An Evaluation of Alcohol Sensitivity in the Context of the Acquired Preparedness Model

BACKGROUND

The acquired preparedness model (APM) posits that relationships between impulsivity-related traits and alcohol use are partly mediated by the biased acquisition of positive alcohol expectancies. Additionally, alcohol administration studies implicate associations between impulsivity-related traits and sensitivity to acute alcohol effects, suggesting that impulsivity-expectancy associations could be partly explained by individual differences in alcohol response. The present study assessed a theoretical extension of the APM by testing the prediction that self-reported sensitivity to alcohol would partly mediate impulsivity-expectancy relationships, and that the addition of alcohol sensitivity variables would account for increased variance in drinking quantity and problems relative to the traditional APM.

METHOD

Young adult heavy drinkers (N = 300, 53% women) completed the Alcohol Sensitivity Questionnaire, the UPPS-P Impulsive Behavior Scale, and measures of alcohol expectancies (Comprehensive Effects of Alcohol Questionnaire) and drinking quantity and related problems. Hypotheses were examined using path analysis.

RESULTS

Results supported significant indirect effects of sensation seeking on drinking quantity and problems via higher positive expectancies. Results also supported a significant indirect effect of negative urgency on drinking problems via negative expectancies. Although alcohol sensitivity variables showed unique associations with drinking outcomes, the addition of these variables did not improve model fit and hypothesized indirect paths involving impulsivity-related traits, alcohol sensitivity, and expectancies were not supported.

CONCLUSIONS

Future research is necessary to reconcile these results with laboratory findings suggesting that impulsive traits are frequently associated with sensitivity to alcohol's acute effects.

Alcohol-related blackouts across 55 weeks of college: Effects of European-American ethnicity, female sex, and low level of response to alcohol

BACKGROUND

While high blood alcohol concentrations (BACs) are required for alcohol-related blackouts (ARBs), additional characteristics also contribute to the risk, including a person's ethnicity, sex, and phenotypes relating to heavier drinking. Few prospective studies of ARBs have evaluated how these additional characteristics interact.

METHOD

Data regarding 398 European American (EA), Asian and Hispanic students were extracted from a 55-week prospective study of different approaches to decrease heavy drinking among college freshmen. Information on past month ARB frequency was determined at 8 assessments. While controlling for the prior month maximum BAC and active education vs. control group assignment, the patterns and intensities of ARBs over time across ethnic groups were evaluated with ANOVA at each follow-up for the full sample, and then separately by sex and then by low vs. high levels of response to alcohol status (LR). The overall pattern of ARBs over time was evaluated with a 3 ethnic groups by 2 sexes by 2 LR status by 8 time points mixed-design ANOVA.

RESULTS

Higher rates of ARBs over time were associated with EA ethnicity, female sex and a low LR to alcohol, with the ethnic differences in ARBs most robust in females and drinkers with high LRs. Participation in education programs aimed at heavy drinking was associated with decreases in ARBs.

CONCLUSIONS

The data indicate that in addition to BACs achieved, propensities toward ARBs relate to complex interactions between additional risk factors, including ethnicity, sex, and LR status.

A Prospective 5-Year Re-examination of Alcohol Response in Heavy Drinkers Progressing in Alcohol Use Disorder

BACKGROUND

The main neurobiological theories of the development of addiction, including tolerance, sensitization, incentive-sensitization, and allostasis, have not been tested in longitudinal human alcohol response research. To address this issue, we conducted the first controlled prospective investigation of subjective and neuroendocrine responses to alcohol measured over a 5-year interval in at-risk young adult heavy drinkers (HD) and light drinker control subjects.

METHODS

Participants were 156 individuals, 86 heavy drinkers and 70 light drinkers, undergoing an initial oral alcohol challenge testing (.8 g/kg alcohol vs. placebo) and an identical re-examination testing 5 to 6 years later. Alcohol use disorder (AUD) symptoms and drinking behaviors were assessed in the interim follow-up period.

