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.     

Alcohol Consumption and Nearly Lethal Suicide Attempts

W e conducted a case‐control study of the association between nearly lethal suicide attempts and facets of alcohol consumption; namely, drinking frequency, drinking quantity, binge drinking, alcoholism, drinking within 3 hours of suicide attempt, and age began drinking. Subjects were 13–34 years of age. In bivariable analyses, all measures were associated with nearly lethal suicide attempts. Odds ratios ranged from 2.4 for alcoholism to 7.0 for drinking within 3 hours of attempt. All exposure variables except age began drinking exhibited a J‐shaped relationship between alcohol exposure and nearly lethal suicide attempt. After controlling for potential confounders and other measures of alcohol exposure, drinking within 3 hours of attempt remained most strongly (odds ratios > 6) associated. Alcoholism remained significantly associated in most models, but at lower strength.     

Short-term effects of behaviour therapy and hospital treatment of chronic alcoholics

Conditioning therapies, including electro-aversion treatment, of advanced states of alcoholism have not yielded an impressive record. There are probably several reasons for this state of affairs. Many studies have neglected the concurrent training of socially acceptable behaviour in the place of heavy drinking (Sobell and Sobell, 1972), and few studies have taught patients' relaxation or other anxiety-relieving methods (Blake, 1965). It may also be that treatment attempts have focused on conditioning fear or disgust to drinking stimuli themselves rather than covert, cognitive associations to various drinking situations (Claesson and Malm, 1973). The elements of electro-aversion therapy of alcoholism are little known and a number of problems remain to be investigated (Rachman and Teasdale, 1969; Hallam and Rachman, 1972). Among these problems are: how do we account for the different effects of electro-aversion therapy for different clients? How long-lasting are the effects of electro-aversion therapy?     

Psychologists and alcoholic women

Alcoholism among women often has been treated using a model based on research with alcoholic men. Women react differently to alcohol than men both physiologically and psychologically and their drinking patterns are different from men's. Treatment facilities for alcoholism have not been as available for women as for men and treatment must be individualized for the differences between men and women problem drinkers and for the differences among alcoholic women.     

Second year treatment outcome of alcoholics treated by individualized behavior therapy: Results

Second year treatment outcome results are reported for 69 of 70 male alcoholics who, while hospitalized at Patton State Hospital, served as subjects in an experiment evaluating ‘Individualized Behavior Therapy (IBT)’ techniques. Subjects were initially assigned to either a controlled drinking or non-drinking (abstinence) treatment goal. and were then randomly assigned to either an experimental group receiving IBT or a control group receiving conventional state hospital treatment oriented towards abstinence. Previously reported results found that IBT subjects functioned significantly better than control subjects throughout the first year of follow-up. Second year follow-up results found that IBT subjects treated with a controlled drinking goal functioned significantly better than their respective control subjects on a variety of measures, including drinking behavior. Differences between IBT subjects treated with a non-drinking goal and their control subjects did not retain statistical significance during the second year of follow-up. Individual drinking profiles are presented for all subjects. Only subjects treated by IBT with a goal of controlled drinking engaged in a substantial amount of limited, non-problem drinking during the second year interval, and those subjects also had more abstinent days than subjects in any other group. The nature of adequate follow-up procedures and measures is discussed. Implications of these findings for alcoholism treatment are considered.     

Longitudinal Associations Between Fathers’ Heavy Drinking Patterns and Children’s Psychosocial Adjustment

Psychosocial adjustment in children of alcoholics (N = 114) was examined in the year before and at three follow-ups in the 15 months after their alcoholic fathers entered alcoholism treatment, testing the hypothesis that children's adjustment problems will vary over time as a function of their fathers' heavy drinking patterns. Three unique patterns of heavy drinking in alcoholic fathers were identified through cluster analysis. The results demonstrated significant and meaningful associations between these drinking patterns in fathers and adjustment problems in children over time. Overall, children whose fathers remained mostly abstinent following their treatment showed lowest and decreasing adjustment problems, while children whose fathers continued and increased heavy drinking following their treatment showed greatest and increasing adjustment problems over time.     

