Severity Of Alcohol-related Problems Research Articles

Direct and Indirect Symptom Severity Indicators of Alcohol Dependence and the Personality Concept of the Biosocial Model

Temperament and character factors are strongly related to the developmental, clinical, and treatment aspects of alcohol dependence. This study had the aim of revealing the underlying personality structure and individual differences in the symptoms of alcohol dependence measured by multiple severity indicators. Patients with alcohol dependence exhibited higher levels of novelty seeking and harm avoidance, and lower levels of persistence, self-directedness, and cooperativeness. Especially novelty seeking was connected with more severe alcohol dependence. These characteristics could be useful targets of interventions and Temperament and Character Inventory is therefore a useful measurement to identify patients with more severe alcohol-related problems.

The CC genotype in the T102C HTR2A polymorphism predicts relapse in individuals after alcohol treatment

The serotonin system is hypothesized to contribute to predisposition and course of alcohol dependence. However, the potential association between the T102C polymorphism (rs6313) in the type 2A serotonin receptor (HTR2A) gene and treatment outcomes in alcohol dependence has not been investigated. The aim of the study was to assess the contribution of this genetic polymorphism as a predictor of relapse in relation to other previously identified predictors. A sample of 254 alcohol dependent subjects, were recruited in alcohol treatment centers in Warsaw, Poland and prospectively assessed at baseline and follow-up after 12 months. At baseline, information about demographics, psychopathological symptoms and alcohol problems was obtained. The stop-signal task was performed and blood samples for genetic analysis of HTR2A T102C (rs6313) were collected. Relapse was defined as any drinking during the follow-up period. The statistical analysis showed that the CC genotype was significantly associated with increased relapse. Other significant factors were baseline depressive symptoms, number of drinking days during the 3 months prior to the baseline assessment, severity of alcohol-related problems, and a lifetime history of impulsive suicide attempts. Logistic regression analysis with and without the genetic factor revealed that adding the genetic factor increased the R square value by about 4%, with the CC genotype in the T102C polymorphism being the strongest predictor of relapse (OR = 2.32). The significant influence on relapse of the CC genotype, which is associated with fewer 5-HT2A receptors in the central nervous system, suggests the possibility that this genetic polymorphism could influence response to serotonergic medications.

The Level of Alexithymia in Alcohol-Dependent Patients Does Not Influence Outcomes after Inpatient Treatment

Background: The inability of individuals with Alcohol Use Disorders (AUD) to recognize and describe their feelings and cravings may be due to alexithymia. Previous researches have shown evidence for a negative influence of alexithymia on treatment outcomes in patients with AUD. Therefore, it was hypothesized that high alexithymic patients with AUD would benefit less from cognitive behavioral therapy (CBT) compared with low alexithymic patients. Methods: One hundred alcohol-dependent inpatients (DSM IV) were assessed with the Mini International Neuropsychiatric Interview for psychiatric disorders, the Toronto Alexithymia Scale (TAS-20), and the European Addiction Severity Index (EuropASI). Baseline alexithymia, as a categorical and continuous variable, was used to compare or relate baseline demographic and addiction characteristics, time in treatment, abstinence, and differences in addiction severity at 1-year follow-up. Analyses were performed using χ2 test, analysis of variance or Kruskal–Wallis, paired t-tests or Wilcoxon’s signed rank tests, multivariate logistic, and linear regression models, as appropriate. Results: The prevalence of high alexithymia (TAS-20 > 61) was 45%. The total TAS-20 score correlated negatively with years of education (r = −.21; p = .04) and positively with the psychiatry domain of the EuropASI (r = .23; p = .04). Alexithymia showed no relation to abstinence, time in treatment, or change in severity of alcohol-related problems on the EuropASI. Conclusion: High alexithymic patients with AUD do benefit equally from inpatient CBT-like treatment as low alexithymic patients with AUD. Scientific significance: Multimethod alexithymia assessments with an observer scale have been advised to judge the relationship with resulting outcome in CBT.

