A Prospective Comparison of Bipolar I and II Subjects With and Without Comorbid Alcohol Dependence From the COGA Dataset.

Objective: Comorbidity of alcohol use disorders in bipolar subjects is high as indicated by epidemiological and clinical studies. Though a more severe course of bipolar disorder in subjects with comorbid alcohol dependence has been reported, fewer studies considered the longitudinal course of alcohol dependence in bipolar subjects and the prospective course of comorbid bipolar II subjects. Beside baseline analysis, longitudinal data of the COGA (Collaborative Study on Genetics in Alcoholism) were used to evaluate the course of bipolar I and II disordered subjects with and without comorbid alcohol dependence over more than 5 years of follow-up. Methods: Characteristics of bipolar disorder, alcohol dependence and comorbid psychiatric disorders were assessed using semi-structured interviews (SSAGA) at baseline and at a 5-year follow-up. Two hundred twenty-eight bipolar I and II patients were subdivided into groups with and without comorbid alcohol dependence. Results: Of the 152 bipolar I and 76 bipolar II patients, 172 (75, 4%) had a comorbid diagnosis of alcohol dependence. Bipolar I patients with alcohol dependence, in particular women, had a more severe course of bipolar disorder, worse social functioning and more suicidal behavior than all other groups of subjects during the 5-year follow-up. In contrast, alcohol dependence improved significantly in both comorbid bipolar I and II individuals during this time. