Compulsive Drinkers Research Articles

An Artificial Appetite: The Nineteenth-Century Struggle to Define Habitual Drunkenness

summary: After discovering in 1811 that alcohol existed as a discrete chemical substance in all intoxicating drinks, physicians reconsidered the individual’s responsibility for becoming a compulsive drinker. Looking to science and medicine for legitimacy, temperance reformers ascribed a deleterious agency to alcohol and personified it as an agent of physiological destruction. Alcohol destroyed the body and transformed natural alimentary desires into a compulsive artificial appetite for alcohol. Reformers, prohibitionists, and physicians were troubled that alcohol possessed the ability to destroy the physical capacity for the power of choice. Ascribing agency to alcohol destabilized long-standing understandings of intemperance as a vice and imbued habitual drunkenness with medical meanings. However, most professionals remained anxious about absolving the habitual drunkard of all responsibility, especially for taking the first drink. An inchoate attempt to capture the medical and moral dilemmas of compulsion, habitual drunkenness represents a conceptual missing link in the genealogy of addiction.

Dietary tryptophan depletion alters the faecal bacterial community structure of compulsive drinker rats in schedule-induced polydipsia

RationaleCompulsive behaviour, present in different psychiatric disorders such as obsessive-compulsive disorder, schizophrenia and drug abuse, is associated with altered levels of serotonin (5-hydroxytryptamine, 5-HT). The gut microbiota regulates tryptophan (TRP) metabolism and may affect global 5-H synthesis in the enteric and central nervous systems, suggesting a possible involvement of gut microbiota in compulsive spectrum disorders. ObjectivesThe present study investigated whether chronic TRP depletion by diet alters the faecal bacterial community profiles of compulsive versus non-compulsive rats in schedule-induced polydipsia (SIP). Peripheral plasma 5-HT and brain-derived neurotrophic factor (BDNF) levels were evaluated. MethodsWistar rats were selected as High Drinkers (HD) or Low Drinkers (LD) according to their SIP behaviour and were fed for 14 days with either a TRP-free diet (T-) or a TRP-supplemented diet (T+). The faecal bacterial community structure was investigated with 16S rRNA gene-targeted denaturing gradient gel electrophoresis (DGGE) fingerprinting analysis. ResultsCompulsive HD rats showed a lower bacterial diversity than LD rats, irrespectively of the diet. The TRP-depleted HD rats, the only group increasing compulsive licking in SIP, showed a reduction of bacterial evenness and a highly functionally organized community compared with the other groups, indicating that this bacterial community is more fragile to external changes due to the dominance of a low number of species. The chronic TRP depletion by diet effectively reduced peripheral plasma 5-HT levels in both HD and LD rats, while plasma BDNF levels were not altered. ConclusionsThese results highlight the possible implication of reduced microbial diversity in compulsive behaviour and the involvement of the serotonergic system in modulating the gut brain-axis in compulsive spectrum disorders.

Increased Fear Memory and Glutamatergic Modulation in Compulsive Drinker Rats Selected by Schedule-Induced Polydipsia.

Compulsive behavior is observed in several neuropsychiatric disorders such as obsessive-compulsive disorder (OCD), anxiety, depression, phobia, and schizophrenia. Thus, compulsivity has been proposed as a transdiagnostic symptom with a highly variable pharmacological treatment. Recent evidence shows that glutamate pharmacotherapy may be of benefit in impaired inhibitory control. The purpose of the present study was: first, to test the comorbidity between compulsivity and other neuropsychiatric symptoms on different preclinical behavioral models; second, to assess the therapeutic potential of different glutamate modulators in a preclinical model of compulsivity. Long Evans rats were selected as either high (HD) or low (LD) drinkers corresponding with their water intake in schedule-induced polydipsia (SIP). We assessed compulsivity in LD and HD rats by marble burying test (MBT), depression by forced swimming test (FST), anxiety by elevated plus maze (EPM) and fear behavior by fear conditioning (FC) test. After that, we measured the effects of acute administration (i.p.) of glutamatergic drugs: N-Acetylcysteine (NAC; 25, 50, 100 and 200 mg/kg), memantine (3.1 and 6.2 mg/kg) and lamotrigine (15 and 30 mg/kg) on compulsive drinking on SIP. The results obtained showed a relation between high compulsive drinking on SIP and a higher number of marbles partially buried in MBT, as well as a higher percentage of freezing on the retrieval day of FC test. We did not detect any significant differences between LD and HD rats in FST, nor in EPM. The psychopharmacological study of glutamatergic drugs revealed that memantine and lamotrigine, at all doses tested, decreased compulsive water consumption in HD rats compared to LD rats on SIP. NAC did not produce any significant effect on SIP. These results indicate that the symptom clusters of different forms of compulsivity and phobia might be found in the compulsive phenotype of HD rats selected by SIP. The effects of memantine and lamotrigine in HD rats point towards a dysregulation in the glutamatergic signaling as a possible underlying mechanism in the vulnerability to compulsive behavior on SIP. Further studies on SIP, could help to elucidate the therapeutic role of glutamatergic drugs as a pharmacological strategy on compulsive spectrum disorders.