Palliative care or end-of-life care in advanced chronic obstructive pulmonary disease A prospective community survey

Calls for better end-of-life care for advanced chronic obstructive pulmonary disease (COPD) reflect the large number who die from the disease and their considerable unmet needs. To determine palliative care needs in advanced COPD. Cross-sectional interview study in patients' homes using structured questionnaires generated from 44 south London general practices. One hundred and sixty-three (61% response) patients were interviewed, mean age 72 years, 50% female, with diagnosis of COPD and at least two of: forced expiratory volume in the first second (FEV(1)) <40% predicted, hospital admissions or acute severe exacerbations with COPD, long-term oxygen therapy, cor pulmonale, use of oral steroids, and being housebound. Patients with advanced cancer, severe alcohol-related or mental health problems, or learning difficulties, were excluded; 145 patients were included in the analysis. One hundred and twenty-eight (88%) participants reported shortness of breath most days/every day, 45% were housebound, 75% had a carer. Medical records indicated that participants were at least as severe as non-participants. Eighty-two (57%) had severe breathlessness; 134 (92%) said breathlessness was their most important problem; 31 (21%) were on suboptimal treatment; 42 (30%) who were severely affected had not been admitted to hospital in the previous 2 years; 86 of 102 who had been admitted would want admission again if unwell to the same extent. None expressed existential concerns and few discussed need in terms of end-of-life care, despite severe breathlessness and impairment. Needs in advanced COPD were considerable, with many reporting severe intractable breathlessness. Palliation of breathlessness was a priority, but discussion of need was seldom in terms of 'end-of-life care'.

Pain, affect and psychotic illness

Dear colleagues, In order to cope with the increasing amount of interesting papers and due to the fact that Prof. Gattaz (Brazil) and Prof. Deakin (UK) discontinued to be co-editors based on their enormous work load, Hans-Juergen Moller and myself decided to renew and enlarge the editorial board. We are happy that Prof. Takeda (Japan), Prof. Heckers (USA), Prof. McGuire (England), Prof. Leboyer (France), Prof. Arango (Spain), Prof. Maier (Germany) and Prof. Rupprecht (Germany) have accepted our invitation to join the Editorial Board. We will soon decide how we will distribute the scientific fields to the individual members of the Editorial Board in order to improve our review process to maintain and improve the impact of our journal in the field. The current issue of the European Archives focuses on psychotic disorders. De Hert et al. [1] examined the effects of sertindole and risperidone on metabolic parameters in the short- and long-term treatment of schizophrenia. Segarra et al. [2] connect cognitive performance with smoking in first-episode psychosis. They discuss whether smoking in itself is a self-medication approach in order to improve symptoms like dyscognition. Park et al. [3] take up the discussion of olfactory identification, which is in the literature for schizophrenia for sometime but examining the specificity of this funding. Transcranial magnetic stimulation in the treatment of depression has received much attention from clinicians but recently less support in the literature. The paper by Langguth et al. [4] gives a good account of the usefulness of this method in the treatment of depression under naturalistic conditions. Disturbed pain modulation in psychiatric disorders has been underestimated for long time. Especially in somatoform disorders, this is changing recently. The paper by Klug et al. [5] focuses on the issue of dysfunctional pain modulation in somatoform pain disorder patients. Affective disorders are closely connected to the functioning of the immune system. Along these lines, Puustinen et al. [6] examines the association between psychological distress and C-reactive protein levels in the blood. Predicting psychiatric disorders in the offspring is currently discussed intensively. Steinlechner et al. [7] examines this issue from the other side by asking the question whether “Restless legs syndrome” is a possible predictor of psychiatric disorders in parents of children with ADHD. Predicting outcome of severe alcohol-related problems is the basis of a 20-year prospective epidemiological community study by Fichter et al. [8]. These are important data as the majority of our patients will suffer from psychiatric comorbidities for a substantial proportion of their life time. We hope that you will like the mix of papers relating to main topics in our field and enjoy reading this issue of the European Archives.

