Metacognitions as a predictor of drinking status and level of alcohol use following CBT in problem drinkers: A prospective study

This study investigated the role of negative emotions and metacognitions in predicting problem drinkers' drinking status (absence or presence of drinking) and level of weekly alcohol use at 3, 6 and 12 months after a course of treatment. A total of 70 problem drinkers with a DSM-IV diagnosis of alcohol abuse participated in the study. Depressive symptoms were assessed with the Beck Depression Inventory and symptoms of anxiety were measured with the state anxiety sub-scale of the State-Trait Anxiety Inventory. Metacognitions were measured with the Meta-Cognitions Questionnaire. Results indicated that beliefs about need to control thoughts predicted: (1) drinking status at 3 and 6 months; and (2) level of weekly alcohol use at 3, 6 and 12 months. The contribution of metacognition was independent of negative emotions and initial level of weekly alcohol use. The results support the role of metacognition in problem drinking. Given that metacognitions are a possible risk factor for drinking status and level of weekly alcohol use it is suggested that treatment for problem drinking could target this variable.     

Instructed versus pharmacological effects of alcohol in alcoholics and social drinkers

Twelve alcoholics and 12 social drinkers were studied in an experiment where instructions about alcohol or placebo were orthogonally crossed with administration of alcohol or placebo in a Balanced Placebo Design. Three subjects were simultaneously observed while watching soccer games on the TV together and having free access to a mixed drink, which in the alcohol conditions contained 150ml of 80% proof vodka. The assessment procedure included several aspects of drinking behavior, behavioral observations during the session, psychiatric ratings and nurse observations before and after each session, ratings for craving, self-reported state anxiety and physiological changes (heart rate and blood pressure). In general, the results showed the alcoholic's behavior to be controlled by instruction-induced expectancies rather than by the actual beverage given, whereas the social drinkers showed tendencies in the opposite direction. The implications of these results for the traditional disease conception of alcoholism and for learning theory approaches are discussed.     

Substance abuse and panic-related anxiety: a critical review

The relationship between substance abuse and panic-related anxiety can be divided into two broad areas: the incidence of anxiety disorders in substance abuse patients and the incidence of substance abuse in patients with panic-related anxiety disorders. Studies indicate that approx. 10-40% of alcoholics have a panic-related anxiety disorder, and about 10-20% of anxiety disorder patients abuse alcohol or other drugs. The majority of patients with both an anxiety and alcohol disorder report that anxiety problems preceded alcohol problems. In some cases substance abuse (e.g. cocaine) triggers the onset of panic attacks. Most patients believe that self-medication is efficacious despite the fact that they appear to have a more serious clinical condition (e.g. higher rates of depression). Directions for future research are outlined, including the proposal for a study to examine the effects of an anxiety intervention procedure for anxious alcoholics to reduce relapse rates.     

Drinking motives in alcohol use disorder patients with and without social anxiety disorder

The high comorbidity of alcohol use disorders (AUD) and social anxiety disorder (SAD) is often explained by excessive drinking in social situations to self-medicate social anxiety. Indeed, the motive to drink alcohol to lower social fears was found to be elevated in socially anxious persons. However, this social anxiety specific motive has not been directly investigated in primarily alcohol dependent individuals. We explored social anxiety, the motivation to drink alcohol in order to cope with social fears, and social anxiety as a consequence of drinking in AUD with and without comorbid SAD. Male AUD inpatients with (AUD+SAD group, N=23) and without comorbid SAD (N=37) completed a clinical interview and a questionnaire assessment. AUD+SAD patients reported higher levels of depression and an elevated motive to drink due to social anxiety but did not experience more social fears as a consequence of drinking. Previous results concerning alcohol drinking motives in order to relieve social fears could be replicated in a clinical AUD sample. Additionally, our findings suggest comorbid AUD+SAD patients to be more burdened regarding broader psychopathological symptoms. Thus, accessibility to SAD-specific screening and treatment procedures may be beneficial for primary AUD patients.     

The effect of ethanol on stress-induced tachycardia

A study was designed to answer the questions if low doses of ethanol would reduce stress induced increases in heart rates, if covariations would be observed between ethanol induced changes in heart rates and changes in emotional states and mental performance and if tolerance to ethanol or other personality factors would influence the ethanol induced cardiac effects. Forty-four male students with a history of high and low alcohol consumption according to questionnaire scores were matched for extraversion and neuroticism and then assigned to a group receiving either 0.8 g/kg of ethanol or a placebo drink. A stress condition of mental arithmetic was applied prior to and 45 minutes after ingestion of the drink. Heart rates and ratings of emotional states by adjective check lists were recorded before and after each stress session. A significant reduction of stress induced heart rate increases in both high and low drinking groups but no ethanol dependent change of resting heart rates were observed. Reductions of autonomic stress response by ethanol were weakly but positively correlated to respective reductions of affective stress responses and impairment of the quality of mental performance. High trait anxiety subjects seemed to benefit more from ethanol with respect to reductions of cardiac and emotional arousal than low anxious subjects.     

