Alcoholics' and nonalcoholics' attributions of control of future life events

Impulsive responding in alcoholics

BACKGROUND

Impaired decision-making is one diagnostic characteristic of alcoholism. Quantifying decision-making with rapid and robust laboratory-based measures is thus desirable for the testing of novel treatments for alcoholism. Previous research has demonstrated the utility of delay discounting (DD) tasks for quantifying differences in decision-making in substance abusers and normal controls. In DD paradigms subjects choose between a small, immediate reward and a larger, delayed reward.

METHODS

We used a novel computerized DD task to demonstrate that abstinent alcoholics (AA, n=14) choose the larger, delayed option significantly less often than control subjects (n=14; p<0.02). This difference in choice tendency was independent of subject age, gender, years of education, or socio-economic status.

RESULTS

All subjects discounted as a function of reward delay and amount, with alcoholics demonstrating steeper discounting curves for both variables. This tendency to discount delayed rewards was positively correlated with subjective reports of both alcohol addiction severity (Drug Use Screening Inventory-Revised, Domain 1, p<0.01), and impulsivity (Barratt Impulsivity Scale-11, p<0.004). Novel aspects of this new paradigm include an element of time pressure, an additional experimental condition that evaluated motor impulsivity by assessing the ability to inhibit a pre-potent response, and another control condition to requiring non-subjective choice.

CONCLUSIONS

Non-alcoholic controls and alcoholics did not differ on motor impulsivity or non-subjective choice, suggesting that the differing choice behavior of the two groups was due mainly to differences in cognitive impulsivity.

Alcoholism and suicidal behavior: a clinical overview

OBJECTIVE

The purpose of this paper was to provide a clinical review of the literature on the relation of alcoholism to suicidal behavior.

METHOD

Studies of alcoholism and suicidal behavior available in MEDLINE, Institute for Scientific Information Databases (Science Citation Index Expanded, Social Sciences Citation Index, and Arts & Humanities Citation Index), EMBASE, and Cochrane Library were identified and reviewed.

RESULTS

Alcoholism is associated with a considerable risk of suicidal behavior. Individuals with alcoholism who attempt or complete suicide are characterized by major depressive episodes, stressful life events, particularly interpersonal difficulties, poor social support, living alone, high aggression/impulsivity, negative affect, hopelessness, severe alcoholism, comorbid substance, especially cocaine abuse, serious medical illness, suicidal communication, and prior suicidal behavior. Partner-relationship disruptions are strongly associated with suicidal behavior in individuals with alcoholism.

CONCLUSION

All individuals with alcoholism should receive a suicide risk assessment based on known risk factors.

Alcohol and suicidal behavior

Alcohol dependence and alcohol intoxication are important risk factors for suicidal behavior. However, the mechanism for the relationship remains unclear. This review presents a conceptual framework relating alcohol to suicidal behavior. Distal risk factors create a statistical potential for suicide. Alcohol dependence, as well as associated comorbid psychopathology and negative life events, act as distal risk factors for suicidal behavior. Proximal risk factors determine the timing of suicidal behavior by translating the statistical potential of distal risk factors into action. The acute effects of alcohol intoxication act as important proximal risk factors for suicidal behavior among the alcoholic and nonalcoholic alike. Mechanisms responsible for alcohol's ability to increase the proximal risk for suicidal behavior include alcohol's ability to: (1) increase psychological distress, (2) increase aggressiveness, (3) propel suicidal ideation into action through suicide-specific alcohol expectancies, and (4) constrict cognition which impairs the generation and implementation of alternative coping strategies. Moreover, the proximal risk factors associated with acute intoxication are consistent with Baumeister's (1990) escape theory of suicide. Suggestions for additional research are discussed, including the possibility that a nonlinear cusp catastrophe model characterizes the relationship between alcohol intoxication and suicidal behavior.

Facilitation of internal locus of control in adolescent alcoholics through a brief biofeedback-assisted autogenic relaxation training procedure

The purpose of the study was to determine if autogenic relaxation training facilitated through biofeedback promotes an increase in internal levels of locus of control. The participants were residents of two Southwest Missouri alcohol treatment centers and ranged in age from 18 to 21 years. Treatment and control groups were compared on their responses on the Drinking Related Locus of Control Scale (DRIE) and fingertip temperature pre- and posttraining. The training was effective in teaching autogenic relaxation as demonstrated by increased fingertip temperature for the treatment group posttraining, while no differences were observed for the control group. Most importantly, the treatment group was not only significantly more internal in their locus of control after training but were also significantly more internal than the control group posttraining. Given that alcoholics are significantly more external in their locus of control than nonalcoholics, and that an internal locus of control implies an individual's belief that he or she has control and is responsible for his or her behavior, autogenic relaxation facilitated through biofeedback may be a very important component in therapeutic intervention for adolescent alcoholics.

Control orientation as a personality dimension among alcoholic and obese adult men undergoing addictions treatment

Rotter's (1966) I-E Locus of Control Scale was administered to 18 men in residential treatment for alcoholism and 13 men in intensive outpatient treatment for obesity. The obese sample scored significantly higher in internal locus of control, whereas the alcoholic sample was comparatively external in control orientation. These findings contradict currently held assumptions on the directionality of control orientation among both alcoholic and obese adults and suggest that internally oriented obese adults may feel that they have little control over their weight and eating behavior but more control over other aspects of their lives. In contrast, externally oriented alcoholics appear to be aware of their inability to control their drinking and their limited control over many factors influencing their lives. Implications for treatment are also discussed.

Life event and treatment attributions in drug abuse and rehabilitation

How positive and negative life events are perceived by drug abusers in nearly unexplored, yet attribution theory specifies ways in which such perceptions might differentiate drug abusers from nonabusers; it also suggests how attributions might relate to treatment effects and to rehabilitation. This study tested attributions about life events by drug abusers and matched controls as the drug abusers first entered residential treatment, and again later during treatment. Attributions about success and failure in treatment were also assessed. Results showed that attribution processes significantly differentiated drug abusers from controls and that those processes were related to ultimate rehabilitation outcome. Ways in which treatment might be made more effective by focusing on attribution processes are suggested.

Hopelessness in the alcoholic patient

The inability of the alcoholic to establish a meaningful posture towards the future has been articulated in terms of hopelessness. This study examines the effects of inpatient treatment on measures of hopelessness and implies that the decrease in hopelessness reported results from the restoration of a meaningful present during the course of treatment.