Gender comparisons of alcohol consumption in alcoholic and nonalcoholic populations

Basic Human Body Dimensions Relate to Alcohol Dependence and Predict Hospital Readmission

Alcohol dependence is a severe mental illness and there is a need for more effective preventive and therapeutic strategies. Translational research suggests that intrauterine sex hormone exposure modulates the risk and course of alcohol dependence during adulthood. During development, sex hormones permanently shape sexually dimorphic body dimensions. Thus, these dimensions may provide insight into sex hormone organization. Here, we compared body measurements (absolute, relative to, and residualized on height) between 200 alcohol-dependent in-patients and 240 age-matched healthy control subjects and investigated how these measurements associate with the patients' prospective 12- and 24-month outcome. The results show that alcohol dependence is related to lower absolute, relative, and residualized body measurements for height and weight, head circumference, bitragion head arc, lip-chin distance, hip, thigh, and calf circumference, and foot length and breadth. In male alcohol-dependent in-patients, higher risk, shorter latency, and more alcohol-related readmissions were predicted by higher absolute, relative, and residualized thigh and calf circumferences. The second-to-fourth finger length ratio, a putative proxy for prenatal sex hormone organization, was not convincingly correlated with the body dimensions, suggesting that the results represent pubertal (or later) effects. The study's findings have implications for further research. The body measurements' high accessibility may facilitate the future transition into clinical settings.

Toward more efficient diagnostic criteria sets and rules: The use of optimization approaches in addiction science

Psychiatric diagnostic systems, such as The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), use expert consensus to determine diagnostic criteria sets and rules (DCSRs), rather than exploiting empirical techniques to arrive at optimal solutions (OS). Our project utilizes complete enumeration (i.e., generating all possible subsets of item combinations A and B with all possible thresholds, T) to evaluate all possible DCSRs given a set of relevant diagnostic data. This method yields the entire population distribution of diagnostic classifications (i.e., diagnosis of the disorder versus no diagnosis) produced by a set of dichotomous predictors (i.e., diagnostic criteria). Once unique sets are enumerated, optimization on some predefined correlate or predictor will maximally separate diagnostic groups on one or more, disorder-specific "outcome" criteria. We used this approach to illustrate how to create a common Substance Use Disorder (SUD) DCSR that is applicable to multiple substances. We demonstrate the utility of this approach with respect to alcohol use disorder and Cannabis Use Disorder (CUD) using DSM-5 criteria as input variables. The optimal SUD solution with a moderate or above severity grading included four criteria (i.e. 1) having a strong urge or craving for the substance (CR), 2) failure to fulfill major role obligations at work school or home (FF), 3) continued use of the substance despite social or interpersonal problems caused by the substance use (SI) and 4) physically hazardous use (HU)) with a diagnostic threshold of two. The derived DCSR was validated with known correlates of SUD and performed as well as DSM-5. Our findings illustrate the value of using an empirical approach to what is typically a subjective process of choosing criteria and algorithms that is prone to bias. The optimization of diagnostic criteria can reduce criteria set sizes, resulting in decreased research, clinician, and patient burden.

Association of lifestyle modification and pharmacological adherence on blood pressure control among patients with hypertension at Kenyatta National Hospital, Kenya: a cross-sectional study

OBJECTIVE

Association of lifestyle modification and pharmacological adherence among patients with hypertension attending a national referral hospital in Kenya.

DESIGN

Descriptive, cross-sectional.

SETTING

Medical wards and outpatient clinic of a national referral hospital.

PARTICIPANTS

Patients (n=229) diagnosed with primary hypertension for at least 6 months.

PRIMARY OUTCOMES

Clinical makers, cholesterol levels, anthropometrics, lifestyle/dietary habits adjusted for age, gender and education; antihypertensive adherence; views on prevention of hypertension and adequacy of hypertension information.

RESULTS

Ageing was associated with elevated diastolic blood pressure (BP) (p<0.05), heart rate (HR) and cholesterol. Females had higher body mass index (BMI). More males reported drinking alcohol and smoking (p<0.001), especially the highly educated. Higher BPs were observed in smokers and drinkers (p<0.05). Daily vegetables and fruits intake were linked to lower BP, HR and BMI (p<0.05). Intake of foods high in saturated fat and cholesterol were associated with raised HR (p<0.05). Respondents on antihypertensive medication, those engaged in healthy lifestyle and took their prescribed medications had lower mean BPs than those on medication only (138/85 vs 140/90). Few respondents (30.8%) considered hypertension as preventable, mainly the single and highly educated (p<0.05). Respondents (53.6%) believed they should stop taking their antihypertensive medication once hypertension is controlled.

CONCLUSION

Missed targets for BP control and hypertension-related risks are associated with ageing, female gender, fast food and animal fat intake. Alcohol and smoking is common in males associated with poor BP control. Daily vegetables and fruits intake are associated with better BP control and overall hypertension risk reduction. Observed suboptimal BP control despite pharmacological adherence suggests lifestyle modification is needed besides antihypertensive medication. Interventions should address modifiable risk factors aggravated by age and adverse lifestyles through adopting combined lifestyle modification, pharmacological adherence and tailored expert delivered hypertension-related information.

The role of the orbitofrontal cortex in alcohol use, abuse, and dependence

One of the major functions of the orbitofrontal cortex (OFC) is to promote flexible motivated behavior. It is no surprise, therefore, that recent work has demonstrated a prominent impact of chronic drug use on the OFC and a potential role for OFC disruption in drug abuse and addiction. Among drugs of abuse, the use of alcohol is particularly salient with respect to OFC function. Although a number of studies in humans have implicated OFC dysregulation in alcohol use disorders, animal models investigating the association between OFC and alcohol use are only beginning to be developed, and there is still a great deal to be revealed. The goal of this review is to consider what is currently known regarding the role of the OFC in alcohol use and dependence. I will first provide a brief, general overview of current views of OFC function and its contributions to drug seeking and addiction. I will then discuss research to date related to the OFC and alcohol use, both in human clinical populations and in non-human models. Finally I will consider issues and strategies to guide future study that may identify this brain region as a key player in the transition from moderated to problematic alcohol use and dependence.

