FFI). There was a moderate correlation between the marital satisfaction scores for husbands and wives. Husbands' marital satisfaction was significantly higher when their self-reported HCTI Detachment scores were lower and their HCTI Aggression scores were higher. Wives' marital satisfaction was higher when their Detachment scores and their husbands' Detachment scores were lower. On the NEO-FFI, only wives' marital satisfaction was significantly related to the more Extraverted and the less Conscientious the husbands reported themselves to be. Clinical implications and research directions are discussed.     

Feasibility of Using Interactive Voice Response to Monitor Daily Drinking,Moods, and Relationship Processes on a Daily Basis in Alcoholic Couples

Background: Daily process research on alcohol involvement has used paper‐and‐pencil and electronic data collection methods, but no studies have yet tested the feasibility of using Interactive Voice Response (IVR) technology to monitor drinking, affective, and social interactional processes among alcoholic (ALC) couples. This study tested the feasibility of using IVR with n = 54 ALC couples. Methods: Participants were n = 54 couples (probands who met criteria for a past 1‐year alcohol use disorder and their partners) recruited from a substance abuse treatment center and the local community. Probands and their partners reported on their daily drinking, marital interactions, and moods once a day for 14 consecutive days using an IVR system. Probands and partners were on average 43.4 and 43.0 years old, respectively. Results: Participants completed a total of 1,418 out of a possible 1,512 diary days for an overall compliance rate of 93.8%. ALC probands completed an average of 13.3 (1.0) diary reports, and partners completed an average of 13.2 (1.0) diary reports. On average, daily IVR calls lasted 7.8 (3.0) minutes for ALC probands and 7.6 (3.0) minutes for partners. Compliance was significantly lower on weekend days (Fridays and Saturdays) compared to other weekdays for probands and spouses. Although today’s intoxication predicted tomorrow’s noncompliance for probands but not spouses, the strongest predictor of proband’s compliance was their spouse’s compliance. Daily anxiety and marital conflict were associated with daily IVR nonresponse, which triggered automated reminder calls. Conclusions: Findings supported that IVR is a useful method for collecting daily drinking, mood, and relationship process data from alcoholic couples. Probands’ compliance is strongly associated with their partners’ compliance, and automated IVR calls may facilitate compliance on high anxiety, high conflict days.     

Development of an Awareness Context Theory Typology for Addressing Communication Patterns in Mild Dementia

Abstract

A two-step qualitative/quantitative method was used to study the applicability and utility of awareness context theory (ACT) for understanding couples' communication when one member has early-stage dementia. Results indicate that the majority of early-stage demented spouses, primarily male in this study, maintain an idealized perception of communication and marital satisfaction that is often not matched by their partner. Where communication is acknowledged as mutually open, there are accompanying elevations in scores on marital satisfaction and intimacy. Disagreement about communication style is positively related to openness to professional help. Findings support the utility of ACT for understanding couples in early-stage dementia. A 6-category typology of ACT is presented for consideration.     

Differences between alcoholic couples accepting and rejecting an offer of outpatient marital therapy

Following an extensive initial evaluation, 35 couples with alcoholic husbands decided to participate in couples therapy (acceptors) and 28 couples did not (rejectors). A significant discriminant function indicated that acceptors were characterized by husbands with more education, better marital adjustment, full-time employment, and larger number of alcohol-related arrests. Acceptors also had sought more outpatient help in the past year. Rejectors were characterized by wives with better marital adjustment, greater living distance from clinic, and husbands with more alcohol-related hospitalizations. Rejector husbands also tended to be older. Practical implications for recruiting alcoholics and spouses into marital therapy are discussed.     

Asthma Patients and Their Partners: Gender Differences in the Relationship Between Psychological Distress and Patient Functioning

This study investigated gender differences in the association between partners' psychological functioning, and patients' perceptions of health functioning and healthcare utilization. Participants were 50 couples in which one person had mild to moderate asthma. Patients and partners completed several questionnaires. Male patients reported significantly greater psychological distress and utilized fewer physician services than female patients. Furthermore, female patients' perceptions of health functioning and their physician utilization were negatively affected by their partners' psychological distress. The findings suggest a need for an interdisciplinary approach to asthma management and the possible inclusion of partners in treatment, especially for female patients.     

A cognitive typology of alcoholism: implications for treatment outcome

The present study related patterns of alcohol-related cognitive deficits to the adjustment of the alcoholic at 2-year posttreatment follow-up. Patterns of cognitive control, based on the extent to which the individual utilized information concerning contemplated action (i.e., internal scanning), were studied within a sample of 42 male alcoholics shortly after the beginning of treatment. Adjustment scores at 2-year follow-up were determined by the subject's level of functioning in a variety of life-functioning domains (based on phone interviews with subjects and collateral sources). More effective internal scanning proved to be predictive of better adjustment 2 years following the assessment. In addition, alcoholics less aware of internal cues, defined as narrow internal scanners, more often reported drinking to reduce tension than did broad scanning alcoholics. The narrow internal scanning alcoholics also were slower learners at an electromyographic biofeedback training task than were the broad internal scanning alcoholics. These findings are interpreted in the context of a cognitive typology of alcoholism based on relative skills/deficits in internal cue processing. Factors relating to differential responsivity to treatment are discussed, and concomitant implications for treatment are noted.     