Severity of alcohol-related problems and mortality: results from a 20-year prospective epidemiological community study

There is evidence that high alcohol use is associated with an increase in mortality. Little is known about long-term effects of problematic alcohol consumption in non-clinical (community) populations. The aim of our study was to obtain data on this and related issues in a representative rural community sample assessed longitudinally over a period of 20years. Assessments focused on a baseline survey from 1980 to 1984 and 20-year follow-up from 2001 to 2004. Based on expert interviews and standardized self-rating scales (e.g. MALT; Munich Alcoholism Test), the following three groups were defined (a) severe alcohol problems, (b) moderate alcohol problems, and (c) no alcohol problems. Mortality and hazard rates were analyzed with logistic and Cox regression adjusted for several health risk factors. From an original community sample of 1,465 individuals, 448 were deceased at 20-year follow-up. Participation rates were high. Baseline prevalence according to the MALT was 1.6% for severe alcohol problems and 4.0% for moderate alcohol problems. Over the 20-year time span, individuals with severe alcohol problems had a significantly elevated risk for dying earlier than the group with no alcohol problems (2.4 times higher). Mortality for those with moderate alcohol problems at baseline had a non-significantly elevated 20-year mortality risk (1.5 times higher) compared to those with no alcohol problems. Cox survival analyses corroborate these findings from multiple sequential logistic regression analyses. In discussing the mortality risk of persons with alcohol problems, the severity of the alcohol problems must be taken into account.

P03-211 - Relationship of posttraumatic stress disorder and alexithymia with relapse during 12 months in male alcohol dependent inpatients

ObjectiveAim of this study was to evaluate the relationship of posttraumatic stress disorder (PTSD) and alexithymia with relapse to alcohol use during 12 month follow-up after inpatient treatment in male alcohol dependents. Age at regular alcohol use, severity of alcohol related problems and psychiatric symptoms were controlled while evaluating these relationships.MethodAmong 156 consecutively admitted male alcohol dependents 136 could be reached at the end of 12 months. Patients were investigated with the Clinician Administered PTSD Scale, the Symptom Check List and the Michigan Alcoholism Screening Test (MAST) and with the Toronto Alexithymia Scale (TAS-20) at baseline.ResultsAmong 136 alcohol dependent patients 66.2% (n=90) were considered to be relapsed according to telephone interview. Among these 102 were interviewed face to face. Rate of alexithymia and relapse and mean of “difficulty in identifying feelings-DIF” of TAS-20 were higher in PTSD group. Other than these there were no significant relationship between PTSD, alexithymia and relapse. PTSD diagnosis predicted relapse during 12 month follow-up (n=136). When only those who were evaluable to interview face to face included, only DIF predicted relapse (n=102).ConclusionsPTSD and alexithymia (particularly DIF factor) may be related with relapse during 12 month follow-up. This study suggest that rather than the early onset of alcohol use, the severity of alcohol related problems and the general psychiatric symptoms, PTSD and DIF, which may be related, are two factors to focus when relapse prevention programs are planning.

Interaction of life quality with alexithymia, temperament and character in male alcohol-dependent inpatients

The aim of this study was to investigate the relationship of life quality with alexithymia, temperament and character dimensions of personality. Participants were 156 consecutively admitted male alcohol dependents. Patients were investigated with the Toronto Alexithymia Scale, the Temperament and Character Inventory, the Michigan Alcoholism Screening Test and the Medical Outcomes Study Short Form 36-item health survey. Among alcohol-dependent inpatients 30.1% were considered as alexithymic. Severity of alcohol related problems was higher in alexithymic group, whereas quality of life (QoL) was lower. Alexithymia, novelty seeking (NS) and harm avoidance (HA) were negatively, reward dependence, self-directedness and cooperativeness were positively correlated with QoL scores. 'Difficulty in identifying feelings' (DIF) factor of alexithymia and HA were the determinants of physical dimension of Life Quality in Linear Regression model, whereas DIF, HA and NS were the predictors of mental dimension score. Among alcohol-dependent men, DIF factor of alexithymia and personality dimensions, particularly HA and NS are associated with impairment of QoL. Direction of this relationship and factors that may mediate this relationship is unclear.