Reduced cortical serotonin 5-HT2A receptor binding and glutamate activity in high compulsive drinker rats

Serotonin2A receptors and glutamate signaling have been implicated in the pathophysiology and treatment of compulsive spectrum disorders. Schedule-Induced Polydipsia (SIP), characterized by excessive drinking under intermittent food reinforcement schedules, is a valid model for studying the compulsive phenotype in rats. We explored the expression, function, and neurochemistry of 5-HT2A receptors in the frontal cortex (FC) of rats with individual differences to compulsivity. Rats were selected for high (HD) versus low (LD) drinking on SIP. First, we measured 5-HT2A, 5-HT1A, and mGlu2/3 receptors and serotonin transporter binding in different brain regions. Second, we assessed the effect of microinfusion into the medial prefrontal cortex (mPFC) of the 5-HT2A/C receptor agonist DOI, the mGlu2/3 agonist LY379268, and the combination of DOI with the 5-HT2A receptor antagonist M100907 and the 5-HT2C receptor antagonist SB242084. Finally, we measured the serotonin and glutamate efflux in mPFC in basal condition and after DOI local application. The compulsive HD rats showed a specific reduction of 5-HT2A receptor binding in FC compared to LD rats. The highest dose of DOI reduced compulsive drinking in HD rats on SIP, whereas LY379268 did not induce any significant effect. The 5-HT2A receptor antagonist M100907 reversed the DOI induced reduction on compulsive drinking in HD rats while blocking the 5-HT2C receptor did not affect SIP. Compulsive HD rats showed increased serotonin and decreased glutamate efflux in basal conditions that were modified by the DOI application. These findings indicate that reduced 5-HT2A receptor binding and glutamate neurochemical mechanisms may underlie compulsive behavior vulnerability.

Excessive habit formation in schedule-induced polydipsia: Microstructural analysis of licking among rat strains and involvement of the orbitofrontal cortex.

Schedule-induced polydipsia (SIP) is an animal model of compulsive drinking that selects for individual differences and varies across rat strains. The aim of this study was to investigate excessive habit formation by analyzing the SIP licking microstructure among rat strains, and to compare the brain areas activated by SIP in different populations. Wistar, Long Evans and Roman High- and Low-Avoidance rat strains were compared using a cluster analysis of 2 main variables, that is, frequency of licking (percentage of interpellet intervals with drinking episodes) and intensity of licking (mean number of licks per interpellet interval), and were found to exhibit high intensity and frequent licking (compulsive drinkers, CD), low intensity but frequent licking (habitual drinkers, HD), and low intensity and low-frequency licking (low drinkers, LD). The Wistar strain showed a higher frequency and intensity of licking, and had the largest group of CD rats when compared with the other strains. Regarding the acquisition of SIP, CD rats showed a higher intensity of licking when compared with the HD and LD rats. Moreover, c-Fos quantification revealed that rats in the CD group showed hyperactivity in the lateral orbitofrontal cortex and basolateral amygdala when compared with the LD group. Analyzing the SIP microstructure could be a valuable tool for understanding the role of excessive habit formation in the development of compulsive drinking and its underpinning neurobiological mechanisms.

Activation of serotonin 5-HT2A receptors inhibits high compulsive drinking on schedule-induced polydipsia.