Investigation of Sex Differences in the Microglial Response to Binge Ethanol and Exercise

The female brain appears selectively vulnerable to the neurotoxic effects of alcohol, but the reasons for this are unclear. One possibility is an exaggerated neuroimmune response in the female brain, such that alcohol increases microglia number and reactivity to subsequent stimuli, such as exercise. It is important to better characterize the interactive neural effects of alcohol and exercise, as exercise is increasingly being used in the treatment of alcohol use disorders. The present study compared the number of microglia and evidence of their activation in alcohol-vulnerable regions of the brain (medial prefrontal cortex and hippocampus) in male and female rats following binge alcohol and/or exercise. Binge alcohol increased microglia number and morphological characteristics consistent with their activation in the female brain but not the male, regardless of exercise. Binge alcohol followed by exercise did increase the number of MHC II+ (immunocompetent) microglia in females, although the vast majority of microglia did not express MHC II. These results indicate that binge alcohol exerts sex-specific effects on microglia that may result in enhanced reactivity to a subsequent challenge and in part underlie the apparent selective vulnerability of the female brain to alcohol.

Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations

AIMS

To review the contemporary evidence reflecting male/female differences in alcohol use and its consequences along with the biological (sex-related) and psycho-socio-cultural (gender-related) factors associated with those differences.

METHODS

MEDLINE, PubMed, Web of Science, SCOPUS, PsycINFO, and CINAHL databases were searched for relevant publications, which were subsequently screened for the presence/absence of pre-specified criteria for high quality evidence.

RESULTS

Compared to men, more women are lifetime abstainers, drink less, and are less likely to engage in problem drinking, develop alcohol-related disorders or alcohol withdrawal symptoms. However, women drinking excessively develop more medical problems. Biological (sex-related) factors, including differences in alcohol pharmacokinetics as well as its effect on brain function and the levels of sex hormones may contribute to some of those differences. In addition, differences in alcohol effects on behavior may also be driven by psycho-socio-cultural (gender-related) factors. This is evident by variation in the magnitude of differences in alcohol use between countries, decreasing difference in the rates of alcohol consumption in recent generations and other findings. Evidence indicates that both sex and gender-related factors are interacting with alcohol use in complex manner, which differentially impacts the risk for development of the behavioral or medical problems and alcohol use disorders in men and women.

CONCLUSIONS

Discovery of the mechanisms underlying biological (sex-related) as well as psycho-socio-cultural (gender-related) differences in alcohol use and related disorders is needed for development of personalized recommendations for prevention and treatment of alcohol use disorders and related problems in men and women.

Emergence of sex differences in the development of substance use and abuse during adolescence

Substance use and abuse begin during adolescence. Male and female adolescent humans initiate use at comparable rates, but males increase use faster. In adulthood, more men than women use and abuse addictive drugs. However, some women progress more rapidly from initiation of use to entry into treatment. In animal models, adolescent males and females consume addictive drugs similarly. However, reproductively mature females acquire self-administration faster, and in some models, escalate use more. Sex/gender differences exist in neurobiologic factors mediating both reinforcement (dopamine, opioids) and aversiveness (CRF, dynorphin), as well as intrinsic factors (personality, psychiatric co-morbidities) and extrinsic factors (history of abuse, environment especially peers and family) which influence the progression from initial use to abuse. Many of these important differences emerge during adolescence, and are moderated by sexual differentiation of the brain. Estradiol effects which enhance both dopaminergic and CRF-mediated processes contribute to the female vulnerability to substance use and abuse. Testosterone enhances impulsivity and sensation seeking in both males and females. Several protective factors in females also influence initiation and progression of substance use including hormonal changes of pregnancy as well as greater capacity for self-regulation and lower peak levels of impulsivity/sensation seeking. Same sex peers represent a risk factor more for males than females during adolescence, while romantic partners increase risk for women during this developmental epoch. In summary, biologic factors, psychiatric co-morbidities as well as personality and environment present sex/gender-specific risks as adolescents begin to initiate substance use.

Effect of sex on ethanol consumption and conditioned taste aversion in adolescent and adult rats

RATIONALE

Vulnerability to alcoholism is determined by many factors, including the balance of pleasurable vs. aversive alcohol-induced sensations: pleasurable sensations increase intake, while aversive sensations decrease it. Female sex and adolescent age are associated with lower sensitivity to intake-reducing effects and more rapid development of alcohol abuse.

OBJECTIVES

This study assessed voluntary drinking and the aversive effects of alcohol to determine whether these measures are inversely related across the sexes and development.

METHODS

Voluntary drinking of 20 % ethanol in an every-other-day (EOD) availability pattern and the dose-response relationship of ethanol conditioned taste aversion (CTA) were assessed in male and female adolescent and adult rats.

RESULTS

CTA was sex specific in adult but not adolescent rats, with adult females exhibiting less aversion. Voluntary ethanol consumption varied according to age and individual differences but was not sex specific. Adolescents initially drank more than adults, exhibited greater day-to-day variation in consumption, were more susceptible to the alcohol deprivation effect, and took longer to establish individual differences in consumption patterns.

CONCLUSIONS

These results show that the emergence of intake patterns differs between adolescents and adults. Adolescents as a group initiate drinking at high levels but decrease intake as they mature. A subset of adolescents maintained high drinking levels into adulthood. In contrast, most adults consumed at steady, low levels, but a small subset quickly established and maintained high-consumption patterns. Adolescents also showed marked deprivation-induced increases. Sex differences were not observed in EOD drinking during either adolescence or adulthood.

