Clinical and biochemical heterogeneity of alcoholism: the role of family history and alexithymia

Of 100 male patients with alcohol dependence, clinical and biochemical data were analysed in relation to family history of alcoholism and alexithymic personality traits. Family history was found in 38 patients and alexithymic personality traits in 79. No relationship was established between these two factors. In patients with a family history alcoholism began at a younger age with more severe clinical symptoms than in the remaining subjects. Patients with alexithymia had lower intensity of psychopathology but higher frequency of concomitant hypertension. Patients with family history had higher leukocyte counts and lower alcohol-induced elevations of liver enzymes and plasma lipids. In patients with alexithymia, higher values of hemoglobin and hematocrit were found. The results suggest that two predisposing factors to alcohol dependence such as family history of alcoholism and alexithymic personality determine the different clinical and biochemical features of the disease.     

Interaction of life quality with alexithymia,temperament and character in male alcohol‐dependent inpatients

Introduction and Aims. The aim of this study was to investigate the relationship of life quality with alexithymia, temperament and character dimensions of personality. Design and Methods. Participants were 156 consecutively admitted male alcohol dependents. Patients were investigated with the Toronto Alexithymia Scale, the Temperament and Character Inventory, the Michigan Alcoholism Screening Test and the Medical Outcomes Study Short Form 36‐item health survey. Results. Among alcohol‐dependent inpatients 30.1% were considered as alexithymic. Severity of alcohol related problems was higher in alexithymic group, whereas quality of life (QoL) was lower. Alexithymia, novelty seeking (NS) and harm avoidance (HA) were negatively, reward dependence, self‐directedness and cooperativeness were positively correlated with QoL scores. ‘Difficulty in identifying feelings’ (DIF) factor of alexithymia and HA were the determinants of physical dimension of Life Quality in Linear Regression model, whereas DIF, HA and NS were the predictors of mental dimension score. Discussion and Conclusions. Among alcohol‐dependent men, DIF factor of alexithymia and personality dimensions, particularly HA and NS are associated with impairment of QoL. Direction of this relationship and factors that may mediate this relationship is unclear. [Evren C, Dalbudak E, Durkaya M, Cetin R, Evren B. Interaction of life quality with alexithymia, temperament and character in male alcohol‐dependent inpatients. Drug Alcohol Rev 2009]     

The Dysfunction of Emotional Expression as a Related Factor for Alcohol Misuse in Young Adolescents

Amidst the research on the psycho-behavioral factors correlating with alcohol abuse, numerous studies have identified psychopathological disorders and alexithymic traits in adult alcohol abusers, but this relationship has yet to be studied in adolescents. To a sample of 1,466 students (mean age of 13.5 years) were administered three questionnaires to assess their alcohol consumption, any alexithymic traits, and any psycho-behavioral problems. There was an association between alcohol consumption and psycho-behavioral problems in the sample as a whole, but a statistically significant relationship between alcohol consumption and alexithymia only in the subsample of students attending middle school (sixth to eighth graders). Among these younger adolescents (11 to 13 years old), those with a higher score for alexithymia and psycho-behavioral problems had a significantly greater alcohol consumption than their peers without these psychological traits. Alexithymic traits, especially when associated with psycho-behavioral problems, constitute a risk factor for alcohol consumption in preadolescence.     

The Impact of Alexithymia on Desire for Alcohol during a Social Stress Test

Background: Alexithymia is a personality construct comprising difficulty in identifying and describing emotions and externally oriented thinking. Its role in heavy and problematic alcohol consumption is well documented, together with its relationship with social stress. However, little research has examined whether social stress has any effect on desire for alcohol among alexithymic individuals. Objectives: In this experimental study, we explored the relationship between alexithymia and desire for alcohol in response to an experimental social stressor. Methods: One hundred and thirty eight social drinkers completed the Toronto Alexithymia Scale, self-report measures of alcohol consumption and a stress-inducing task. Desire for alcohol was measured at three time points: baseline, stressor and recovery. Results: Correlation analysis demonstrated that alexithymia was associated with significantly higher rates of alcohol consumption and higher levels of desire for alcohol. Mixed measures ANOVA demonstrated a significant main effect of alexithymia and a significant group by time effect of alexithymia on desire for alcohol. Conclusions/Importance: The findings demonstrate increased desire for alcohol before, during and after a social stressor among alexithymic participants. These findings offer an insight into the relationship between alexithymia, social stress and alcohol consumption.     