Toward a Model for Counseling the Wives of Alcoholics

Earlier literature on the wives of alcoholics confused the causes with the effects of alcoholism. Wives of alcoholics were thought to be highly neurotic contributors to their husbands' illness. Furthermore, sexist biases influenced opinion and research with the result that while wives were blamed for their spouses' illness, husbands of alcoholic wives were considered blameless victims. Despite recent gains in the understanding of alcoholism and its effects on family dynamics, treatment of alcoholic marriages continues to reflect subtle sexist attitudes and values. For example, wives are often viewed as little more than adjuncts to their husbands' treatment. Such approaches undermine reality-centered and effective treatment. A model for counseling wives of alcoholics is proposed which addresses her special and separate concerns.     

The longitudinal association between multiple substance use discrepancies and marital satisfaction

Aims   The objective of this work was to examine the relation between patterns of substance use among newly married couples and marital satisfaction over time. In particular, this work examined if differences between husbands' and wives' heavy alcohol use and cigarette smoking, rather than simply use per se , predicted decreases in marital satisfaction over the first 7 years of marriage.
Methods   Married couples ( n  = 634 couples) were assessed on a variety of substance use and relationship variables at the time of marriage and again at the first, second, fourth and seventh years of marriage.
Results   After controlling for key socio-demographic variables, discrepancies in husband and wife cigarette smoking and heavy alcohol use were related to significant reductions in marital satisfaction. Importantly, couples who were discrepant on both substances experienced the greatest declines in marital satisfaction over time.
Conclusions   Patterns of substance use among newly married couples are important predictors of changes in marital functioning over time. It was not simply the heavy alcohol use or cigarette smoking that predicted dissatisfaction but, rather, differences between husbands' and wives' substance use that impacted the relationship.     

Adult Children of Alcoholics

The purpose of this study was to develop the Mucowski Typology inventory, to test the hypothetical constructs regarding adult children from alcoholic families (ACOAs) prouosed by Claudia Black. This was done in order to discriminate them from others who were not raised in families in which there was alcoholism present. The subjects used in this study included entering freshmen college students and volunteer ACOAs identified through the ACOA Networker. Data from the subjects' responses to the Mucowski Typology Inventory were factor analyzed to establish the structure of the instrument. Results showed that three of Black's hypothesized typologies emerged along with other factors which Wegscheider hypothesized in her typology. Additional factors, the Obstinate Naysayer, Avoider and Stabilizer, also appeared; the current researchers attempted to identify these additional types based upon role characteristics that emerged from the study.     

A Comparison of the Home and Social Environments of Children of Alcoholic and Non-alcoholic Parents

The home environments of 32 children of alcoholic parents and 22 children with neither parent alcoholic are compared. The home environments of the children of alcoholics show diminished global functioning. In particular they are characterized by marital conflict, parent-child conflict, poor adaptive functioning on the part of the parents and in some cases by physical abuse. Out of the 32 children with alcoholic parents, a majority of the children received 1 or more DSM-III diagnoses. A comparison of the home environments of the children of alcoholics with and without psychiatric diagnoses shows that the homes of the ‘disturbed’ children are characterized by a greater exposure to the effects of parental drinking, more parent-child conflict and less parent-child interaction than the homes of children who received no diagnoses.     

Marital Interactions and the Duration of Alcoholic Husbands′ Sobriety

Recent studies of the family interactions of alcoholics have suggested that the alcoholic's general drinking adjustment may influence marital interactions. The present investigation examined the marital interactions of 30 male alcoholics who had maintained continuous sobriety for various lengths of time ranging from a few days to over 7 years. It was predicted that longer periods of sobriety would be associated with less conflict and fewer struggles for control between husbands and wives. The findings supported the hypothesis, in that the duration of the husbands′ sobriety was significantly negatively correlated with the number of statements of disagreement emitted by husbands and wives. Also, there were trends for duration of sobriety to be negatively associated with the frequencies of question-asking and aggressive behaviors by husbands, and positively associated with the amount of talk time by husbands. Contrasts of 11 high sobriety couples (duration of sobriety: 2 years or longer) and 11 low sobriety couples (duration of sobriety: less than 4 months) revealed that high sobriety husbands asked fewer questions, stated fewer disagreements, and emitted fewer aggressive behaviors than husbands in the low sobriety group. In addition, high sobriety husbands displayed a trend toward more active talk time, and their wives showed a trend toward asking fewer questions than their low sobriety counterparts. The results suggest that marital functioning is superior in couples with longer periods of sobriety. The need for examining possible causal links in this relationship is emphasized.     