Female rats display enhanced rewarding effects of ethanol that are hormone dependent

BACKGROUND

Ethanol (EtOH) abuse is a major health and economic concern, particularly for females who appear to be more sensitive to the rewarding effects of EtOH. This study compared sex differences to the rewarding and aversive effects of EtOH using place-conditioning procedures in rats.

METHODS

Separate groups of adult (male, female, ovariectomized [OVX] female) and adolescent (male and female) rats received EtOH (0, 0.5, 1.0, 2.0, or 2.5 g/kg, intraperitoneal) and were confined to their initially nonpreferred side of our conditioning apparatus for 30 minutes. On alternate days, they received saline and were confined to the other side. Following 5 drug pairings, the rats were retested for preference behavior. Separate cohorts of the same groups of rats were injected with a similar dose range of EtOH, and blood EtOH levels (BELs) were compared 30 minutes later.

RESULTS

EtOH produced rewarding or aversive effects in a dose-dependent manner. An intermediate dose of EtOH (1.0 g/kg) produced rewarding effects in adult female, but not in male or OVX female rats, suggesting that ovarian hormones facilitate the rewarding effects of EtOH. Similarly, this intermediate dose of EtOH produced rewarding effects in adolescent female, but not in male rats. The highest dose of EtOH (2.5 g/kg) produced aversive effects that were similar across all adult groups. However, the aversive effects of EtOH were lower in adolescents than adults, suggesting that adolescents are less sensitive to the aversive effects of EtOH. The aversive effects of EtOH did not vary across the estrous cycle in intact adult females. There were also no group differences in BELs, suggesting that our results are not related to EtOH metabolism.

CONCLUSION

Our results in rats suggest that human females may be more vulnerable to EtOH abuse due to enhanced rewarding effects of this drug that are mediated by the presence of ovarian hormones.

Teasing Apart the Roles of Gender and Alcohol in Drinking Consequences Using an Event-Level Analysis

The objective was: to assess gender differences in university students' likelihood of experiencing negative drinking consequences across the first academic year, controlling for amount of alcohol consumed on each occasion; also to assess whether the relation between amount consumed and experiencing the consequence is moderated by gender. On weekly assessments over 26 weeks, first-year university students (N = 265; 177 women; Mage = 18.48) recorded number of drinks consumed and negative drinking consequences experienced each day. A greater percentage of men experienced at least one drinking consequence. However, when analyses focused on drinking occasions controlling for consumption, women were at greater risk for experiencing many drinking consequences including unplanned sex, injury, and memory lapses. Further, the likelihood of experiencing unprotected sex increased with greater alcohol consumption for women but not for men. A greater focus on risks for women is needed in understanding and preventing negative drinking consequences.

Selected sociodemographic factors and related differences in patterns of alcohol use among university students in Slovakia

Background

Alcohol use and misuse and their relation to sociodemograhic factors are well studied among university students in Western European countries and the USA, but less is known about students in Eastern Europe. The historical past as communistic countries might have affected the social life among these populations, which is again one of the main factors determining the alcohol consumption among university students. The aim of our study was to assess the association of selected sociodemographic factors with different patterns of alcohol use among university students in Slovakia.

Methods

A sample of 813 young adults (mean age 21.1 years, 63.8% females; response rate of 71%) from four universities in Kosice answered questions about their sociodemographic background and about alcohol use. To obtain a detailed picture of different aspects, alcohol use was measured by four variables: frequency of alcohol use, heavy episodic drinking, frequency of drunkenness and problem drinking. Four separate logistic regression models were used to assess the association between sociodemographic and alcohol-related variables. To assess the potentially different effects in both genders, all two-way interactions with gender were tested.

Results

While 41% of the students drank alcohol once a week or more often, 77% reported heavy episodic drinking and 49% had been drunk more than once in the last month. Problem drinking existed in 23.3% of the sample. Gender was consistently associated with all four alcohol-related variables, with males being at higher risk. A higher study year was associated only with lower levels of heavy episodic drinking, but displayed no association with the other studied variables. Living with parents during the semester was consistently associated with less frequent heavy episodic drinking, drunkenness episodes, and problem drinking while having an intimate relationship was associated with less problem drinking only.

Conclusions

Our findings for the university students from Slovakia are in line with previous studies in Western Europe. Additionally, it appears that frequent alcohol use, excessive alcohol use (heavy episodic drinking and drunkenness) and problem drinking among university students represent a continuum and are influenced by the same sociodemographic factors.

Defining "binge" drinking as five drinks per occasion or drinking to a .08% BAC: which is more sensitive to risk?

Heavy episodic or "binge" drinking is commonly defined as drinking 4-5 drinks per occasion (5/4 definition) or drinking that results in a blood alcohol concentration (BAC) of .08%. The present study compared the validity of each binge definition as an indicator of at-risk, problem drinking. Two hundred and fifty-one college students were classified as nonbinge drinkers or as binge drinkers based on the 5/4 definition or the .08% BAC definition. The two definitions of binge drinking were examined in terms of their sensitivity and specificity as indicators of alcohol-related problems as determined by scores on the Alcohol Use Disorders Identification Test (AUDIT). Over half the sample (56%) were at-risk drinkers according to the AUDIT. The .08% definition detected only one-half of these individuals. Gender differences were also evident. Female binge drinkers actually achieved significantly higher estimated BACs per episode than their male binge drinking counterparts. The findings suggest that drinking to a subthreshold BAC (ie, <.08%) is not sufficient to avoid alcohol-related problems, and that total quantity (ie, total standard drinks) per occasion might contribute to risk independent of the BAC achieved during drinking episodes. The findings also highlight the importance of considering frequency of consumption in determining risky drinking versus relying solely on quantity measures. 

An interaction between DAT1 and having an alcoholic father predicts serious alcohol problems in a sample of males

The current study examines whether the dopamine transporter (DAT1) VNTR polymorphism and paternal alcoholism are related to serious alcohol problems. Using data from the National Longitudinal Study of Adolescent Health (Add Health), we found that the DAT1 polymorphism interacted with paternal alcoholism to predict serious alcohol problems among males. Specifically, the 10-repeat allele conferred an increase of alcohol problems only among males who also had an alcoholic father; the 10-repeat allele was unrelated to alcohol problems for males without an alcoholic father. Coefficient tests revealed that this interaction effect was stronger among African-American males. Females who possessed the 9-repeat allele were more likely to report serious alcohol problems, but this effect was not moderated by paternal alcoholism. These analyses suggest that additive and interactive effects of DAT1 and paternal alcoholism may operate differently across genders and races.

Paternal alcohol use and the mother-infant relationship

The purpose of this study was to examine the association between paternal alcohol use and the mother-infant relationship. A related goal was to investigate the role of maternal depression and marital satisfaction in moderating this relationship. Subjects were 55 mother-infant dyads (12–24-month-old infants) who were observed in the Strange Situation paradigm to assess infant attachment and in structured play interactions. There were 23 families with heavy drinking fathers and 32 with light drinking fathers. As predicted, infants of heavy drinking fathers were more likely to be insecurely attached compared to infants of light drinking fathers. Contrary to expectations, neither maternal depression nor marital interaction mediated the relationship between paternal alcohol use and mother-infant interactions. However, maternal depression did interact with paternal alcohol use to predict infant attachment security and maternal sensitivity. There was also an interactive effect of marital satisfaction and paternal alcohol use on maternal sensitivity. The results suggest that paternal alcohol use may influence family functioning and the mother-child relationship as early as infancy and suggest one possible pathway toward maladjustment among infants of heavy drinking fathers. However, in addition to investigating the impact of paternal alcohol use on the father-infant relationship, the influence of various familial factors associated with paternal alcohol use need to be more closely examined from a longitudinal perspective.

Patterns of alcohol use between genders: a cross-cultural evaluation

INTRODUCTION

Alcohol use by men and women is very much influenced by social habits and customs. Cultural peculiarities and biological differences between the sexes require more focused and standardized studies. The objective was to systematize information on patterns of alcohol use between the sexes.

METHOD

A literary review (1972-2004) identified 96 publications (Lilacs, Scielo, Medline) and some related books.

RESULTS AND CONCLUSIONS

Men drank more and presented more problems (legal, family, social, clinical, traumas and mortality) associated with alcohol use; the consequences of alcohol use in developing countries with low death rates is even higher. Women can face more discrimination by using alcohol as well as worse health problems when they abuse drinking (liver, pancreas, and central and peripheral nervous system problems, psychiatric comorbidity, etc.); sexual abuse is more commonly associated with women than discussing the different responses to treatment. As for social roles/responsibilities exercised by women, there are indications that marriage, employment, and children have a good influence, discouraging alcohol use, while divorce, unemployment, and no children contribute to higher consumption. For both sexes, religion was a protective factor for alcohol use; acculturation was a strong influence in the pattern of alcohol use, and alcohol worsened the evolution of existing psychiatric disorders.

Alcoholism in women: is it different in onset and outcome compared to men?

Onset and course of alcohol dependence show gender related differences (telescoping effect) suggesting that women are more vulnerable to chronic alcohol consumption. This raises the question whether the differences are associated with a different treatment outcome as well. We hypothesized, that alcohol dependent women with a telescoping course show a less favourable treatment outcome compared to men. We investigated 212 alcohol dependent patients; matching 106 consecutively admitted women with 106 men drawn from a total sample of 343 male patients. The treatment program consisted of a 6 week inpatient treatment and 12 months of outpatient aftercare. We assessed milestone variables in development and course of alcoholism and carried out standardized diagnostic tests, physical and blood examinations to evaluate the course of the disease and treatment outcome. Overall, we confirm the telescoping effect, a faster progression in the course of alcoholism (developmental events and adverse consequences) in women compared to men ("telescoping effect"). However, despite the telescoping effect treatment outcome was similar in women and men. During the inpatient treatment program no alcohol relapse occurred. Throughout the 12 months outpatient treatment we found no significant differences in the survival analysis between women (283.29+/-11.26 days) and men (284.72+/-12.16 days). At the end of the 12 months both groups had an abstinence rate of approximately 50% and a drop-out rate of 33%.

Behaviour problems in 18- to 36-month old children of alcoholic fathers: secure mother-infant attachment as a protective factor

This study examined the relationship between paternal alcoholism and toddler behavior problems from 18 to 36 months of age, as well as the potential moderating effects of 12-month infant-mother attachment security on this relationship. Children with alcoholic fathers had higher levels of internalizing and externalizing behavior than children of nonalcoholic fathers. Simple effects testing of an interaction effect of child age, group, and attachment security with mothers on externalizing behaviour suggested that at 24 and 36 months of age mother-infant attachment security moderated the relationship between alcohol group status and externalizing behaviour. Namely, within the alcohol group, those children with secure relationships with their mothers had significantly lower externalizing than insecure children of alcoholics. A similar pattern was noted for internalizing behavior at 36 months of age. Implications for intervention are discussed.

Association of age at first drink with current alcohol drinking variables in a national general population sample

BACKGROUND

Age at first drink has been found to be associated with alcohol problems in adulthood, but little is known regarding the relationship of age at first drink and current alcohol intake variables. This study was designed to determine the relationship of age at first drink to traditional drinking variables as well as novel current drinking variables assessed for the first time in a national general population sample.

METHOD

Data on age of first drink, pathological drinking (DSM-IV alcohol abuse or dependence) and alcohol intake on typical drinking occasions were collected on a national general population sample of 2631 subjects by means of computerized telephone interviewing. Variables assessed for the first time in a national survey included the duration of the typical drinking episode and the predicted peak blood alcohol levels achieved during those episodes.

RESULTS

Data from 2276 subjects who reported an age at first drink were used in this study. Men and lifetime pathological drinkers reported an earlier age at first drink than did, respectively, women or lifetime nonpathological drinkers. There were significant regression coefficients between age at first drink and several current drinking measures. The largest coefficients were usually found within younger age groups.

CONCLUSIONS

Age at first drink may be a useful predictive variable for some current drinking measures, including predicted peak blood alcohol levels as well as lifetime alcohol pathology. Further support was provided for the "convergence" hypothesis that the drinking habits of women have become more like those of men.

Alcohol impairment of behavior in men and women

AIMS

Studies have shown that alcohol impairs the ability to inhibit behavioral responses in humans and some evidence suggests that men might display greater impairment than women. The present study compared men and women in the degree to which a moderate dose of alcohol impaired their inhibitory control at comparable blood alcohol concentrations.

DESIGN

Twelve male and 12 female adult social drinkers received a moderate dose of alcohol (0.65 g/kg) and a placebo in a counterbalanced order and performed a cued go/no-go task that measured the ability to inhibit and execute behavioral responses.

FINDINGS

When the behavioral response was pre-potent (i.e. instigated), men displayed greater impairment of inhibitory control under alcohol than women. Men also reported greater levels of subjective stimulation from alcohol compared with women, who reported more sedation from the drug.

CONCLUSIONS

A gender difference in alcohol impairment of inhibitory control could account for observations that disinhibited and aggressive behaviors under alcohol are more pronounced in men than in women.

IMPACT OF FATHERS' ALCOHOLISM AND ASSOCIATED RISK FACTORS ON PARENT-INFANT ATTACHMENT STABILITY FROM 12 TO 18 MONTHS

This study examined short-term attachment stability and sought to identify predictors of stability and change within a sample characterized by fathers' alcoholism. Results suggest moderate stability of attachment classifications (60% for mothers, 53% for fathers) from 12 to 18 months. Higher paternal and maternal alcohol symptoms, maternal depression, and maternal antisocial behavior were found in families with stable insecure mother-infant attachment compared to those who were stable secure. Mother-infant stable insecurity was associated with higher levels of maternal negative affect expression during play. Father-infant stable insecurity was associated with lower levels of paternal positive affect expression and decreased sensitivity during play. Stable insecure children also had higher levels of negative affect during parent-infant interactions and higher negative emotionality during other episodes compared to stable secure children. Results indicate that infants who were insecure at both time points had the highest constellation of family risk characteristics.

Role of parasympathetic (vagal) cardiac control in elevated heart rates of smokers

Smokers may develop chronic increases in cardiac rate and alterations in cardiovascular control. If the increased mean heart rate (HR) in cigarette smokers is due in part to a deficit in vagal cardiac rate control, this should be reflected in a decreased amplitude of respiratory sinus arrhythmia (RSA). To test this hypothesis we studied 36 smokers and 36 non-smokers, matched for age, race, gender and blood pressure. All subjects were studied in the supine and seated positions. Mean heart rate was determined from the ECG during 30 s of quiet breathing; RSA was determined for 10 consecutive deep (>50% vital capacity) slow (5-7/min) breaths. Mean HRs in smokers were significantly higher than in non-smokers, but the increases in mean HRs evoked by a shift from the supine to seated position were lower in smokers than in non-smokers, suggesting that chronic tobacco use may alter the relative contributions of sympathetic and parasympathetic control of cardiac rate. Because neither the RSAs nor the position-dependent increase in RSA were different between smokers and non-smokers, we conclude that the elevated mean HRs in smokers were not the result of decreased respiratory or vasomotor modulation of vagal cardiac control, but instead were the result primarily of sympathetic stimulation.

Auditory P3 in female alcoholics

BACKGROUND

The P3 (P300) has been considered to be a phenotypical marker of the risk for alcoholism. Although reductions in visual P3 in male and female alcoholics have been replicated, studies of auditory target P3 have been inconsistent. Our objective was to study the magnitude of auditory P3 reduction in female alcoholics and to establish the association between P3 reduction and alcoholism while taking into account comorbid depression and psychoactive drug dependence. The characteristics of P3 reduction were further examined by studying the reduction in family history-positive and -negative individuals.

METHODS

Auditory target P3s recorded from 61 scalp electrodes in female alcoholics (n = 71) were compared with P3s from female controls (n = 159) ranging in age from 18 to 50 years. The amplitudes and latencies were statistically analyzed, by using repeated-measures ANOVA, in six regional electrode arrays and at representative electrode sites, with age and comorbid depression as covariates. The effects of family density and clinical variables such as depression and drug dependence were also examined with correlation analysis.

RESULTS

Alcoholic women had significantly lower P3 amplitudes in all six regions and at midline electrode sites. The reductions were not associated with comorbid depression, as shown by low correlations and similar P3 amplitudes at Pz in female alcoholics with and without depression. The P3 amplitudes in women with a high family density were smaller than those in women with a low family density of alcohol dependence. Drug dependency did not influence P3 amplitude, as shown by similar responses in drug-dependent and non-drug-dependent alcoholic women.

CONCLUSIONS

These findings highlight the significance of P3 reductions associated with alcoholism in women, independently of comorbid depression. Family density effects further support the evidence that these findings are heritable. These results suggest that P3 can be considered as a phenotypical marker of vulnerability to alcoholism in women.

Cognitive deficits and CNS damage after a 4-day binge ethanol exposure in rats

Impairments of learning and memory are common neuropsychological sequelae of chronic alcohol abuse. Alcoholics often have impairments of anterograde memory, including spatial memory dysfunction, and a tendency toward response perseveration. This study was designed to assess the effects of binge ethanol exposure on neurodegeneration and cognitive function. Rats were given ethanol three times daily for 4 days. Silver staining revealed neurodegeneration in the olfactory bulb, piriform cortex, perirhinal cortex, entorhinal cortex, and dentate gyrus. After withdrawal, behavioral testing in the Morris water maze revealed significant differences in reversal learning between treatment groups. Ethanol-treated animals required more trials to learn the reversal task, entered the previously trained quadrant more often, and spent more time there than controls. [3H]PK-11195 binding, an index of CNS damage, was elevated in the piriform cortex of ethanol-treated animals. Thus, binge ethanol exposure resulted in neurodegeneration of a corticolimbic circuit with common excitatory inputs from the olfactory bulb and was associated with perseverative responding on a spatial learning task. These studies suggest that a single binge drinking episode could cause neurodegeneration and cognitive dysfunction in humans. The perseverative nature of the behavioral deficit could be related to both cognitive dysfunction and the behavioral components of the addiction process.

Microstructural but not macrostructural disruption of white matter in women with chronic alcoholism

The results of in vivo neuroimaging studies assessing whether and where brain white matter damage occurs in alcoholic women is controversial. To address this controversy, we examined regional white matter macrostructure and microstructure, the latter of which may be more sensitive to the detection of subtle fiber disruption than gross measures of size. Accordingly, we used conventional magnetic resonance imaging (MRI) to quantify regional callosal size and diffusion tensor imaging (DTI) to examine intravoxel coherence (fractional anisotropy, FA) and intervoxel coherence (C) of white matter of the genu and splenium of the corpus callosum and of the centrum semiovale in 12 detoxified alcoholic women and 18 control women. Additional analyses examined sex differences in FA and C in alcoholic women compared with alcoholic men. Despite absence of group differences in regional areas of callosal macrostructure, the alcoholic women had lower FA and C in genu and centrum semiovale than the control group of women. These measures also correlated with total lifetime consumption of alcohol and performance on a test of visual search in the alcoholic women. Sex comparisons revealed similar extents of FA abnormality in the genu and centrum semiovale in alcoholic men and women and differential effects in other DTI measures, with abnormalities present in splenium FA and C in the men and abnormalities present in centrum C in the women. These results provide in vivo evidence for disruption of white matter microstructure in alcoholic women not necessarily detectable with coarser measures of white matter mass and perhaps antedating its appearance.

A profile of neuropsychological deficits in alcoholic women

Neuropsychological deficits, most notable in executive, visuospatial, and functions of gait and balance, are detectable in alcoholic men even after a month of sobriety. Less well established are the severity and profile of persisting deficits in alcoholic women. The authors used an extensive test battery to examine cognitive and motor functions in 43 alcoholic women who were sober, on average, for 3.6 months. Functions most severely affected in alcoholic women involved visuospatial and verbal and nonverbal working memory processes as well as gait and balance. Areas of relative sparing were executive functions, declarative memory, and upper-limb strength and speed. The authors found that lifetime alcohol consumption was related to impairment severity on Block Design (Wechsler Adult Intelligence Scale-Revised, D. Wechsler, 1981) and verbal and nonverbal working memory, suggesting a dose effect of alcohol abuse. The alcohol-related deficits in working memory, visuospatial, and balance implicate disruption of prefrontal, superior parietal, and cerebellar brain systems.

TEMPERAMENT AND BEHAVIORAL PROBLEMS AMONG INFANTS IN ALCOHOLIC FAMILIES

This study examined the association between paternal alcoholism and 12-month infant temperament and 18-month behavior problems. The role of associated parental psychopathology and maternal drinking in exacerbating risk for maladaptive behavioral outcomes was also examined. Participants were 213 families (102 control families, 94 paternal alcoholic families, and 17 families with alcoholic fathers and heavy drinking mothers) who were assessed when their child was 12 months old and reassessed again when their child was 18 months old. Infants of alcoholics displayed marginally more stubborn/persistent temperaments at 12 months of age, but significantly more internalizing problems at 18 months. Analyses suggested that internalizing problems in the infants of alcoholics could be attributed to the paternal depression concomitant with paternal alcoholism. In addition, an interaction was observed, indicating that paternal alcohol problems predicted 18-month externalizing problems among families with low maternal depression, but not among families with high maternal depression. Children of depressed mothers exhibited uniformly higher externalizing scores, but were not further impacted by paternal alcohol problems. However, children of nondepressed mothers were adversely affected by fathers' drinking as reflected by higher externalizing behavior scores. The results highlight the necessity of addressing the overall contextual risks that occur with paternal alcoholism in studies of the development of children in alcoholic families.

Bitter and sweet components of ethanol taste in humans

This study examined taste descriptions elicited by ethanol and by other tastants in humans. All subjects described 10% ethanol as bitter and approximately 30% of the subjects described it as sweet and/or sour. Highly significant correlations were found between sweetness of some sucrose solutions (0.6-1%) and intensity of the taste of ethanol. In another experiment, quinine (bitter) solutions were rated as similar to 10% ethanol taste and this effect was potentiated by the addition of sucrose. In contrast, citric acid (sour) tended to decrease similarity ratings when added to the quinine solutions. Taken together, these findings suggest that: (1) in humans ethanol tastes both bitter and sweet; and (2) the relationship between sucrose and ethanol intakes previously found in animals and humans may result, at least partially, from similar taste responses elicited by sucrose and ethanol.