Avoidance coping strategies, alexithymia and alcohol abuse: a mediation analysis

Alexithymia and avoidance coping strategies are both associated with alcohol abuse, but their effects have been seldom studied simultaneously. The present study investigated the interplay between alexithymia and avoidance coping strategies in predicting the severity of alcohol abuse in an alcohol-dependent sample. The TAS-20 and COPE-NVI questionnaires were administered to 110 alcoholic inpatients enrolled into a recovery program at the Center for Alcohol Abuse of the Department of Clinical Medicine, Sapienza University of Rome, Italy. The alcohol abuse index consisted of the mean alcohol units consumed by participants and days of abstinence before being enrolled into the recovery program. Results showed that alexithymic alcoholics consumed significantly more alcohol and were less abstinent than non-alexithymic alcoholics. Concerning the relationship among alexithymia, coping strategies and alcohol abuse, data showed that alexithymia completely mediated the effects of avoidance coping strategies on alcohol abuse, suggesting that avoidance strategies have therefore an indirect effect on alcohol abuse among alcoholics. Theoretical and clinical implications of the results are discussed.     

Caffeine Use and Alexithymia in University Students

Alexithymia refers to difficulties with identifying, describing, and regulating one’s own emotions. This trait dimension has been linked to risky or harmful use of alcohol and illicit drugs; however, the most widely used psychoactive drug in the world, caffeine, has not been examined previously in relation to alexithymia. The present study assessed 106 male and female university students aged 18-30 years on their caffeine use in relation to several traits, including alexithymia. The 18 participants defined as alexithymic based on their Toronto Alexithymia Scale (TAS-20) scores reported consuming nearly twice as much caffeine per day as did non-alexithymic or borderline alexithymic participants. They also scored significantly higher than controls on indices of frontal lobe dysfunction as well as anxiety symptoms and sensitivity to punishment. In a hierarchical linear regression model, sensitivity to punishment negatively predicted daily caffeine intake, suggesting caffeine avoidance by trait-anxious individuals. Surprisingly, however, TAS-20 alexithymia scores positively predicted caffeine consumption. Possible reasons for the positive relationship between caffeine use and alexithymia are discussed, concluding that this outcome is tentatively consistent with the hypo-arousal model of alexithymia.     

The relationship of alexithymia to emotional dysregulation within an alcohol dependent treatment sample

Difficulties regulating emotions have implications for the development, maintenance, and recovery from alcohol problems. One construct thought to impede the regulation of emotion is alexithymia. Alexithymia is characterized by difficulties identifying, differentiating and expressing feelings, a limited imagination and fantasy life, and an externally-oriented thinking style (e.g., prefer talking about daily activities rather than feelings). Given that poor emotion regulation skills have been found to predict posttreatment levels of alcohol use, and that several defining characteristics of alexithymia bear similarity to deficits in emotion regulation skills, it is possible that alexithymia may predict poorer alcohol treatment outcomes. Thus, the present study first examined the relationship of alexithymia to several other emotion regulation measures and then investigated the impact of alexithymia on attrition and alcohol treatment outcomes in men and women (N=77) enrolled in a 12-week cognitive-behavioral intervention for alcohol dependence. At baseline, higher scores on alexithymia were associated poorer emotion regulation skills, fewer percent days abstinent, greater alcohol dependence severity, and several high-risk drinking situations. Alexithymia was unrelated to attrition and to level of alcohol consumption at posttreatment. Overall, the construct of alexithymia is shown to be related to several theoretically-related constructs (e.g., emotion regulation, mindfulness) but demonstrated a limited relationship to drinking outcomes in those seeking treatment for alcohol dependence.     

Attachment security and alexithymia in a heavy drinking sample

Attachment difficulties have been proposed as a key risk factor for the development of alexithymia, a multifaceted personality trait characterised by difficulties identifying and describing feelings, a lack of imagination and an externally oriented thinking style. This study investigated the relationship between attachment and alexithymia in an alcohol-dependent population. Participants were 210 outpatients in a Cognitive Behavioural Treatment programme assessed on the Toronto Alexithymia Scale and the Revised Adult Attachment Scale. Significant relationships between anxious attachment and alexithymia factors were confirmed. Furthermore, alexithymic alcoholics reported significantly higher levels of anxious attachment and significantly lower levels of closeness (secure attachment) compared to non-alexithymic alcoholics. These findings highlight the importance of assessing and targeting anxious attachment among alexithymic alcoholics in order to improve alcohol treatment outcomes.     