Schedule-induced polydipsia (SIP) is an established model for studying compulsive behaviour in rats. Serotoninergic drugs effectively reduce compulsive drinking on SIP, and high compulsive drinker rats selected by SIP have shown differences in serotoninergic brain activity. However, the specific serotoninergic receptors that modulate compulsive SIP remain unclear. We investigated the functional role of serotonin 5-hydroxytryptamine 2A or C (5-HT2A/C) receptors in compulsive SIP behaviour. Rats were selected for low (LD) versus high drinking (HD) behaviour on SIP. The effects of the systemic administration of the selective serotonin reuptake inhibitor citalopram, selective norepinephrine reuptake inhibitor atomoxetine, serotonin 5-HT2A/C receptor agonist DOI hydrochloride ((±)-2,5-dimethoxy-4-iodoamphetamine), serotonin 5-HT2C receptor antagonist SB242084, serotonin 5-HT2A receptor antagonist ketanserin and M100907 were assessed on SIP. Subsequently, the effects of DOI were tested after the pre-administration of SB242084, ketanserin and M100907 on SIP. Citalopram and DOI reduced compulsive drinking in HD compared with LD rats on SIP. In contrast, SB242084 increased compulsive drinking in HD compared with LD rats on SIP. Atomoxetine, ketanserin and M100907 had no effect on SIP. The reduction in water intake produced by DOI was blocked by ketanserin and M100907, but not by SB242084 administration, in HD rats. These findings highlight the contribution of serotoninergic 5-HT2A/C receptors compared with noradrenergic mechanisms on SIP and reveal the "therapeutic" activation of serotonin 5-HT2A in the inhibition of the compulsive drinking behaviour in HD rats. Thus, it may represent a potentially new marker of vulnerability and provides additional insight for potential treatments on compulsive behaviours in neuropsychiatric populations.

Erratum to: Poor inhibitory control and neurochemical differences in high compulsive drinker rats selected by schedule-induced polydipsia

Erratum to: Poor inhibitory control and neurochemical differences in high compulsive drinker rats selected by schedule-induced polydipsia

Poor inhibitory control and neurochemical differences in high compulsive drinker rats selected by schedule-induced polydipsia

Schedule-induced polydipsia (SIP), characterized by the development of excessive drinking under intermittent food reinforcement schedules, has been proposed as a model for obsessive-compulsive disorder, schizophrenia and drug abuse. The purpose of this study is to investigate if individual differences in SIP reflect psychopathological behavioural traits related to lack of inhibitory control and reactivity to novelty, and if these differences have neurochemical correlates. Outbred Wistar rats were selected for being either high (HD) or low (LD) drinkers according to their SIP behaviour. We tested locomotor reactivity to a novel environment and inhibitory control on the five-choice serial reaction time task (5-CSRTT), under baseline vs. extinction conditions and following challenge with D: -amphetamine (saline, 0.5 or 1 mg/kg). Post-mortem analyses of the monoaminergic levels in different brain regions were also analysed. Compared to LD animals, HD rats exhibiting SIP acquisition showed no differences in spontaneous locomotor reactivity to novelty. On the 5-CSRTT, HD rats showed a greater increase in perseverative responses under extinction, a trend towards elevated premature responses on baseline, and a significantly greater elevation of premature responses to D: -amphetamine 0.5 mg/kg. The HD animals also exhibited increased serotonin activity in the amygdala, and correlational analyses between the rate of drinking on SIP and monoamine levels also revealed altered dopaminergic mesolimbic function. These findings show that HD rats selected by SIP exhibit compulsive and impulsive behaviour based on measures of performance on the five-choice serial reaction time task and associated with changes in monoaminergic systems in limbic-striatal circuitry.

RATIONAL CAPACITY AS A CONDITION ON BLAME

Suppose that a particular woman intentionally takes a drink. To provide an evaluative context, suppose she ought not to have another because she will then be unfit to fulfill some of her obligations. Preanalytically, most of us would insist on the possibility and significance of the following three descriptions of the case: (1) the reckless or self-indulgent case; (2) the weak case; and (3) the compulsive case. In (1), the woman knows what she is doing but accepts the consequences. Her choice is to get drunk or risk getting drunk. She acts in accordance with her judgment. In (2) the woman knowingly takes the drink contrary to her (conscious) better judgment; the explanation for this lack of self-control is that she is weak-willed. In (3), she knowingly takes the drink contrary to her better judgment, but she is the victim of a compulsive (irresistible) desire to drink. (41–42) Distinguishing these three categories is important, because they are thought to license different responses to the drinker. While we blame both the reckless drinker and the weak-willed drinker, we do so in different ways, or for different things; the compulsive drinker, on the other hand, is excused in virtue of her compulsion. Although matters of moral importance thus hang on distinguishing these cases, providing a way to distinguish them proves difficult. Watson believes that both the weak-willed and the compulsive drinker act contrary to their better judgment. This distinguishes them from the reckless drinker. Distinguishing them from one another proves more difficult. In a natural first attempt, one might claim that the weak-willed drinker could have resisted the temptation while the compelled drinker could not have—she was compelled. This is a preprint. The final version can be found in Philosophical Books 48, no. 2 (April 2007): 109–123.