Determinants of the risk and timing of alcohol and illicit drug use onset among natives and non-natives: similarities and differences in family attachment processes

This study examines data from Native Ontario reserve residents (Embree, 1993) and a sample from the Ontario Health Survey Supplement (1990-91) in order to compare and contrast the importance of family attributes such as parent-child attachment to Native and Non-native patterns of drug and alcohol use onset. Proportional Hazards modeling (Cox, 1972) was employed to identify factors associated with the risk and timing of onset of alcohol and illicit drugs for both cultural groups. For both Natives and Non-natives alike, and considering both drinking and drug use onset together, age cohort predominates as a risk factor, with youngest groups at greatest risk, and especially in the case of drug use other than alcohol. For the model of drug use timing, age of alcohol use onset is the second best predictor for Natives, although its effect is still apparent, albeit weaker, in the case of Non-natives. As for family characteristics, a number of factors emerge as determinants of risk and depend, in part, on the cultural group and the substance under consideration. Consistent with attachment theory's prediction about the universal applicability of the need for close parent-child relations (Bowlby, 1969), the findings for both Natives and Non-natives alike point to the salience of psychosocial attachment and other indicators of family functioning in affecting early onset drinking and drug use, behaviors well-recognized to lead to potentially adverse mental and physical health consequences as well as to negative social outcomes.

Clinical significance of alcohol intake parameters at initiation of drinking

A considerable effort is now being focused upon the identification in young adulthood of predictive variables that can be used to detect individuals at risk for developing future alcohol problems. One goal is that such individuals may be targeted for early intervention efforts aimed at preventing the development of serious alcohol-related problems. Another goal is to extend the understanding of the etiology of alcoholism by identifying physiological and behavioral mechanisms underlying the addictive process. Reviewed below are efforts focused upon the importance and predictive value of the response to early exposures to ethanol, including alcohol intake variables at onset of drinking.

Gender, heroin consumption and economic behaviour

The study examines differences in consumption and economic behaviour among male and female heroin users. A sample of heroin injectors (n = 1834) was interviewed near the needle-exchange service in Oslo and information on consumption, prices, and income was recorded. The consumption pattern of the heroin addicts varies by gender, with females consuming relatively less alcohol and cannabis but significantly more heroin than their male counterparts. The finding of greater heroin consumption among women is surprising. By means of a switching regression model, price and income elasticities for heroin are estimated. Women appear to be more responsive than men to changes in prices. However, the elasticities also differ substantially by dealing status, and non-dealers are more price-responsive than dealers. Non-dealing males emerge with a higher income elasticity compared with their female counterparts, whereas female dealers seem to respond more to changes in income than do male dealers.

Nutritional status and body fluid distribution in chronic alcoholics compared with controls

BACKGROUND

At present few data are available on the total body water (TBW) content and in particular on the distribution of water in the intra- and extracellular compartments (ICW and ECW) of alcoholics. The aim of this study was to evaluate TBW, ICW, and ECW in chronic alcoholic patients.

METHODS

Thirty-six alcoholics meeting DSM-III-R criteria for diagnosis (20 men, 16 women; body mass index [BMI] 22.3+/-2.57 kg/m2) were enrolled. Fifty-four healthy social drinkers (31 men, 23 women; BMI 23.7+/-1.68 kg/m2) matched for age and height were used as controls. Systolic and diastolic blood pressure was measured for all cases. All patients were assessed using specific anthropometric measurements. The waist-to-hip ratio (WHR) was used as an indicator of body fat distribution. TBW was measured by isotopic dilution by giving 100 microCi of tritiated water. ICW and ECW were assessed by multifrequence bioelectric impedance analysis (BIA). Basal metabolic rate (BMR) was measured by indirect calorimetry.

RESULTS

Body weight was lower in the alcoholics than in the controls (61.9+/-5.5 kg vs. 65.8+/-5.2 kg;p < 0.01), essentially due to a reduction in fat mass. Significantly higher WHR values were found in both male (p < 0.001) and female (p < 0.001) alcoholics than in healthy subjects. A higher ECW/TBW ratio was found in the alcoholics compared with the controls, both as a whole (0.53+/-0.04 vs. 0.41+/-0.03; p < 0.0001) and separated by gender (p < 0.001).

CONCLUSIONS

The increased ECW could derive from an increase in cellular permeability related to endothelial damage linked to the vasoconstriction present in the alcoholics and/or to a direct toxic effect of ethanol on cellular membranes. In addition, because the high ECW volumes correlated positively with WHR in the alcoholics, a potential association of these two factors in determining an increased risk of liver disease, hypertension, and cardiovascular disease may exist. Finally, the lower TBW characteristic of women may be one of the reasons for the observed greater rate of toxic effects of ethanol that occur in women.

The drinking day as a unit of exposure in the epidemiology of alcohol-related medical disorders

Tissue or organ system damage resulting from alcohol ingestion typically requires several years of heavy drinking to reach clinical significance. Based upon earlier empirical findings and theorizing, we hypothesized that the lifetime number of exposures (drinking days) may be of significance in understanding the relationship between chronic alcohol consumption and organ system perturbations in alcoholic populations. To test this hypothesis, detailed lifetime alcohol consumption histories from a racially mixed cohort of detoxified alcoholics (n = 253) and nonalcoholics (n = 61) were examined to determine the lifetime total number of drinking days. Linear regressions corrected for lifetime total dose and pertinent confounding variables yielded statistically significant correlations of moderate size of the number of lifetime alcohol drinking days with diastolic blood pressure and quadriceps muscle strength. The findings were considered to provide evidence that an alcohol exposure (drinking day), independent of dose, is a biologically significant event in the genesis of tissue toxicities in the cohorts studied.