RESULTS

At re-examination, HD continued to exhibit higher sensitivity on alcohol's stimulating and rewarding effects with lower sensitivity to sedative effects and cortisol reactivity, relative to light drinkers. In HD with high AUD symptom trajectories over follow-up, heightened alcohol stimulation and reward persisted at re-examination. HD with low AUD symptoms showed reduced alcohol stimulation over time and lower reward throughout compared with the HD with high and intermediate AUD symptoms.

CONCLUSIONS

Results support the early stage phase of the allostasis model, with persistently heightened reward sensitivity and stimulation in heavy drinkers exhibiting AUD progression in early mid-adulthood. While there are multiple pathways to development of a disorder as complex as AUD, maintenance of alcohol stimulatory and rewarding effects may play an important role in the continuation and progression of alcohol addiction.

Integrating alcohol response feedback in a brief intervention for young adult heavy drinkers who smoke: A pilot study

BACKGROUND

More effective approaches are needed to enhance drinking and other health behavior (e.g., smoking) outcomes of alcohol brief intervention (BI). Young adult heavy drinkers often engage in other health risk behaviors and show sensitivity to alcohol's stimulating and rewarding effects, which predicts future alcohol-related problems. However, standard alcohol BIs do not address these issues. The current pilot study tested the utility of including feedback on alcohol response phenotype to improve BI outcomes among young adult heavy drinkers who smoke (HDS).

METHODS

Thirty-three young adult (M±SD age=23.8±2.1 years) HDS (8.7±4.3 binge episodes/month; 23.6±6.3 smoking days/month) were randomly assigned to standard alcohol BI (BI-S; n=11), standard alcohol BI with personalized alcohol response feedback (BI-ARF; n=10), or a health behavior attention control BI (AC; n=11). Alcohol responses (stimulation, sedation, reward, and smoking urge) for the BI-ARF were recorded during a separate alcohol challenge session (.8g/kg). Outcomes were past-month drinking and smoking behavior assessed at 1- and 6-months post-intervention.

RESULTS

At 6-month follow-up, the BI-ARF produced significant reductions in binge drinking, alcohol-smoking co-use, drinking quantity and frequency, and smoking frequency, but not maximum drinks per occasion, relative to baseline. Overall, the BI-ARF produced larger reductions in drinking/smoking behaviors at follow-up than did the BI-S or AC.

CONCLUSIONS

Including personalized feedback on alcohol response phenotype may improve BI outcomes for young adult HDS. Additional research is warranted to enhance and refine this approach in a broader sample.

Alcohol challenge responses predict future alcohol use disorder symptoms: a 6-year prospective study

BACKGROUND

Propensity for alcohol misuse may be linked to an individuals' response to alcohol. This study examined the role of alcohol response phenotypes to future drinking problems.

METHODS

One hundred four young heavy social drinkers participated in a within-subject, double-blind, placebo-controlled laboratory alcohol challenge study with 6-year follow-up. Participants were examined for subjective responses before and after receiving an intoxicating dose of alcohol (.8 g/kg) or a placebo beverage, given in random order. Follow-up was conducted in 5 waves over 6 years after the sessions to assess drinking behaviors and alcohol use disorder (AUD) symptoms. Retention was high with 98% (509 of 520) of possible follow-ups completed.

RESULTS

Greater sensitivity to alcohol, in terms of stimulation and rewarding effects (like, want more) and lower sensitivity to alcohol sedation predicted greater number of AUD symptoms through 6 years of follow-up. Cluster analyses revealed that for half the sample, increasing levels of stimulation and liking were predictors of more AUD symptoms with the other half divided between those showing like and want more and want more alone as significant predictors.

CONCLUSIONS

The findings extend previous findings and offer new empirical insights into the propensity for excessive drinking and alcohol problems. Heightened alcohol stimulation and reward sensitivity robustly predicted more alcohol use disorder symptoms over time associated with greater binge-drinking frequency. These drinking problems were maintained and progressed as these participants were entering their third decade of life, a developmental interval when continued alcohol misuse becomes more deviant.