Fingarette on the disease concept of alcoholism

Herbert Fingarette [1] argues that alcoholism is not a disease and that the alleged alcoholic under certain circumstances has the power to control his or her drinking disorders. I shall analyze Fingarette's argument and show that his position rests on some logical and conceptual confusions. In analyzing Fingarette's argument for the self-control theory of drinking disorders I conclude that it is problematic for the following reasons: (1) his argument assumes that the identification of a single cause of alcoholism is a necessary condition of its being a disease; (2) unless it is already assumed (a priori) that persons with drinking disorders possess freedom and self-control to the extent that Fingarette assumes they do, then such persons are likely to suffer from apathy or defeatism regarding their condition; (3) even if Fingarette is correct in his criticism of certain health care programs for those with drinking disorders, it does not follow from this that certain theories about the possible causes of such disorders are false; (4) Fingarette's claim that those with drinking disorders are morally responsible for their actions that result from their disorders is problematic, that is, unless it can be shown that such persons act freely; and (5) Fingarette attempts to support the self-control theory of alcoholism by refuting a ‘straw man’ conception of the disease model of alcoholism.     

Alcoholism: etiologies proposed and therapeutic approaches tried

Alcohol, probably the most popular mood-altering drug, has frightening consequences when abused. Genetic factors and sociocultural influences contribute to alcoholic behavior. Study of endocrines, neurotransmitters, and neuropeptides may reveal biological markers to help identify those at risk for alcoholism. Drinking patterns are often based on the expectation of alcohol's mood-altering quality. The focus of treatment has expanded to include not only drinking behavior but also emotional, social, and vocational adjustment. Controlled drinking has proved effective for some, so that complete abstinence is no longer the sole goal of therapy. Behavioral, martial, group and individual, outpatient and inpatient therapy, and drugs as adjuncts, all help some alcoholics, but none is a cure for all. Answers still lag behind questions but researchers have registered some advances that challenge therapists to enlarge therapeutic approaches to fit the multifaceted picture of alcoholism.     

Trajectories of alcohol and drug use and dependence from adolescence to adulthood: the effects of familial alcoholism and personality

This study describes trajectories of substance use and dependence from adolescence to adulthood. Identified consumption groups include heavy drinking/heavy drug use, moderate drinking/experimental drug use, and light drinking/rare drug use. Dependence groups include alcohol only, drug only, and comorbid groups. The heavy drinking/heavy drug use group was at risk for alcohol and drug dependence and persistent dependence and showed more familial alcoholism, negative emotionality, and low constraint. The moderate drinking/experimental drug use group was at risk for alcohol dependence but not comorbid or persistent dependence and showed less negative emotionality and higher constraint. Familial alcoholism raised risk for alcohol and drug use and dependence in part because children from alcoholic families were more impulsive and lower in agreeableness.     

An operant treatment procedure for alcoholics

For many years total abstinence was regarded as the appropriate criterion for the successful treatment of alcoholism. It is suggested that given societal norms for social consumption of alcohol, plus the social reinforcers which maintain beverage alcohol ingestion, social drinking may serve as a realistic treatment goal. The efficacy of a social drinking criterion was clearly demonstrated by Bigelow et al. (1972). Chronic alcoholic in-patients were placed in a choice situation in which they earned the opportunity to participate in an ‘enriched’ environment contingent upon either moderate drinking or abstinence. Subjects overwhelmingly chose the moderate drinking alternative. Results also suggested that moderate drinking is more reinforcing than abstinence for alcoholics. Further support for the moderate drinking concept was rendered by Mills, Sobel and Schaeffer (1971) in a study which made electric shock contingent on gulping drinks, ordering straight alcoholic drinks and ordering and consuming more than three drinks. Time-out (Cohen et al., 1971), positive reinforcement (Cohen et al., 1971) and social contracting procedures (Miller, 1972) have been effectively employed to reduce drinking behavior from maladaptive to adaptive frequencies.

The present study attempts to extend treatment with a controlled drinking outcome to out-patient alcoholics     

A community-reinforcement approach to alcoholism

Several theoretical approaches to alcoholism exist. An opérant reinforcement approach was used in the present study to develop a new procedure that rearranged community reinforcers such as the job, family and social relations of the alcoholic such that drinking produced a time-out from a high density of reinforcement. The results showed that the alcoholics who received this Community-Reinforcement counseling drank less, worked more, spent more time with their families and out of institutions than did a matched control group of alcoholics who did not receive these procedures. This new approach appears to be an effective method of reducing alcoholism. An analysis in reinforcement terms is presented of the etiology, epidemiology, and treatment of alcoholism.     

