Risk for alcohol use problems in severe mental illness: Interactions with sex and racial/ethnic minority status.

BACKGROUND: Alcohol use disorder (AUD) is exceedingly common among individuals with bipolar disorder and schizophrenia. However, studies on alcohol use in psychiatric illness rely largely on population surveys with limited representation of severe mental illness (SMI); schizophrenia and bipolar disorder. METHODS: Using data from the Genomic Psychiatry Cohort (GPC) (Pato MT, 2013), associations of bipolar disorder and schizophrenia with alcohol use problems were examined in a diverse US based sample, considering the influence of self-described race (African Ancestry (AA), European Ancestry (EA), or Latinx Ancestry (LA)), sex, and tobacco use. Participants answered alcohol use problem items derived from the CAGE instrument, yielding a summed "probable" alcohol use disorder (pAUD) risk score. RESULTS: This study included 1952 individuals with bipolar disorder with psychosis (BDwP), 409 with bipolar disorder without psychosis (BD), 9218 with schizophrenia (SCZ), and 10,416 unaffected individuals. We found that SMI (BDwP, BD, SCZ) was associated with elevated AUD risk scores (B = 0.223, p < 0.001), an association which was strongest in females, particularly those of AA and LA, and in tobacco users. Schizophrenia was associated with the greatest increase in pAUD score (B = 0.141, p < 0.001). pAUD risk scores were increased among participants with bipolar disorder, with greater increases in BDwP (B = 0.125, p < 0.001) than in BD without psychosis (B = 0.027, p < 0.001). LIMITATIONS: Limitations include reliance on self-report data, screening items for AUD, voluntary recruitment bias, and differences in race/sex distribution between groups, which were statistically adjusted for in analytic models. CONCLUSIONS: SMI is associated with risk for AUD, particularly among females from racial minority groups, smokers, and those with psychotic disorders.

Under the influence: Effects of adolescent ethanol exposure and anxiety on motivation for uncertain gambling-like cues in male and female rats.

Gambling disorder (GD) frequently co-occurs with alcohol use and anxiety disorders, suggesting possible shared mechanisms. Recent research suggests reward uncertainty may powerfully enhance attraction towards reward cues. Here, we examined the effects of adolescent ethanol exposure, anxiety, and reward uncertainty on cue-triggered motivation. Male and female adolescent rats were given free access to ethanol or control jello for 20days. Following withdrawal, rats underwent autoshaping on a certain (100%-1) or uncertain (50%-1-2-3) reward contingency, followed by single-session conditioned reinforcement and progressive ratio tasks, and 7days of omission training, during which lever pressing resulted in omission of reward. Finally, anxiety levels were quantified on the elevated plus maze. Here, we found that uncertainty narrowed cue attraction by significantly increasing the ratio of sign-tracking to goal-tracking, particularly amongst control jello and high anxiety animals, but not in animals exposed to ethanol during adolescence. In addition, attentional bias towards the lever cue was more persistent under uncertain conditions following omission training. We also found that females consumed more ethanol, and that uncertainty mitigated the anxiolytic effects of ethanol exposure observed in high ethanol intake animals under certainty conditions. Our results further support that reward uncertainty biases attraction towards reward cues, suggesting also that heightened anxiety may enhance vulnerability to the effects of reward uncertainty. Chronic, elevated alcohol consumption may contribute to heightened anxiety levels, while high anxiety may promote the over-attribution of incentive value to reward cues, highlighting possible mechanisms that may drive concurrent anxiety, heavy drinking, and problematic gambling.