Alexithymia and alcohol use disorders: A critical review

All human beings experience emotion. However a number of individuals have difficulties recognising, processing and regulating their emotions. This set of emotional “deficits’ is classified as alexithymia. The prevalence rate of alexithymia in alcohol use disorders is between 45 and 67%. The objective of this paper is to review the published research on alexithymia and alcohol use, assess the methodological quality of this evidence, and draw the findings together to present a critical update on the relationship between alexithymia and alcohol use disorders. Yet, few research studies have comprehensively investigated alexithymia in alcohol use disorders, and a number of key issues still remain to be addressed in exploring the veracity of the link between alexithymia and alcohol use. For example, limited evidence exists regarding the association between alexithymia, alcohol consumption and severity of alcohol dependence. Furthermore, there is no current knowledge about the predictive utility of alexithymia in relation to more well researched and established psychological drinking constructs. Although alexithymia is often considered a risk factor for the development of alcohol use disorders, there is little evidence to support this notion. Given that alexithymia may have the potential to interfere with treatment outcomes, a better understanding of the role of alexithymia in alcohol use is needed.     

Substance abusers report being more alexithymic than others but do not show emotional processing deficits on a performance measure of alexithymia

Substance abusers report that they have deficits in emotional processing (“alexithymia”; Taylor et al. ), but is their actual emotional processing performance actually deficient? The prevalence of self-reported alexithymia in a group of newly abstinent substance abusers (N = 40) was 50%, which is considerably higher than that found in normal and psychiatric outpatient samples. However, the actual performance of this group on a task that required them to identify and describe feelings was not significantly different from either a group of university students (after controlling for IQ, age, and gender) or a normal group of adults. In addition, there was no relationship between self-reported and actual emotional processing performance, which is contrary to what has been found in a normal sample. Substance abusers believe they are more alexithymic than others, but do not perform as if they are so.     

Alexithymia, craving and attachment in a heavy drinking population

Up to fifty per cent of individuals with Alcohol use disorders (AUD) also have alexithymia a personality construct hypothesized to be related to attachment difficulties. The relationship between alexithymia, craving, anxious attachment and alcohol-dependence severity was examined in 254 patients participating in a Cognitive-Behavioral Therapy (CBT) program for alcohol-dependence. Participants completed the Toronto Alexithymia Scale (TAS-20), the Obsessive Compulsive Drinking Scale (OCDS), the Revised Adult Attachment Anxiety Subscale (RAAS-Anxiety) and the Alcohol Use Disorder Identification Test (AUDIT). MANOVA indicated that individuals with alexithymia reported significantly higher levels of total OCDS, obsessive thoughts about alcohol, and compulsive drinking urges and behavior, compared to the non-alexithymic group. Regression analyses found that anxious attachment partially mediated the relationship between alexithymia and craving. Anxious attachment may be a potential treatment target to reduce alcohol consumption in those with alcohol-dependence and alexithymia.     

Clinical characteristics and family histories of alcoholics with stimulant dependence

OBJECTIVE: While much is known about the clinical patterns and family histories of individuals with alcoholism or stimulant (cocaine and amphetamine) dependence, there are few data that describe men and women with concomitant alcohol and stimulant dependence. METHOD: As part of the Collaborative Study on the Genetics of Alcoholism, structured interviews were administered to 3,882 (2,432 male) DSM-III-R defined alcohol and/or stimulant dependent subjects. The characteristics and family histories of four groups were compared: Group 1 (26%), with the onset of alcohol before stimulant dependence; Group 2 (10%), with alcohol dependence simultaneously with or after stimulant dependence; Group 3 (58%), with alcohol dependence only; Group 4 (6%), with stimulant dependence only. RESULTS: Individuals with concomitant alcohol and stimulant dependence (Groups 1 and 2) reported more general life problems (e.g., marital instability), a higher rate of antisocial personality disorder and more substance-induced mood disorders, additional drug dependencies and substance-related difficulties than those with dependence on one substance only. People with alcohol dependence before stimulant dependence had the most severe clinical patterns. In addition, alcohol dependence and stimulant dependence were found to breed true in families of subjects with these concomitant disorders. The major findings were confirmed with logistic regression analyses, and were independent of ASPD and gender. CONCLUSIONS: It is important for clinicians to be aware of the severe clinical characteristics of patients with concomitant alcohol and stimulant dependence. In addition, the data consistent with drug-specific heritability in this heterogeneous population may be useful to researchers.     