Observations Of Conjointly Hospitalized “Alcoholic Couples” During Sobriety And Intoxication: Implications For Theory and Therapy

This paper presents clinical data from a research study designed to examine the relation between alcohol consumption and interactional behavior in “alcoholic couples.” The central innovative feature of the study was the simultaneous admission to an inpatient setting of up to three couples, one or both members of which was alcoholic. The in-patient experience was part of an intensive, six-week, multiple-couples, group-therapy program. During hospitalization couples were encouraged to reproduce as closely as possible their usual drinking patterns and interactional behavior. Therapists utilized observations of interactional behavior during intoxication and sobriety to formulate central interactional and psychological issues for each couple. The authors utilized these same observations to develop the interactional model of alcoholism in families that is presented in detail in this paper. This model is an extension of earlier work delimiting an interactional theory of alcoholism based on general systems concepts. Two extensive case histories are presented to illustrate both theoretical issues and the treatment process.     

The Relationship of Appetitive, Reproductive and Posterior Pituitary Hormones to Alcoholism and Craving in Humans

A significant challenge for understanding alcoholism lies in discovering why some, but not other individuals, become dependent on alcohol. Genetic, environmental, cultural, developmental, and neurobiological influences are recognized as essential factors underlying a person's risk for becoming alcohol dependent (AD); however, the neurobiological processes that trigger this vulnerability are still poorly understood. Hormones are important in the regulation of many functions and several hormones are strongly associated with alcohol use. While medical consequences are important, the primary focus of this review is on the underlying confluence of appetitive/feeding, reproductive and posterior pituitary hormones associated with distinct phases of alcoholism or assessed by alcohol craving in humans. While these hormones are of diverse origin, the involvement with alcoholism by these hormone systems is unmistakable, and demonstrates the complexity of interactions with alcohol and the difficulty of successfully pursuing effective treatments. Whether alcohol associated changes in the activity of certain hormones are the result of alcohol use or are the result of an underlying predisposition for alcoholism, or a combination of both, is currently of great scientific interest. The evidence we present in this review suggests that appetitive hormones may be markers as they appear involved in alcohol dependence and craving, that reproductive hormones provide an example of the consequences of drinking and are affected by alcohol, and that posterior pituitary hormones have potential for being targets for treatment. A better understanding of the nature of these associations may contribute to diagnosing and more comprehensively treating alcoholism. Pharmacotherapies that take advantage of our new understanding of hormones, their receptors, or their potential relationship to craving may shed light on the treatment of this disorder.     

The effects of familial risk, personality, and expectancies on alcohol use and abuse

This study tested a structural model of the association between familial risk, personality risk, alcohol expectancies, and alcohol abuse in a sample of 224 young adult offspring of alcoholics and 209 offspring of nonalcoholics. The results provided support for 2 personality-risk pathways, a social deviance proneness and an excitement/pleasure seeking path, that accounted for a significant portion of the association between a familial alcoholism and alcohol abuse. The path from familial alcoholism to social deviance proneness lead directly to alcohol problems. The path from familial alcoholism to excitement/pleasure seeking was associated with increased drinking, which, in turn, was associated with alcohol problems. Positive alcohol expectancies accounted for part of the association between excitement seeking and alcohol use. The results suggest 2 different biopsychosocial mechanisms that elevate risk for abuse in the offspring of alcoholics.     

Individualized Behavior Therapy for Alcoholics – Republished Article

A behavior therapy for alcoholism was designed based on the rationale that alcoholic drinking is a discriminated, operant response. Treatment emphasized determining setting events for each subject’s drinking and training equally effective alternative responses to those situations. Seventy male, hospitalized, Gamma alcoholics were assigned to a treatment goal of either nondrinking (N = 30) or controlled drinking (N = 40). Subjects of each group were then randomly assigned to either an experimental group receiving 17 behavioral treatment sessions or a control group receiving only conventional treatment. Treatment of experimental groups differed only in drinking behaviors allowed during sessions and electric shock avoidance schedules. Nondrinker experimental subjects shaped to abstinence, while controlled drinker experimental subjects practiced appropriate drinking behaviors with little shaping, a result attributed to instructions. Follow-up measuring drinking and other behaviors found that experimental subjects functioned significantly better after discharge than control subjects, regardless of treatment goal. Successful experimental subjects could apply treatment principles to setting events not considered during treatment, suggesting the occurrence of rule learning. Results are discussed as evidence that some “alcoholics” can acquire and maintain controlled drinking behaviors. Traditional treatment of alcoholics may be handicapped by unvalidated beliefs concerning the nature of the disorder.     