Gender, health beliefs, health behaviors, and alcohol consumption

We conducted a study of the relationship between health beliefs, health practices, and alcohol consumption among women and men using the Health Belief Model (HBM). The study sample (N = 41,104) was drawn from the 1990 National Health Interview Survey. A 15% random sample was selected from the total data set for the purpose of selecting variables. Alcohol consumption was defined as a health-related behavior and was regressed on demographic characteristics, health beliefs, and health practices. Quantity and frequency of alcohol consumption were assessed for each gender, using the HBM. The HBM explained similar amounts of the variance in alcohol use for women and men. Quantity of alcohol consumed accounted for more variance than did frequency of consumption. We conclude that health beliefs and behaviors are related to alcohol consumption after adjustment for demographic characteristics, and that differences exist between perceived risks and behaviors for both women and men.

Residual pressor effects of chronic alcohol in detoxified alcoholics

Although research in population studies has indicated that recent alcohol intake is positively correlated with blood pressure, there is a need to study the relationship of blood pressure to measures of lifetime alcohol intake in alcoholics. To this end, we assessed systolic and diastolic pressures and lifetime alcohol intake through structured interviews with 253 normotensive recovering alcoholics. Blood pressures were first corrected with multiple linear regression for the influence of confounding or modifying variables and then were regressed against alcohol consumption measures. Systolic pressure was significantly correlated (positively) with only a few measures of recent alcohol intake, and the correlations were not high (r2 = .05 to .11, P < .05). Diastolic pressure was found to be highly and positively correlated with the duration of the drinking career, but more so in blacks than in whites. The total lifetime dose of alcohol was found to be positively correlated with diastolic but not systolic pressure, but only in black male alcoholics. The steeper slope of the regression of blood pressure versus lifetime total alcohol or duration of the drinking career in black alcoholics suggests greater cardiovascular susceptibility to alcohol toxicity as lifetime doses increase and as the drinking career lengthens.

Gender difference in alcohol-evoked hypothalamic-pituitary-adrenal activity in the rat: ontogeny and role of neonatal steroids

Alcohol administration results in activation of the hypothalamic-pituitary-adrenal (HPA) axis, with female rats secreting more adrenocorticotropin (ACTH) and corticosterone (B) than males in response to the same dose of alcohol. We first examined the ontogeny of the gender difference in HPA responsiveness to alcohol by administering four doses (0, 1, 2, or 3 g/kg body weight) to animals at 21, 41, and 61 days of age (prepubertal, peripubertal, and postpubertal, respectively). We then investigated the organizational role of steroids by manipulating the neonatal steroidal milieu. Rats of both genders were gonadectomized or injected with testosterone propionate within 24 hr of birth and the HPA response to 3 g/kg body weight alcohol was tested in adulthood (postpubertal period). Our data show that the gender difference in HPA responsiveness to alcohol administration arises peripubertally. In addition, HPA response to alcohol is quantitatively smaller in intact male rats than in feminized groups (gonadectomized males and females, intact females) and masculinized female rats. We conclude that the gender difference in HPA response to alcohol observed in postpubertal rats injected with alcohol depends on the activational role of testicular androgens, rather than on their organizational influence.

Alcohol consumption in high school adolescents: frequency of use and dimensional structure of associated problems

The goal of this paper is to present data regarding the occurrence of alcohol consumption and the relative prevalences and the factorial structure of DSM-IV symptoms of alcohol abuse/dependence in a sample of 1507 older (14-18 years) community adolescents. Participants were diagnostically assessed at two time points, approximately 1 year apart. Three-quarters of the sample had tried alcohol. Boys in general had greater usual frequency and quantity of alcohol consumption than girls and began drinking at an earlier age; girls with a diagnosis of alcohol abuse/dependence had a significantly earlier mean age of alcohol disorder onset and were more likely to have a relapse of alcohol disorder. However, gender differences in symptom prevalence were non-significant. Seventeen per cent of the sample had at least one alcohol abuse/dependence symptom. The most frequent symptoms included reduced activities because of alcohol use, consumed more than intended, and tolerance. Eight of the 11 symptoms made a unique contribution to the prediction of diagnosis in a multiple logistic regression analysis. Components analysis supported the general division of symptoms into the categories of abuse and dependence.

Application of bioelectric impedance methodology and prediction equations to determine the volume of distribution for ethanol

In large-scale epidemiologic studies of drinking behavior there is a need for simple and reliable estimates of the body water compartment of subjects. This, in turn, provides an estimate of the volume of distribution of ingested ethanol and a better estimate of tissue exposure levels than the use of total body weight as the volume of distribution for alcohol. The volume of distribution for ethanol (total body water, TBW) was estimated in a racially mixed group of 276 alcoholics and 166 nonalcoholics (aged 20-59 years) by means of bioelectric impedance methodology (BIA) and by means of prediction equations based upon age, body weight, and height. Estimations of mean TBW from BIA were found to be only slightly higher (1-4%) than those provided by the prediction equations. TBW values generated from both prediction equations were also highly correlated with TBW values obtained by impedance methodology, with the highest correlations observed in females (particularly black) and in alcoholics (particularly female).

Drinking patterns and health status in smoking and nonsmoking alcoholics

Alcoholics who smoked also reported that they drank more frequently and consumed more alcohol on drinking occasions than alcoholics who did not smoke, a practice that resulted in a substantially greater lifetime alcohol consumption in the smokers. Smoking alcoholics also consumed more cigarettes and reported more smoking-related physical symptoms than social drinkers who smoked. The heart rates (HRs) of smoking and nonsmoking alcoholics were similar and both exceeded the HRs for the smoking social drinkers by approximately 13 beats/min (bpm) in males and by approximately 7 bpm in females. Surprisingly, correlations between HR and lifetime alcohol consumption were higher and slopes were steeper in controls than in alcoholics. HRs in a subset of the male alcoholics fell only approximately 3 bpm after 24 weeks of abstinence, but changed no further over an additional 24-week period. Taken together, the findings suggest that HRs may have been higher in this group of alcoholics before the onset of alcohol abuse and that alcohol intake contributed only slightly to the high HR.