Neuropsychological executive functioning in children at elevated risk for alcoholism: findings in early adolescence

One component of individual risk for alcoholism may involve cognitive vulnerabilities prodromal to alcoholism onset. This prospective study of 198 boys followed between 3 and 14 years of age evaluated neurocognitive functioning across three groups who varied in familial risk for future alcoholism. Measures of intelligence, reward-response, and a battery of neuropsychological executive and cognitive inhibitory measures were used. Executive functioning weaknesses were greater in families with alcoholism but no antisocial comorbidity. IQ and reward-response weaknesses were associated with familial antisocial alcoholism. Executive function effects were clearest for response inhibition, response speed, and symbol-digit modalities. Results suggest that executive deficits are not part of the highest risk, antisocial pathway to alcoholism but that some executive function weaknesses may contribute to a secondary risk pathway.     

A multiple regression analysis of family factors affecting the potential for alcoholism in college students

This study explored the effects of the family system on the potential for alcoholism in college students. Analysis of the data indicated that students' gender, race, and how often they consumed alcohol were unrelated to the potential for alcoholism. However, perceived conflict in the students' family of origin appeared to increase the potential for alcoholism. This finding is consistent with family systems theory, used by many human service professionals as a basis for assessing and treating chemical dependency.     

A longitudinal study of children of alcoholics: predicting young adult substance use disorders, anxiety, and depression

This study tested the specificity of parent alcoholism effects on young adult alcohol and drug abuse/dependence, anxiety, and depression, and tested whether adolescent symptomatology and substance use mediated parent alcoholism effects. Participants were from a longitudinal study in which a target child was assessed in adolescence and young adulthood with structured interview measures (N = 454 families at Time 1). Results showed unique effects of parent alcoholism on young adult substance abuse/dependence diagnoses over and above the effects of other parental psychopathology. There was some evidence of parent alcoholism effects on young adult depression and of maternal alcoholism effects on young adult anxiety, although these were not found consistently across subsamples. Mediational models suggested that parent alcoholism effects could be partially (but not totally) explained by adolescent externalizing symptoms.     

The Behavioral Genetics of Alcoholism

Twin and adoption studies consistently implicate the importance of genetic influences on alcoholism risk, especially in men. Heritability estimates suggest that approximately 50% to 60% of the variability in alcoholism liability is associated with genetic factors. Although there has been progress in identifying specific genes that predispose toward alcoholism, we know relatively little about the nature of the genetic influence on alcoholism risk. We also know relatively little about how genetic factors combine with environmental factors to affect alcoholism risk. Genotype-environment interaction models posit that alcoholism occurs when individuals both inherit a vulnerability to develop alcoholism and are reared in a provocative environment. Such models hold great promise for understanding alcoholism's etiology.     

Couples at risk for transmission of alcoholism: protective influences

A two-generation, sociocultural model of the transmission of alcoholism in families was operationalized and tested. Sixty-eight married children of alcoholic parents and their spouses were interviewed regarding dinner-time and holiday ritual practices in their families of origin, and heritage and ritual practices in the couples' current generation. Coders rated transcribed interviews along 14 theory-derived predictor variables, nine for the family of origin and five for the current nuclear family. Multiple regression analysis was applied in a two-step hierarchical method, with the dependent variable being transmission of alcoholism to the couple. The 14 predictor variables contributed significantly (p less than .01) to the couple's alcoholism outcome. A general theme of selective disengagement and reengagement for couples in families at risk for alcoholism recurrence is discussed.     

Effects of alcohol abuse and familial alcoholism on physical health in men and women

Detoxified alcoholic men (n = 76) and women (n = 72) and nonalcoholic control men (n = 50) and women (n = 51) were given a structured interview that assessed five categories of physical health: medical history, alcohol-related disorders, trauma history, drug use history, and, for females, female-related disorders. Approximately half the subjects in each group were family history positive for alcoholism. Significant differences between alcoholics and controls were found for all five categories; family history effects were significant for four of the five categories, and sex differences were present in two categories. The results indicate that (a) alcoholics suffer pervasive physical health difficulties, (b) a family history of alcoholism is predictive of health problems in both alcoholics and controls, (c) the effects of alcohol abuse and family history of alcoholism on health appear to be independent and additive, and (d) women may be more "illness prone" than men and exhibit an increased vulnerability to the adverse effects of alcoholism.     