Alexithymia and personality dimensions in relation to depression and anxiety in male alcohol-dependent inpatients

Objective. The aim of this study was to determine the relationship of alexithymia and temperament and character model of personality with depression and anxiety symptoms in detoxified male alcohol-dependent inpatients. Method. The subjects consisted of 176 male alcohol-dependent inpatients according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Patients were investigated with the Beck Depression Inventory, Beck Anxiety Inventory, State and Trait Anxiety Inventory, Michigan Alcoholism Screening Test (MAST), Toronto Alexithymia Scale (TAS-20) and Temperament and Character Inventory (TCI). Results. MAST score and scores of all three factors of the TAS-20 significantly predicted depression scale and anxiety scales. Difficulty in identifying feelings and difficulty in describing feelings factors were particularly effective, relative to the externally orientated thinking factor of the TAS-20 for prediction depression and anxiety. The TCI dimensions emerged as distinct and conceptually meaningful predictors for the depression scale and anxiety scales. Conclusion. Depression and anxiety symptoms among detoxified male alcohol dependents are associated with alexithymia, a broad range of personality dimensions and higher severity of alcohol-related problems, which make these related factors highly relevant for clinical practice.

NETER alcoholic 5 subtypes: Validity with Lesch four evolutionary subtypes

Objective. To validate NAT (NETER's alcoholic typology), taking into account the differentiated distribution of the measures used as external criteria in alcohol-dependent sub-groups and its relationship with Lesch's alcoholic typology (LAT). Method. A sample of 133 alcohol-dependent patients integrated in the alcoholism unit of the Psychiatric Service of Santa Maria University Hospital were included in the study. Results and Conclusions. Convergent validity was assured by the agreement between the subtypes of the two typologies (NAT and Lesch), considering the same underlying model of alcoholism development: anxiopathic subtype of NAT and Type II (model of anxiety, alcohol as conflict solution) of Lesch and the tymopathic subtype of NAT and type III (model of depression, alcohol as antidepressant) of Lesch. Discriminant analysis (external criteria) showed significant differences between the subtypes in the following variables: gender; tobacco; beer and whisky consumption; daily average of drinks; clinical conditions such as delirium tremens, alcoholic blackouts and seizures; severity of alcohol-related problems; psychological dimensions such as psychological maturity and extroversion; and suicidal ideation during the alcohol consumption period. A more exhaustive description of alcoholic sub-groups may improve genetic studies of alcoholism and provide the alcoholic patient with an adequate specific therapeutic protocol.

Aggression Levels in Treatment Seeking Inpatients With Alcohol-Related Problems Compared to Levels in the General Population in Hungary

Association between aggression and heavy alcohol use is documented in the literature in various disparate samples and settings. Comparison of trait aggression levels using a uniform methodology across different samples is almost entirely lacking. This study compared trait aggression levels of treated inpatients with severe alcohol-related problems with those of a nationally representative sample of the general adult population using the same methodology. Results indicated that in the patient population the trait aggression levels were substantially higher than in the general population. Because several studies have demonstrated that aggressive personality traits are closely linked with violence after drinking alcohol, our results further highlight the importance of treatment programs in this at-risk population. From a methodological perspective, the higher trait aggression level of inpatients with alcohol-related problems compared with the general population supports the assumption that the underrepresentation of alcoholics in the population surveys may restrict the range in the severity of alcohol use and dependence, and may therefore produce severely biased results in such studies.

Alcohol addiction and perceived sanction risks: Deterring drinking drivers

This study argued that while sanctions deter offenders from being involved in future drinking-driving offenses, alcohol addiction prevents individuals from making rational choices, and, thus, increases offenders' chances of being involved in drinking driving regardless of the certain, severe, and swift punishments they had experienced. Results indicated that, individuals with more severe alcohol addiction problems had increased chances of committing multiple offenses regardless of the sanctions that they had experienced relative to those with less severe alcohol-related problems. Findings seemed to suggest that criminal justice sanctions alone might not obtain expected deterrent impacts on individuals with alcohol and other addiction problems. Drinking drivers and other drug and alcohol offenders should be screened for substance abuse problems, and, if necessary, provided with treatment.

Premenstrual symptomatology and alcohol consumption in college women.

