Controlled study on the combined effect of alcohol and tobacco smoking on testosterone in alcohol-dependent men.

AIMS: The present study examined the association between pre-treatment drinking and smoking parameters and plasma testosterone levels before and after alcohol withdrawal. METHODS: A total of 51 alcohol-dependent men and 43 age-matched healthy men were investigated. In alcoholics, free testosterone in plasma was measured on the day of admission, after detoxification and after 6 weeks of sobriety. RESULTS: While the testosterone level of alcoholic men did not differ from healthy controls at the onset of withdrawal, it was significantly higher for the alcoholics after 6 weeks of sobriety than for the healthy controls. Higher alcohol consumption and higher tobacco use before detoxification led to higher levels of testosterone concentration before and after withdrawal. CONCLUSIONS: The effect of alcohol and tobacco is cumulative, with higher levels of alcohol and tobacco consumption being associated with higher levels of testosterone before and after alcohol withdrawal.

Social factors but not stress-coping styles predict relapse in detoxified alcoholics.

Alcohol-dependent patients face a substantial risk of relapse after detoxification. Though psychosocial stress and coping strategies are regarded as major contributing factors in returning to drinking, the direct effects of coping styles on relapse are not clear. In this treatment outcome study, a mixed gender sample of 130 detoxified and well-characterized alcohol-dependent patients (37 women) was followed up over a period of 12 months after 6 weeks of inpatient treatment. Patients had completed a comprehensive baseline assessment, including a stress coping questionnaire (SVF120). We hypothesized that these individual stress coping styles would contribute to treatment outcome. A logistic regression analysis was used to evaluate the impact of stress coping styles, as well as the effect of pretreatment drinking and social characteristics on relapse. Approximately half the patients (49%) relapsed within 1 year after treatment. In contrast to our hypothesis, stress coping styles did not predict relapse. However, significant predictors of relapse were social factors related to living situation (living alone), marital status (being separated from the spouse) and pretreatment frequency of alcohol intake. These findings suggest that a partnership is more relevant for the risk of relapse than stress coping styles.

A functional polymorphism in the promoter region of the monoamine oxidase A gene is associated with the cigarette smoking quantity in alcohol-dependent heavy smokers.

Tobacco smoking represents a leading cause of morbidity and mortality with a strong dose-response relation between the amount of smoking and the risks of tobacco-related diseases and death. The quantity that is smoked is determined predominantly by genetic factors. The present study examined whether there is an association between the quantity of cigarettes smoked and length variation of a functional 30-bp repeat polymorphism in the promoter region of the monoamine oxidase A (MAO-A) gene. The number of 30-bp repeats, which is associated with enzyme activity was assessed in 121 Caucasian men suffering from both alcohol and tobacco dependence. Analysis revealed that the highly active long allele (4 repeat) is associated with a significantly greater amount of cigarette smoking in comparison with the less active short allele (3 repeat). In a logistic regression model (dichotomized), smoking quantity was significantly predicted by MAO-A genotype while no other variable (age, height, body weight, frequency of smoking, quantity and frequency of alcohol consumption) met the significance level. Since tobacco smoke is a potent inhibitor of MAO-A, this result could be regarded as a genotype-related dosage effect. Taken together, in alcohol-dependent heavily smoking men there is evidence for a MAO-A gene-associated effect on the quantity that is smoked as reflected by the daily number of cigarettes consumed.

Cortisol concentrations, stress-coping styles after withdrawal and long-term abstinence in alcohol dependence.

Alcohol-dependent patients face a substantial risk of relapse after detoxification. A major risk factor for relapse is stress which is reflected biologically by various physiological changes that include an activation of the hypothalamic-pituitary-adrenal (HPA) axis and release of glucocorticoids. The prospective study examined cortisol concentrations and stress-coping styles in relation to abstinence 1 year following discharge from treatment. Cortisol concentrations were measured in the plasma of 46 alcohol-dependent patients (12 women) on initial presentation for treatment (day 1), and again in plasma and in cerebrospinal fluid (CSF) after 6 weeks of abstinence (day 40). These results were compared with those of 26 age- and sex-matched, healthy control subjects. After withdrawal, the patients completed a comprehensive baseline assessment including a stress-coping questionnaire (Stressverarbeitungsfragebogen SVF120) and were monitored for 1 year after discharge. Negative stress-coping styles (e.g. flight, resignation) positively correlated with higher cortisol concentration in plasma and in CSF after withdrawal (day 40). Compared with relapsers after 1 year, abstainers had significantly lower levels for cortisol in CSF, whereas the stress-coping styles did not differ between abstainers and relapsers in this sample. These findings suggest that relatively stable personality traits like stress-coping styles have no measurable influence on abstinence. The lower cortisol concentration in CSF as an indicator for HPA axis functioning is associated with long-term abstinence in detoxified alcoholics.

A three-axes approach of subtyping the alcohol dependence syndrome.

Subtyping of alcoholics according to specific characteristics has a long tradition in alcoholism research with a number of different typologies that emerged in the literature. The goal of the present study was to test a multidimensional approach of subtyping with characteristics from different axes. Therefore, male inpatients meeting ICD-10 criteria for alcohol dependence were rated on three axes by assessing their degree of sensation seeking (personality axis), age of alcoholism onset (clinical axis) and level of dopamine activity (neurobiological axis). By using a configuration frequency analysis, we identified a subtype that was characterized by high sensation seeking early age of alcoholism onset and high dopamine activity. This subtype, which is in accordance with clinical experience and cannot be explained by antisocial personality disorder, embodied a significantly greater proportion of alcoholics than expected. The result emphasizes the usefulness of multidimensional approaches integrating personality, clinical and neurobiological characteristics.

Serotonin transporter gene polymorphism and personality traits in primary alcohol dependence.

We tested the hypothesis of an association between the serotonin transporter (5-HTT) gene regulatory region polymorphism and the Temperament and Character Inventory (TCI) personality dimension of Harm Avoidance. For the study, 124 subjects seeking inpatient treatment for primary alcohol dependence were grouped by their 5-HTT genotype and assessed with the TCI. Genotypes differed statistically significantly in Harm Avoidance but not in any other personality trait. This gives support to the hypothesis that the TCI temperament Harm Avoidance is associated with serotonergic neurotransmission in primary alcohol dependence.