Differences between employed and unemployed alcoholic inpatients in trouble for drinking and denial

The Trouble-Due-to-Drinking scale and the Denial scale of the MMPI were administered to two groups of inpatients of low socioeconomic status, an employed group (27 men, 3 women) and an unemployed one (44 men, 12 women), at a state alcoholism facility in an inner city catchment area. The former were significantly older than the latter; Ms = 40.4 and 35.5 yr., respectively. The Trouble scale correctly identified 98% of the unemployed group but only 83% of the employed group. The unemployed scored significantly higher on MMPI Denial and significantly lower on the Trouble scale than the unemployed. The Pearson r between scores on the two measures was negative and significant for the combined sample and for the unemployed as well, whereas r for the unemployed was negative but nonsignificant. It was concluded that the unemployed group was less given to the use of denial and had encountered more alcohol-related problems than the employed group.     

Alcoholism,Aging, and Cognition: A Review of Evidence for Shared or Independent Impairments

Little is known about the combined effects of aging and alcoholism on cognitive function, in spite of the potential importance of this knowledge. Studies reported to date have focused on whether aging and alcoholism have shared mechanisms (i.e., the premature aging hypothesis) or independent mechanisms. Most have concluded that the effects of aging and alcoholism on cognition operate through independent mechanisms. However, there are reasons to doubt this conclusion. Many of the studies were not optimally designed to discover shared mechanisms because they used a limited range of ages, included several different groups in their analyses, or had low statistical power. Furthermore, interpretation of the patterns of main effects and interactions between aging and alcoholism is not straightforward. Assumptions must be made about the nature of the impairments in order to interpret the data. This review uses several theories of cognitive aging as an organizing heuristic for interpreting the extant data on aging, cognition, and alcoholism. Some potential shared mechanisms for cognitive deficits in aging and alcoholism are identified, such as information processing speed and proactive interference in working memory. In contrast, some potential independent mechanisms are also identified, such as decay from working and long-term memory. These mechanisms should be used as a base to guide necessary further research.     

Late onset of alcoholism among older midwestern men in treatment

60 men were administered a questionnaire to assess whether the prevalence of alcoholism in men over 60 years of age in alcoholism treatment centers parallels the reported rates of late-onset for one-third or more alcoholics. Analysis showed 11% of the subjects were of late onset while 33% were quasilate onset. There were no significant differences in the life stress between alcoholics of early and later onset.     

Parental ratings of son's behavior problems in high-risk families: convergent validity,internal structure,and interparent agreement

In this research, we examined the convergent validity, internal structure, and interparent agreement of the Child Behavior Checklist (CBCL; Achenbach, 1991a) using data from a community sample of 317 high-risk families. The sample consisted of 218 families with alcoholism (biological mother, father, and son) and 99 matched comparison families without alcoholism; all families were intact and included a 3- to 5-year-old son at first contact. Evidence was found for the convergent validity of the CBCL. In addition, although interparent agreement was low, the internal structure was confirmed, and structural invariance was high between mothers and fathers and in families with and without alcoholism. The effects of parental psychological and cognitive functioning on parent agreement were examined and found to have a minimal effect on parent agreement. These results demonstrate the validity of the CBCL for use by parent raters with alcoholism and their sons and emphasize the importance of including both versus only 1 parent in research using the CBCL.     

Late Onset Alcoholism: Stress or Structure

We studied 60 men (M age = 63.6 years) from six midwest treatment centers to determine whether stress resulting from loss of social-psychological structures was greater for later onset alcoholics. Each subject completed a modified Veteran's Alcoholism Screening Test (V.A.S.T.; Magruder-Habib, Harris, & Franker, 1982) and the Drinking Practices Survey (Adams, 1990). They were then identified as early onset (problem drinking before age 40) and later onset (problem drinking after age 40). Cross tabulations using the chi-square statistic showed that more early onset alcoholics were married than later onset alcoholics. Of the social-psychological structures, only marital status showed a significant relationship with alcoholism. This seemed to confirm that the onset of problem drinking has less to do with stress than with the loss of a spouse who may serve to regulate the older man's drinking.     