Dependence symptoms but no diagnosis: diagnostic 'orphans' in a 1992 national sample

The alcohol dependence syndrome was initially presented as a condition with graded severity. However, to receive a diagnosis that is categorical, a diagnostic threshold must be determined. Much previous research on this issue has focused on setting a threshold that will produce the highest possible consistency in rates between one set of diagnostic criteria and the next. It is possible that a different threshold may be more valid. Results from a community sample supported a minimum diagnostic threshold of three or more dependence symptoms but the sample was not nationally representative. Therefore, we investigated the meaning of the 'orphan' status (one or two dependence symptoms but no DSM-IV alcohol dependence diagnosis) in a large national sample. Two sets of analyses were performed, the first using a current timeframe and the second using a lifetime timeframe. Abstainers were excluded from all analyses. In each set of analyses, three groups were compared: subjects with no symptoms of any alcohol use disorder; diagnostic 'orphans' with one or two symptoms of dependence; and subjects who met full criteria for DSM-IV alcohol dependence. Several variables significantly differentiated the three groups, including heavy drinking and family history of alcoholism. Group differences were reduced among 'orphans' and subjects with no symptoms who had at least one occasion of drinking five or more drinks in the year prior to the interview. The results provide support for the decision to require a minimum of three symptoms to make a diagnosis of alcohol dependence, for scientific as well as pragmatic reasons.     

Traumatic experiences,alexithymia, and Internet addiction symptoms among late adolescents: A moderated mediation analysis

The association between traumatic experiences, alexithymia, and substance abuse is well established. Less is known about the role of traumatic experiences and alexithymia in the onset and maintenance of Internet-related disorders. In the present study, self-report measures on traumatic experiences, alexithymia, and problematic Internet use were administered to 358 high school students (57% females) aged 18–19 years old, to test whether alexithymic traits mediated the relationship between traumatic experiences and Internet addiction symptoms, and whether gender moderated the proposed mediation in the sample. While partial mediation occurred in the entire sample, gender directly affected the relationship between the investigated constructs: Internet addiction symptoms were independently related to traumatic experiences among males, and to alexithymic traits among females. Therefore, the results of this study suggest that trauma memories among males, and problems with affect regulation among females, may increase the risk of problematic Internet use during late adolescence. Such findings might have relevant implications to inform any treatment plan for late adolescent students who are overinvolved with online activities, pointing out that tailored approaches to their problems and difficulties are particularly needed in clinical practice.     

Patient characteristics and treatment implications of marijuana abuse among bipolar alcoholics: results from a double blind, placebo-controlled study

OBJECTIVE: Marijuana abuse, primarily a disorder of adolescents and young adults, is highly prevalent among patients with severely ill psychiatric population, especially those with bipolar disorder. Additional marijuana abuse may impact on the clinical presentation of bipolar illness and may potentially act as mediator of treatment response in this population. However, the characterization of bipolar disorder patients with additional marijuana abuse and the impact of such abuse on treatment outcome has been rarely examined. The aim of this study was to characterize bipolar alcoholic patients with comorbid marijuana abuse and test the impact of marijuana abuse on alcohol and mood outcome of patients with bipolar disorder and comorbid alcohol dependence. METHOD: We conducted secondary analyses of a randomized, double blind, placebo-controlled trial testing valproate in 52 bipolar alcoholics. Subjects had a comprehensive assessment at baseline using structured diagnostic assessments, and they were then assessed every 2 weeks for 24 weeks. RESULTS: Twenty-five subjects (48%) reported marijuana abuse. Those with co-occurring marijuana abuse were younger, had fewer years of education, and had significantly higher number of additional psychiatric comorbidity. They also had more severe alcohol and other drug use and were significantly more likely to present in the manic phase. The mixed model indicated that the placebo-treated marijuana abuse group had the worst alcohol use outcome. CONCLUSIONS: Marijuana abuse among patients with bipolar disorder and alcohol dependence is associated with higher degree of severity of alcohol and other drugs of abuse and may negatively impact on alcohol treatment outcome.     

Alexithymia in relation to parental alcoholism, everyday frontal lobe functioning and alcohol consumption in a non-clinical sample

Background

Recent studies have indicated that 45-67% of those in treatment for alcohol use disorders suffer from alexithymia, a multifaceted personality trait characterized by difficulties identifying and describing emotions and an externally oriented cognitive style. The high reported prevalence rates of alexithymia among those with alcohol dependence led to speculation that alexithymia is a personality dimension that may predispose to risky or problematic alcohol use.

Methods

This notion was examined in 314 adult volunteers (54% female) aged 18-45 years (M = 27.6 years), all of whom reported at least occasional alcohol consumption, who completed online surveys assessing alexithymia (Toronto Alexithymia Scale, or TAS-20), parental alcoholism (Children of Alcoholics Screening Test, or CAST), everyday signs of frontal lobe dysfunction (Frontal Systems Behavior Scale, or FrSBe) and risky alcohol use (Alcohol Use Disorders Identification Test, or AUDIT).