Social anxiety and problematic alcohol consumption: the mediating role of drinking motives and situations

Social anxiety is inconsistently associated with alcohol use variables. To elucidate factors that contribute to the relationship between social anxiety and problematic alcohol use, the present study investigated drinking motives and drinking situations in an undergraduate sample (N = 293). Social anxiety was significantly correlated with endorsement of enhancement drinking motives (i.e., drinking to enhance positive experiences or emotions) but not social or coping motives. Social anxiety was also correlated with endorsement of drinking in the following high-risk situations: unpleasant emotions, conflict with others, social pressure, and testing personal control. Importantly, enhancement motives and each of these drinking situations mediated the relationship between social anxiety and alcohol-related problems. Findings suggest that alcohol use to enhance positive affect or in response to these specific situations may account for the risk for alcohol-related problems among those with social anxiety.     

Standardized measures of alcohol-related problems: a review of their use among college students

College students' alcohol consumption has received considerable attention in the scientific literature and the media for its impact on students and the college community. Misuse of alcohol can lead to a wide range of consequences, the most severe being alcohol abuse, dependence, and death. Researchers have struggled to develop effective methods to assess problems related to alcohol, and the literature on college drinking lacks a strong theoretical framework for such assessment. The authors contend that measures of alcohol-related problems for college students should assess specific dimensions pertaining to 3 main domains: alcohol abuse, alcohol dependence, and what the authors define as risky drinking. The authors examined how existing measures fit into this model. In a comprehensive review of the college literature, the authors identified 9 measures (and their revised versions) assessing alcohol-related problems. Their analysis revealed that most measures do not assess comprehensively the domains outlined, and instead provide only partial assessments of the potential consequences of drinking for college students. The authors include directions for future research so that measurement of drinking consequences for college students can be refined.     

Metadehumanization and Self-dehumanization are Linked to Reduced Drinking Refusal Self-Efficacy and Increased Anxiety and Depression Symptoms in Patients with Severe Alcohol Use Disorder

Metadehumanization, the perception of being treated as less than a human by others, is a pervasive phenomenon in intergroup relations. It is dissociated from stigmatization or stereotypes, and it has been recently identified as a critical process in severe alcohol use disorders (SAUD). Metadehumanization is associated with a wide array of negative consequences for the victim, including negative emotions, aversive self-awareness, cognitive deconstruction, and psychosomatic strains, which are related to anxiety and depression. This study aims to investigate if metadehumanization occurring among patients with SAUD is associated with clinical factors involved in the maintenance of the disease, namely symptoms of depression or anxiety and drinking refusal self-efficacy. A cross-sectional study was conducted among 120 patients with SAUD. Self-reported questionnaires measured metadehumanization, self-dehumanization (i.e., the feeling of being less than a human), anxiety, depression, drinking refusal self-efficacy, and demographics. Metadehumanization was significantly associated with self-dehumanization, anxiety, depression, and drinking refusal self-efficacy. Additionally, path analyses showed that self-dehumanization mediated the links between metadehumanization and clinical variables. These results indicate that metadehumanization and self-dehumanization could be essential factors to consider during SAUD treatment, as they are associated with increased psychiatric symptoms and reduced drinking refusal self-efficacy.     

Mood and alcohol consumption: an experience sampling test of the self-medication hypothesis

In this investigation the authors applied the experience sampling method to prospectively test the self-medication hypothesis. In vivo reports gathered in the context of daily life demonstrated that nervousness was the only negative mood state to predict increases in alcohol consumption later in the course of the day. Further examination of this within-person relationship demonstrated that men were more likely to consume alcohol when nervous than were women, but this association was unrelated to family history of alcoholism, problem drinking patterns, or trait anxiety and depression. Consistent with the self-medication hypothesis, cross-sectional analyses also confirmed that alcohol consumption was generally associated with lower levels of nervousness; this effect varied by several demographic and clinical variables. These findings are discussed in terms of the diversity of reasons for alcohol consumption and their potential for explaining problem drinking.     