Developmental trajectories of disruptive behavior problems among sons of alcoholics: effects of parent psychopathology,family conflict,and child undercontrol

This study examined trajectories of disruptive behavior problems from preschool to early adolescence in 302 boys from a community-recruited sample of high-risk families. Growth modeling showed that paternal alcoholism was associated with elevated levels of sons' disruptive behavior problems. Family conflict predicted more disruptive behaviors at school entry and a slower rate of decline in such problems. Parent antisocial personality disorder (ASPD) exacerbated the effects of high preschool levels of sons' undercontrol on level of disruptive behaviors at school entry; this effect became progressively stronger across time. Low levels of undercontrol protected sons of ASPD parents from experiencing heightened levels of disruptive behaviors both at school entry and increasingly as sons grew older. Implications for subsequent maladjustment are discussed.     

Skin-conductance orienting deficits and increased alcoholism in schizotypal criminals.

This study tested the interaction hypothesis that a subgroup of criminals with schizotypal personality would show skin-conductance orienting deficits and increased alcoholism. In a prospective, longitudinal study of alcoholism in 134 males, schizotypy was assessed during adolescence, skin-conductance orienting was assessed at ages 18-20 years, and criminal offending and alcohol abuse were assessed at ages 30-33 years. A significant interaction between schizotypy and criminality indicated that schizotypal criminals were characterized by autonomic orienting deficits. Furthermore, the rate of alcoholism in schizotypal criminals (54.8%) was significantly higher than in criminals (23.8%), schizotypal noncriminals (13.9%), and comparisons (21.7%). It is argued that schizotypal criminals are a relatively distinct group and that prefrontal dysfunction may underlie both orienting deficits and alcoholism in this group.     

Loneliness and alcoholism risk in late adolescence: a comparative study of adults and adolescents.

The Short Michigan Alcoholism Screening Test (SMAST) was administered via phone survey to a random sample of subjects 18 years of age and older in a large metropolitan county. Among late adolescents (aged 18 to 20), lonely females had the highest mean score on the SMAST, indicating a higher degree of alcoholism risk than lonely males and nonlonely males and females. Among lonely females, late adolescents scored higher on the SMAST than any other age group. For males, loneliness did not appear to increase alcoholism risk in the late adolescent age group, but did appear to do so during the early and middle adulthood years. The implications of these findings for mental health professionals and adolescent substance abuse treatment personnel are discussed.     

Ketamine Enhanced Psychotherapy: Preliminary Clinical Observations on Its Effectiveness in Treating Alcoholism

Ketamine is a dissociative anesthetic widely used by physicians in the United States and also a psychedelic drug that physicians can legally prescribe off-label within the United States for other therapeutic purposes. It has been used in Russia and elsewhere to successfully treat alcoholism and other psychological or psychiatric problems, but has not been researched for this purpose in the United States. Results of a series of clinical trials using ketamine for treating alcoholism in the United States are retrospectively reported, along with 2 case studies of how psychotherapy facilitated by this substance helped two individuals achieve abstinence through ketamine's transpersonal effects. Considering the massive problems caused by alcoholism, the need to begin formal research studies on ketamine psychotherapy for alcoholism is emphasized.     

Perceptions of Liver Transplant Candidates with or Without an Alcohol Use History

Cirrhosis secondary to alcohol use is a primary cause of liver disease and a medical condition for which liver transplantation is a viable treatment option. However, there remains considerable debate within both the lay and the medical communities regarding the distribution of a scarce medical resource to adults with alcoholism. This study examined college students' perceptions toward an adult, presented in a written vignette, for whom liver transplantation was medically indicated. The influence of gender (female and male) and alcohol use history (no alcohol history, alcoholism history with long-term abstinence, alcoholism history with current use) on these ratings was examined. Subjects rated the adult presented with no alcohol history more positively than they did the adults presented with a history of alcoholism. Also, the adult with no alcohol history was more likely to be offered transplantation and was given higher priority ratings for transplantation by subjects. While subjects' own alcohol use history and organ donor registration status were not associated with ratings, having a family member with an alcohol problem and personally knowing a transplant recipient were related to more favorable ratings toward the adult presented in the vignette. Implications of these findings as well as limitations of the study are discussed.     