Results

TAS-20 scores were positively correlated with the index of parental alcoholism CAST, index of frontal lobe dysfunction FrSBe and measure of alcohol-related problems AUDIT. Chi-square test showed an association between TAS-20-defined alexithymia and being the offspring of an alcoholic parent as defined by CAST. Regression analysis showed that frontal lobe dysfunction (FrSBe) mediated the relationship between alexithymia (TAS-20 total score) and risky alcohol use (AUDIT).

Conclusions

The findings suggest that alexithymia is related to deficiencies in frontal lobe functioning that may reflect a heritable predisposition to alcohol problems.     

A double-blind,placebo-controlled trial of topiramate for the treatment of comorbid cocaine and alcohol dependence

Background

Topiramate increases GABAergic activity and antagonizes the AMPA/kainate subtype of glutamate receptors. Through these mechanisms of action, topiramate may reduce alcohol and cocaine reward and may reduce alcohol and cocaine craving. Topiramate has been shown to reduce drinking in persons with alcohol dependence, and reduce relapse in stimulant-dependent patients. The current trial was intended to test the ability of topiramate to promote cocaine and alcohol abstinence among patients addicted to both drugs.

Methods

The study was a double-blind, placebo-controlled, 13-week trial involving 170 cocaine and alcohol dependent subjects. After achieving a period of cocaine and alcohol abstinence, subjects were randomized to topiramate, 300 mg daily, or identical placebo capsules. In addition, subjects received weekly individual psychotherapy. Primary outcome measures included self-reported alcohol and cocaine use, and thrice weekly urine drug screens. Secondary outcome measures included cocaine and alcohol craving, Addiction Severity Index results, cocaine withdrawal symptoms, and clinical global improvement ratings.

Results

Topiramate was not better than placebo in reducing cocaine use on the a priori primary outcome measure, or in reducing alcohol use. Topiramate was not better than placebo in reducing cocaine craving. Topiramate-treated subjects, compared to placebo-treated subjects, were more likely to be retained in treatment and more likely to be abstinent from cocaine during the last three weeks of the trial. Subjects who entered treatment with more severe cocaine withdrawal symptoms responded better to topiramate.

Discussion

Topiramate plus cognitive behavioral therapy may reduce cocaine use for some patients with comorbid cocaine and alcohol dependence.     

Positron emission tomography study of regional brain metabolic responses to a serotonergic challenge in major depressive disorder with and without comorbid lifetime alcohol dependence.

This is the first study contrasting regional glucose metabolic rate (rCMRglu) responses to a serotonergic challenge in major depressive disorder (MDD) with and without comorbid alcohol dependence. In a university hospital, patients with MDD without a history of alcohol dependence (MDD only) and patients with MDD and comorbid alcohol dependence (MDD/ALC) were enrolled in this study. Subjects with comorbid borderline personality disorder were excluded. A bolus injection of approximately 5 mCi of (18)fluorodeoxyglucose was administered 3 h after the administration of placebo or fenfluramine. We found an anterior medial prefrontal cortical area where MDD/ALC subjects had more severe hypofrontality than MDD only patients. This area encompassed the left medial frontal and left and right anterior cingulate gyri. This group difference disappeared after fenfluramine administration. The fact that the observed group difference disappeared after the fenfluramine challenge suggests that serotonergic mechanisms play a role in the observed differences between the groups.     

Substance use disorders and the risk of HIV infection in gay men

OBJECTIVE: Previous studies have suggested that high rates of recent alcohol or drug use are associated with increased risk for HIV infection in gay men. To examine whether this relationship is mediated by substance use per se or by more enduring patterns of problematic substance use, lifetime DSM-III-R alcohol and other drug dependence disorders were ascertained and used to predict self-reported serostatus. METHOD: Gay men (N = 187) who had been tested for HIV and knew their serostatus (31 are HIV+) completed demographic, drug use and sexual practices questionnaires. Formal DSM-III-R psychiatric diagnoses were made on the basis of an individual interview, using the Structured Clinical Interview for DSM-III-R. RESULTS: Subjects had lifetime rates of alcohol dependence and drug dependence disorders that were two to three times higher than the general population, and 58% of the subjects who met criteria for alcohol dependence also met criteria for other substance dependence. Logistic regression analysis indicated that serostatus was best predicted by presence of both alcohol and drug dependence, and by race. When analyses were repeated in seronegative men, using unprotected anal sex as the outcome and recent substance use as predictors, no relationship between alcohol and behavior was found. CONCLUSIONS: Data do not support the view that alcohol use alone increases the risk of HIV infection in gay men. Finding that risk for HIV is highest in men with histories of both alcohol and drug problems suggests that the link between HIV infection and substance use may be mediated by "third variables" that may include personality characteristics and situational factors.