Collegiate COAs and Alcohol Abuse: Problem Drinking in Relation to Assessments of Parent and Grandparent Alcoholism

In a survey of college students (N = 860), significantly greater problem drinking was indicated by students who reported having a parent or grandparent diagnosed or treated for alcoholism. The highest rates of problem drinking were found among students who reported both an alcoholic parent and grandparent. Students who had experienced distress and family discord from parental alcohol abuse, though without a diagnosed alcoholic parent, also indicated greater problem drinking. The increased alcohol problems of students without a diagnosed alcoholic parent, however, were somewhat different from other children of alcoholics (COAs). Thus, different types of COAs must be considered in research, treatment, and prevention programs.     

Abstinence or control: The outcome for excessive drinkers two years after consultation

This report presents the two-year follow-up results for a sample of married male alcoholics who had been the subjects of a controlled treatment trial. Cumulative relapse curves for the two-year period were found to be similar in form to those which Hunt and Matarazzo (1970) have drawn for drug addicts, alcoholics and smokers. Outcome at 12 and 24 months were compared: changes from good to bad outcome, or vice versa, were rare. The degree of hardship reported by wives remained predictive of outcome two years later. Not all drinking reported at two years was uncontrolled. Of 26 men with a good outcome. 11 were agreed by husband and wife to be abstaining, and 10 were agreed to be controlling their drinking. Most of the latter had not shown lengthy periods of abstinence prior to resuming drinking. Controlled drinkers reported fewer symptoms at intake (morning drinking, shakes, secret drinking, hallucinations etc.), were more likely to have been sub-diagnosed as Alpha alcoholics (psychologically dependent), and were more likely to have been only briefly counselled. Abstainers reported more symptoms at intake, were more likely to be sub-diagnosed as Gamma alcoholics (physically dependent), and were more likely to have been intensively treated. These results suggest an interaction between degree of dependence, type of treatment, and goal of treatment. If confirmed by future research this would have strong implications for the planning of comprehensive alcoholism treatment services.     

Stability/Instability in the Alcoholic Marriage: The Interrelationships Between Course of Alcoholism,Family Process,and Marital Outcome

Thirty-one alcoholic families who were originally studied in home, multiple-family group, and laboratory settings were reassessed two years later to determine course of alcoholism and degree of marital stability. This paper presents data comparing baseline alcohol consumption and family interactional behavior at home with subsequent alcoholism and marital stability outcomes. Findings suggest that the relative degree of stability/instability in these marriages is best understood as a function of the “goodness-of-fit” between the relative predictability of drinking on the part of the identified alcoholic and the family's characteristic pattern of interactional behavior at home.     

Leisure Activity Profile Measuring Use of Leisure Time by Persons with Alcoholism

Use of leisure time by persons with alcoholism differs from that of non-alcoholics. Some leisure activities may even contribute to a pattern of heavy drinking. The Leisure Activity Profile (LAP) was designed to identify dysfunctional leisure activity patterns, specifically those activity patterns associated with high levels of alcohol consumption. The initial developmental work on the LAP is described in this article. The LAP includes a list of 38 activities, half of which were selected for their association with alcohol consumption. Respondents indicate the activities in which they participate, and the level of alcohol consumption with each activity. Respondents also indicate if they complete the activity alone or with close friends or relatives. The LAP should prove useful to occupational therapists who treat persons with alcoholism, both in identifying dysfunctional leisure activity patterns and in developing and measuring treatment approaches.     

Chemical aversion treatment of alcoholism: Lithium as the aversive agent

Animal work indicating flavour aversion produced by chemical aversion therapy (CAT) with lithium might be effective in the treatment of alcoholism led to this treatment being given to 25 patients. The abstinence rate six months later of 36% was significantly better than the 12% rate for an equivalent group of patients, treated with a disulfuram-like drinking deterrent, calcium carbimide. The rate for the CAT group improves to 47% if 8 patients are excluded who did not develop sickness reactions to lithium. CAT with lithium appears safe given proper medical precautions.