Family Process as a Mediator of the Negative Effects of Parental Alcoholism on Young Adult Dating Relationships

The effects of parental alcoholism on young adult dating relationship quality (trust, intimacy, commitment, and satisfaction) were considered in the context of the mediating variable of family process (cohesion, conflict resolution, and family competence). A model was tested with a sample of 287 young adults (95 were adult children of alcoholics) that suggested that healthier family process mediates the negative effects of having an alcoholic parent on dating relationship quality. Structural equation modeling results showed that the model fit the data. Young adults from alcoholic families in which family process was less negatively affected by parental alcoholism were less likely to report lower dating relationship quality than those from families in which family process was more negatively affected by parental alcoholism. Parental divorce was directly related to lower relationship quality. Clinical implications for working with young adult children of alcoholics are discussed.     

The Use of the MacAndrew Alcoholism Scale in Detecting Substance Abuse and Antisocial Personality

We evaluated the hypothesis that characterological factors, particularly antisocial personality, influence scores on the MacAndrew Alcoholism Scale (MAC). Using the Washington University research criteria to establish diagnoses, the following subgroups were defined: subjects who received no psychiatric diagnoses; subjects who received diagnoses other than alcoholism, drug dependence, or antisocial personality; and subjects who received a diagnosis of alcoholism, drug dependence, and/or antisocial personality, alone or in combination with other psychiatric diagnoses. The highest MAC scores were obtained by subjects diagnosed as having antisocial personality without alcoholism or drug dependence and subjects diagnosed with antisocial personality, drug dependence, and alcoholism. Alcoholics without antisocial personality or drug dependence, and subjects with other psychiatric diagnoses scored lowest. Although higher MAC scores were obtained by males, MAC scores greater than 24 correctly classified the greatest number of males and females as alcoholic, drug dependent and/or antisocial. These findings are interpreted as consistent with MacAndrew's reinterpretation of the scale as assessing a dimension of personality, rather than solely a tendency to addiction.     

The use of the MacAndrew Alcoholism Scale in detecting substance abuse and antisocial personality

We evaluated the hypothesis that characterological factors, particularly antisocial personality, influence scores on the MacAndrew Alcoholism Scale (MAC). Using the Washington University research criteria to establish diagnoses, the following subgroups were defined: subjects who received no psychiatric diagnoses; subjects who received diagnoses other than alcoholism, drug dependence, or antisocial personality; and subjects who received a diagnosis of alcoholism, drug dependence, and/or antisocial personality, alone or in combination with other psychiatric diagnoses. The highest MAC scores were obtained by subjects diagnosed as having antisocial personality without alcoholism or drug dependence and subjects diagnosed with antisocial personality, drug dependence, and alcoholism. Alcoholics without antisocial personality or drug dependence, and subjects with other psychiatric diagnoses scored lowest. Although higher MAC scores were obtained by males, MAC scores greater than 24 correctly classified the greatest number of males and females as alcoholic, drug dependent and/or antisocial. These findings are interpreted as consistent with MacAndrew's reinterpretation of the scale as assessing a dimension of personality, rather than solely a tendency to addiction.     

The relation of personality to alcohol abuse/dependence in a high-risk sample

The current study had two goals. The first goal was to test the mediational role of young adult personality in the relation between parental alcoholism and young adult alcoholism. The second was to examine the associations between personality and alcohol use motives and reasons to limit drinking in order to explore possible mechanisms by which personality may influence alcohol abuse/dependence. Multilevel modeling techniques were used to analyze data obtained from a community sample of young adult children of alcoholics and demographically matched controls. Results revealed that young adult neuroticism and agreeableness each, in part, mediated the effect of parental alcoholism on young adult alcoholism. Moreover, individuals high in neuloticism reported stronger coping motives to use alcohol, individuals low in agreeableness reported stronger coping motives and weaker upbringing reasons to limit drinking, and individuals low in conscientiousness reported stronger coping and enhancement motives to use alcohol, and weaker performance reasons to limit drinking.