Because research has indicated women may be at increased risk for alcohol-related health problems, identifying risk factors for alcohol use among college women has become increasingly important. Previous studies report a relationship between premenstrual symptoms (PMS) and alcohol consumption among women seeking treatment for symptoms; however, results have been inconsistent among nonclinical samples. The purpose of this study was to examine the relationship between premenstrual symptomatology and alcohol consumption in a sample of college women. Women (N = 193) from a large urban university consented to complete an assessment battery of health behavior questionnaires which included a retrospective assessment of PMS severity and typical weekend and weekday alcohol consumption during the past year. Results revealed that PMS severity significantly predicted annual weekday alcohol consumption but did not predict annual weekend alcohol consumption. Our study suggests the relationship between PMS and alcohol consumption exists in nonclinical samples of college women who are relatively early in their drinking careers, before the development of severe alcohol-related problems. Thus, premenstrual symptomatology may be an important risk factor for alcohol consumption among college women. Education on the relationship between PMS and risk for alcohol misuse may provide beneficial information for both alcohol prevention and intervention efforts on college campuses and may be helpful in identifying women at risk for heavy alcohol consumption and alcohol problems.

The interplay between help-seeking and alcohol-related outcomes: divergent processes for professional treatment and self-help groups

This study examined the influence of self-selection, as reflected in alcohol-related functioning, on the duration of professional treatment and Alcoholics Anonymous (AA), and the influence of social causation, as reflected in the duration of treatment and AA, on alcohol-related outcomes. A sample of alcoholic individuals was surveyed at baseline and 1, 3, and 8 years later. At each point, participants completed an inventory that assessed participation in treatment and AA since the last assessment and alcohol-related functioning. There were divergent processes of self-selection and social causation with respect to the duration of participation in professional treatment and AA. Individuals with more severe alcohol-related problems obtained longer episodes of professional treatment, but this self-selection process was much less evident for AA. Longer participation in professional treatment in the first year predicted better alcohol-related outcomes; however, the duration of subsequent treatment was not associated with better subsequent outcomes. In contrast, longer participation in AA consistently predicted better subsequent alcohol-related outcomes. These findings are consistent with a need-based model of professional treatment, in which more treatment is selected by and allocated to individuals with more severe problems, and an egalitarian model of self-help, in which need factors play little or no role in continued participation.

The role of drinking restraint in alcohol dependence: validation of the temptation and restraint inventory in an alcohol dependent sample.

The Temptation and Restraint Inventory (TRI) is commonly used to measure drinking restraint in relation to problem drinking behavior. However, as yet the TRI has not been validated in a clinical group with alcohol dependence. Male (n = 111) and female (n = 57) inpatients with DSM-IV diagnosed alcohol dependence completed the TRI and measures of problem drinking severity, including the Alcohol Dependence Scale and the quantity, frequency and week total of alcohol consumed. The factor structure of the TRI was replicated in the alcohol dependent sample. Cognitive Emotional Pre-occupation (CEP), one of the two higher order factors of the TRI, demonstrated sound predictive power toward all dependence severity indices. The other higher order factor, Cognitive Behavioral Control (CBC), was related to frequency of drinking. There was limited support for the CEP/CBC interactional model of drinking restraint. Although the construct validity of the TRI was sound, the measure appears more useful in understanding the development, maintenance and severity of alcohol-related problems in nondependent drinkers. The TRI may show promise in detecting either continuous drinking or heavy episodic type dependent drinkers.

Prevalence of alcohol use in Istanbul.

The current research assessed the prevalence of alcohol use in Istanbul, Turkey along with characteristics and severity of related problems. The data were collected from structured interviews including the CAGE Questionnaire to eliminate the severity of alcohol-related problems of 1,550 residents (743 women, 807 men) of Istanbul, ages 12 to 65 years. Current alcohol use was 25.6% (397 persons, 118 women and 279 men), including 15.9% of the women and 34.5% of the men. 67% reported never having used alcohol. The rate of alcohol use was highest in the 40- to 49-yr. age group: the onset of use was reported as most common for the 16- to 19-yr.-olds. Prevalence of risky drinking was 6.8% (106 persons). Men were more likely to have an earlier initiation to alcohol use, to consume more [5.2 standard drinks (SD=3.4) vs 3.6 standard drinks (SD=2.5)] and be problem drinkers (31.5% vs 15.2%) than women. Prevalence of alcohol use seems to be relatively low in Istanbul. Data on characteristics of alcohol use are important in estimating groups at risk for problems and in planning prevention strategies.