Symptomatic Hyponatremia after Voluntary Excessive Water Ingestion in a Patient without Psychiatric Problems

Water intoxication usually happens in patients with a psychiatric problem, who are subject to compulsive water ingestion, and during clinical examinations, such as uroflowmetry, and is seldom observed in ordinary people. Here we report a patient with severe hyponatremia due to voluntary water drinking coexisting with no psychiatric problems. The case presented clinically significant hyponatremia 124 mmol/L without any signs of dehydration after voluntary ingestion of 4000 ml of water over 3 hours. She normally responded to ingestion of 1000 ml of water over 20 min after recovery from hyponatremia, and did not meet the diagnostic criteria of SIADH. She was not a compulsive drinker. The present case suggests that one should consider water intoxication as a cause of hyponatremia in a patient without signs of dehydration, even if he/she does not have a history of compulsive water ingestion.

The codependent relationships of compulsive eaters and drinkers: Drawing parallels

Abstract This study compares compulsive eaters and their spouses with compulsive drinkers and their spouses. Through intensive interviewing, a pattern evolved revealing that these couples are often unable to process feelings and resolve conflicts. In order to cope with the resulting feelings and distance, the IPs, and often their spouses, engage in compulsive behaviors. The spouses' attempts to control and change the IPs' compulsivity exacerbates it; the couples' communication is organized around the compulsive behaviors. Thus, more feelings and conflict result which cannot be expressed constructively and resolved, perpetuating the cycle. The paper offers insight into and operationalizes the codependent nature of these relationships and implications for treatment.

Tobacco Smoking and Hyponatremia in Psychiatric Patients

To the Editor.— In his article, Dr Blum 1 states that in his study of ten compulsive drinkers he found that episodes of hyponatremia developed only in heavy smokers. We have previously looked at this question of heavy smokers and hyponatremia and polydipsia. 2 In our study, we found that most of the patients who presented with hyponatremia and severe neurological dysfunction were heavy smokers. However, when compared with normonatremic schizophrenics, the rate of smoking was not different. Many studies concerning hyponatremia and schizophrenia do show that these patients may have inappropriate release of antidiuretic hormone (ADH) associated with their polydipsia. Factors that cause this release of ADH remain uncertain. Studies with ADH levels and their relationship to smoking would be helpful to settle this matter.

Delabeling and relabeling in Gamblers Anonymous: Problems with transferring the Alcoholics Anonymous paradigm

Exploratory data from both structured and unstructured interviews with members of Alcoholics Anonymous and Gamblers Anonymous, as well as additional data from previous observations, suggest that the recovery rate of A.A. is higher than that of G.A.. Since the programs are virtually the same an examination of the social context of the labeling process reveals that the more readily available use of the medical model for both the alcoholic and the significant others of the alcoholic are likely significant differences between the compulsive gambler and the compulsive drinker.

The effects of Guided Participation and Systematic Desensitization in the treatment of a Paranoid Alcoholic: A Case Report

SummaryA compulsive drinker with severe behavorial problems, diagnosed as paranoid schizophrenic, was treated using several behavior modification techniques. Guided participation, role‐playing and systematic desensitization were used in an effort to reduce inappropriate fears and increase more adaptive behavior. The alcoholism was not treated directly. Upon termination of therapy (14 sessions), he had an extended period of sobriety and his social‐interpersonal situation was greatly improved. In a 12‐month follow‐up, he continued to remain sober without the emergence of other pathological features.

INTENSIVE CALCIUM THERAPY AS AN INITIAL APPROACH TO THE PSYCHOTHERAPEUTIC RELATIONSHIP IN THE REHABILITATION OF THE COMPULSIVE DRINKER.

INTENSIVE CALCIUM THERAPY AS AN INITIAL APPROACH TO THE PSYCHOTHERAPEUTIC RELATIONSHIP IN THE REHABILITATION OF THE COMPULSIVE DRINKER.

Chronic Alcoholics as Drinking Drivers

To the Editor:— Police records are replete with instances of drivers convicted again and again of driving while intoxicated. These records reveal that drivers, after an arbitrary length of time, are allowed their licenses, until finally they kill some other driver or themselves. It is finally coming to be realized that many of these drivers are chronic alcoholics. The chronic alcoholic, or problem drinker, is completely immune to slogans. Safety campaigns do not touch him at all. Scathing lectures by judges, even terms in jail, are just water on this duck's back. He is a compulsive drinker. Repetitive offenders should be sentenced to psychiatric investigation. Increasingly, traffic courts must have good, closely related psychiatric clinics. Detroit's Recorder's Court was the first of these and is still the best. The numbers of feeble-minded, psychotic, alcoholic, emotionally deranged, licensed drivers revealed by this clinic is appalling. If investigation reveals a chronic alcoholic,