Learning techniques for alcohol abuse

Eighteen month follow-up data are presented for two projects evaluating the effectiveness of learning techniques for treating alcohol abuse and achieving moderation using three groups of subjects-inpatient alcoholics, outpatient alcoholics and problem drinkers. Subjects received various combinations of the following procedures: videotape self-confrontation of drunken comportment, blood alcohol concentration discriminating training, aversion training for overconsumption, avoidance practice, behavior counseling and alternatives training, and alcohol education. While the loss of subjects was considerable between 12 and 18 months follow-up, the data were very similar. Subjects in all groups improved in terms of reductions in alcohol intake and on drinking-related variables. Significant between-groups differences in favor of subjects whose training included actual experience in drinking moderately were found only for the inpatient alcoholics. In this research, the best candidate for moderation was the less chronic. younger drinker with a relatively lower alcohol intake, a more stable vocational record and no history of hospitalization for alcohol abuse or physical deterioration from drinking. We believe that the techniques with the greatest potential for the prevention and treatment of alcohol abuse are videotape self-confrontation, blood alcohol discrimination training, and alcohol education/alternatives training.     

Suicidality in a Sample of Arctic Households

We investigated the association of suicidal ideation and behavior with depression, anxiety, and alcohol abuse in a Canadian Arctic Inuit community. Inuit (N = 111) from a random sample of households completed assessments of anxiety and depression, alcohol abuse, and suicidality. High rates of suicidal ideation within the past week (43.6%), and suicide attempts within last 6 months (30%), were reported. Ideation was more frequent among younger persons, whereas those favoring local native language were less likely to report a wish to die. Higher overall suicidality scores were associated with higher anxiety, and alcohol abuse, but not with depression or gender. Implications for future research are discussed.     

Fitting in and feeling fine: conformity and coping motives as mediators of the relationship between social anxiety and problematic drinking.

The present research was conducted to clarify the relationships among social anxiety, alcohol consumption, alcohol-related problems, and negative-reinforcement drinking motives among college students. Heavy drinking students (N = 316, 53.80% female) completed self-report measures of social anxiety, alcohol consumption, alcohol-related problems, and drinking motives. Findings indicated that students higher in social anxiety consumed less alcohol but experienced more negative consequences. Moreover, the relationship between social anxiety and negative consequences was mediated by coping and conformity drinking motives in addition to alcohol consumption. In the context of social anxiety, the current research demonstrates the importance of examining problematic drinking as distinct constructs: alcohol consumption and negative consequences. Findings are also discussed in terms of implications for interventions with socially anxious students.     

Putting the relationship between social anxiety and alcohol use into context: A daily diary investigation of drinking in response to embarrassing events

The goal of this study was to clarify mixed findings regarding the association between dispositional social anxiety and drinking among college students by using a daily diary method to examine whether a within-person social-contextual event moderated the relationship between social anxiety and alcohol use. College students (n = 476) completed a measure of dispositional social anxiety and then for 30 days reported whether they experienced an embarrassing event in public and the amount of alcohol they drank each day. We examined whether experiencing an embarrassing event moderated the relationship between dispositional social anxiety and alcohol use for same-day, same-evening, next-day, and next-evening drinking. While there was a positive relationship between dispositional social anxiety and alcohol use on evenings when an embarrassing event occurred earlier that day, this appeared to be driven by a reduction in drinking among those low in social anxiety. Individuals with high social anxiety drank in the evening regardless of embarrassing event occurrence. Results suggest that people with low social anxiety show an adaptive response to embarrassing events by lowering drinking on such evenings, while those with high social anxiety may drink to reduce their already high levels of anxiety independent of daily social events.     

Motives and Consequences of Alcohol Use in People With Social Anxiety Disorder: A Daily Diary Study

People with social anxiety disorder (SAD) are at increased risk for alcohol-related problems. Most research exploring social anxiety and alcohol use has examined negative drinking consequences, with less consideration of positive consequences—namely positive social experiences—that may reinforce alcohol use. In this daily diary study, we examined how adults diagnosed with SAD (N = 26) and a psychologically healthy control group (N = 28) experienced positive drinking consequences in naturally occurring drinking episodes during the study period. For 14 consecutive days, participants answered questions about alcohol use, motives for drinking, and positive consequences of drinking. On days when participants drank, those with SAD were more likely than healthy controls to perceive a reduction in anxiety, but the two groups did not differ in their likelihood of experiencing positive social drinking consequences. For both groups, on days when they were more motivated to drink to enhance social experiences (affiliation motives) or cope with distress (coping motives), they were more likely to obtain positive consequences from drinking. Compared to controls, participants with SAD endorsed stronger trait and daily coping motives (anxiety-coping, social anxiety-coping, and depression-coping). Results are discussed in the context of reinforcement mechanisms that may maintain social anxiety and alcohol use.     

Sex differences in the alcohol deprivation effect in rats

Few studies have investigated the relationship between early onset of alcohol drinking and relapse in adulthood, which may be larger in females, as revealed by studies using rats as subjects. The present study assesses the alcohol deprivation effect (ADE) in adult rats of both sexes that began alcohol consumption during preadolescence or adolescence. Female and male Wistar rats received free-choice access to water, 5, 10 and 20% (v/v) ethanol solutions during the ethanol exposures. The effects of age and sex on ADE in adult rats were assessed after repeated periods of abstinence. The results showed that female but not male rats increased ethanol intake after the second and third deprivation (showing ADE), irrespective of the onset-age of alcohol drinking.     