Prevalence and Determinants of Alcohol-Related Problems

In this study, we sought to determine what factors, in addition to alcohol consumption, were the best predictors of social and physical alcohol-related problems. Variables examined as possible predictors of problems included circumstances under which people drink, feelings of alienation, and religious affiliation. Data for this study were collected continually from 1984 to 1989 using a random telephone survey of 2094 New York State residents aged 18 or older; the study sample was comprised of the 1076 who had consumed alcohol in the previous 30 days. Stepwise regression analyses examined the main effects of all possible predictors of problems while controlling for alcohol consumption. Forced-entry regressions examined interaction effects of problem predictors while controlling for basic demographics. Drinking with breakfast, smoking marijuana, and drinking in bars alone were all significant predictors of more problems. This suggests that problems are associated with an aberrant lifestyle (i.e., different from a typical lifestyle), although it makes no assumption about motivations. Further investigation of this subject area is warranted to ascertain which population subgroups are the most vulnerable to alcohol-related problems and to guide the design of prevention programs.

Treatment setting and treatment outcome in alcohol dependency: residential and day-care options compared.

When empowered to select either a residential or a day care treatment programme for problem drinking, more patients favour the latter option. Those completing the full programme, which was similar in content in both settings, were followed up at approximately 9 months after initial engagement in treatment. Attrition was a major problem, particularly in the day-patient sample. Of the 103 patients who began each programme, 91 completed the residential option but only 23 completed all sessions in the day-patient course. Day-care completers tended to have less severe alcohol-related problems than in-patient completers. They were also older, had experienced fewer episodes of alcohol-related admissions in the past and were less likely to show biochemical evidence of alcohol-related physical damage. Both groups showed positive changes in drinking intake, drink-related problems, the use of adjunct services and the self-ratings of improvement throughout the follow-up period. Outcome in the day programme completers group was, however, generally better than that shown by the in-patients. The results should be interpreted with caution owing to the significant inter-group differences at the start of treatment and the considerably higher non-attendance and attrition rates for the day-care programme. A cognitive-behavioural in-patient programme for alcohol dependent patients can be provided in a day-care setting. For some patients, this option is both attractive and effective.

Three clusters of male alcoholics

The study comprises 296 male alcoholics in whom detailed studies of family history, clinical factors, psychopathology of dependence as well as psychological and neurophysiological tests were made. On the basis of five clinical factors: age of onset of dependence, history of familial alcoholism, severity of alcohol-related problems and the prevalence of psychiatric and somatic diseases, K-means cluster analysis delineated three types of alcoholics. Type 1 was characterized by late onset of dependence, low prevalence of familial alcoholism and mild course. Type 2 was characterized by early onset of dependence, high familial alcoholism in fathers, frequent antisocial personality, severe intensity of alcohol-related problems. Type 3 was characterized by early onset of dependence, familial history of psychiatric diseases, severe intensity of alcohol-related problems and high prevalence of psychiatric disturbances and somatic diseases. Type 3 may be characterized as alcoholism associated with high predisposition and comorbidity. This may make a distinct type of male alcoholics.

The changes in the social class distribution of moderate and high alcohol consumption and of alcohol-related disabilities over time in Stockholm County and in Sweden

The purpose of this paper was to analyse the role of social class concerning changes in alcohol consumption and severe alcohol-related problems from the end of the 1960s to the 1990s in Stockholm County, and in the whole of Sweden for consumption. Survey data showed that the prevalence of moderate and/or high alcohol consumption in adults of both sexes was highest among non-manual employees at medium and high level, in 1967 as well as in 1980 in the whole of Sweden. After 1980, an equalization occurred. A similar change in the social class pattern of alcohol consumption was noted in young people. We analysed all 36,404 male and 10,648 female hospitalizations and all the 3175 male and 713 female deaths with a diagnosis of alcoholism, alcohol psychosis or alcohol intoxication in Stockholm County during 1970-86 (1970-84 for mortality) linked to individual census data. There was a greater increase in rates among women than among men, especially among women outside the labour market. We found pronounced social class differences between manual and non-manual employees, which widened up to 1986 (1984 for mortality)-a period with an initial increase and a subsequent decrease in alcohol consumption. Thus, the changes in consumption and alcohol-related problems developed differently in principal social classes over time, suggesting that an expanded theory on alcohol consumption in the population should take socio-economic factors into account.