A Longitudinal Study of Incarceration and HIV Risk Among Methadone Maintained Men and Their Primary Female Partners

This study examines the longitudinal relationship between personal and sexual partner incarceration and subsequent HIV risk behaviors among drug-involved men and their primary female sexual partners. A random sample of 356 men in methadone treatment in New York City were interviewed at baseline, 6 and 12 months; these men also reported information on their primary female sexual partners. Female partner recent incarceration was associated with subsequent increase in multiple partnerships for the male participants (AOR: 3.31; 95% C.I.: 1.26–8.72, P < .05). Female partner incarceration was also associated with reduced likelihood of subsequent unprotected sex between primary partners (AOR: .13; 95% C.I.: .05–.40, P < .01); this finding is somewhat unique and warrants further investigation. Findings support the notion of mutual influence in the case of female partner incarceration, which is associated with both female partner and male partner risk behaviors. HIV prevention implications are discussed, including the need for couple-based HIV prevention interventions targeting couples affected by incarceration.     

Gender Differences in Comorbidly Depressed Alcohol-Dependent Outpatients

Clinical profiles of alcohol-dependent male and female outpatients were evaluated at treatment entry to compare the level of clinical severity in alcoholics with a coexistent comorbid depressive disorder to alcoholics who have never been depressed. Due to a higher proportion of females than males in the depressed alcoholic population, selected patient groups were oversampled to create a study group with equivalent number of males and females with and without comorbid depression. Clinical severity was assessed by examining both the extent of alcohol problems, and depressive symptomatology at treatment entry with respect to gender differences (unrelated to depression), effects of comorbid depression (unrelated to gender), and effects from the interaction of gender and depression. There were 93 DSM-III-R alcohol-dependent outpatients (SO males, 43 females), half of whom had a current or lifetime DSM-III-R depressive disorder. The amount of drinking in the 90 days before treatment entry, the degree of alcohol severity, and the number of lifetime drinking-related consequences were collected in the first week after detoxification. Diagnoses of lifetime and current depression were determined via the Structured Clinical Interview for DSM-III-R, and depressive symptoms were evaluated with rating scales 1 week after detoxification. In most cases, a depressive disorder was diagnosed only if sometime in the patient's history depressive symptoms had either predated problem drinking or been present during a 6-month abstinent period. Results: depressed males had a more severe clinical profile with respect to their alcoholism (i.e., more drinking, drinking-related problems, and alcohol severity than depressed females and never-depressed males). Surprisingly, females who had never been depressed (also no family history of depression) reported drinking the same quantities of alcohol in the 90 days before treatment and had comparable alcohol severity and number of consequences as males who had never been depressed. Depressed females, however, were more severely depressed (i.e., reported more intensive depressive symptoms than depressed male alcoholics). Thus, determining the type and extent of clinical severity at treatment entry in comorbidly depressed alcoholics depends on the gender of the patient. The significant interaction between gender and the presence of comorbid depression that was found in this study may have important implications for predicting success in treatment.     

Effects of Alcoholism Typology on Response to Naltrexone in the COMBINE Study

Background:  This study investigated whether subgroups of alcohol-dependent patients responded differently to naltrexone versus placebo in the NIAAA COMBINE study. In particular, the A versus B and the Early Onset versus Late Onset typologies were examined. Relative to Type A alcoholics, Type B alcoholics are characterized by greater severity, earlier onset, stronger family history, more childhood risk factors (e.g., conduct disorder), and greater frequency of comorbid psychiatric and substance use disorders.
Methods:  COMBINE study participants were categorized as Type A or Type B using k-means cluster analysis and variables from 5 domains that have been shown to replicate the original Babor typology efficiently. Early Onset was defined as alcohol dependence beginning before age 25. For the planned analyses, the sample was reduced to the 618 participants receiving naltrexone alone or placebo, either with medical management (MM) alone or with MM plus the Combined Behavioral Intervention (CBI). The a priori primary outcome was percent heavy drinking days during treatment in the groups receiving MM without CBI.
Results:  Among those receiving MM without CBI, Type A alcoholics had better drinking outcomes with naltrexone than placebo, whereas medication condition did not influence outcomes significantly in the Type Bs. Age of onset was not significantly related to outcome. For those receiving CBI, no significant effects were found for either typology.
Conclusions:  In this sample, the beneficial effects of opioid antagonism were limited to Type A alcoholics receiving treatment in a MM model. Future studies should investigate the relationship between clinically relevant genotypes, phenotypes such as typologies, and treatment response. More work is also needed to develop practical algorithms for phenotypic assignment.