Aggression is associated with greater subsequent alcohol consumption: A shared neural basis in the ventral striatum

Alcohol use and abuse (e.g., binge drinking) are among the most reliable causes of aggressive behavior. Conversely, people with aggressive dispositions (e.g., intermittent explosive disorder) are at greater risk for subsequent substance abuse. Yet it remains unknown why aggression might promote subsequent alcohol use. Both aggressive acts and alcohol use are rewarding and linked to greater activity in neural reward circuitry. Through this shared instantiation of reward, aggression may then increase subsequent alcohol consumption. Supporting this mechanistic hypothesis, participants’ aggressive behavior directed at someone who had recently rejected them, was associated with more subsequent beer consumption on an ad‐lib drinking task. Using functional MRI, both aggressive behavior and beer consumption were associated with greater activity in the bilateral ventral striatum during acts of retaliatory aggression. These results imply that aggression is linked to subsequent alcohol abuse, and that a mechanism underlying this effect is likely to be the activation of the brain's reward circuitry during aggressive acts.

     

Emotional Abuse in Childhood and Attachment Anxiety in Adult Romantic Relationships as Predictors of Personality Disorders

Personality disorders are characterized by interpersonal problems. These problems might arise not only in current, but also in past relationships. To test this hypothesis, recollections of abuse and neglect in childhood and representations of adult attachment to the romantic partner were related to dimensional ratings of the 10 DSM-5 personality disorders. Ultimately, 110 patients of a psychosomatic clinic took part in the study. All data were collected with self-report measures. Among the different types of child abuse and neglect, emotional abuse was shown to be most frequently correlated with personality disorders. Attachment dimensions avoidance and anxiety were both associated with personality disorders; anxiety, however, showed stronger correlations. The results reveal that personality disorders come along with enduring adversities in close relationships, mainly experiences of emotional abuse and attachment anxiety, starting in the family of origin and continuing in adult attachment bonds.     

Weekend alcoholism in youth and neurocognitive aging

Numerous studies have shown that alcohol intake causes neuropsychological disorders that affect various brain structures. The ?premature ageing? hypothesis proposes that the brain areas of alcoholics undergo deterioration similar to that observed in old age. We investigated whether alcohol abuse by young people (binge drinking) causes alterations comparable to some found in elderly people. Ninety-one people were divided into four groups: a) young people who abused alcohol; b) young people who drank alcohol in moderation; c) young people who did not drink alcohol; and d) elderly adults without any significant cognitive deterioration. All of them were assessed with a neuropsychological battery. We observed some similarities in the results obtained by young drinkers and the elderly participants, which would provide some support for the hypothesis of premature aging. The tasks that young drinkers performed worse were those related to executive functions, in which the prefrontal cortex plays an essential role. We also found differences between the two groups of young drinkers (moderate and high consumption), which leads us to believe that the amount of alcohol consumed and the pattern of consumption are factors to consider in relation to cognitive impairment.     

Contingent reinforcement of lowered blood-alcohol levels in an outpatient chronic alcoholic

Recently. the proposition that alcohol abuse is an operant behavior and thus functionally related to its consequences has been investigated under experimental conditions. In controlled laboratory settings, in which inpatient chronic alcoholics are allowed access to alcoholic beverages, alcohol consumption has been markedly altered via operant strategies. Monetary rewards (Cohen et al., 1971), the opportunity to participate in an enriched environment (Cohen et al., 1971). and visits to a girlfriend (Bigelow et al., 1973) have been used as reinforcers for decreased drinking.Other investigators (Sulzer, 1965; Miller, 1972: Hunt and Azrin, 1973) have successfully applied similar contingency management techniques to alcoholics in the natural environment. However, failure to control for the influence of extraneous therapeutic variables (e.g., attention-placebo factors, job counseling) together with reliance on self-report measures of drinking behavior seriously limit the conclusiveness of these results. Objective assessment is particularly essential with operant techniques since consequent events must be systematically scheduled upon the occurrence or non-occurrence of drinking. Documentation of drinking in the natural environment is a difficult task since the alcoholic frequently consumes alcohol when he is alone. In lieu of direct observation, blood alcohol concentrations are an obvious means of objective assessment. Such data are most conveniently obtained via breath tests similar to the ones that law enforcement officers utilize to identify intoxicated motorists.The purpose of the present study was to investigate the influence of reinforcement contingencies on lowering blood alcohol concentrations obtained in an alcoholic's natural environment.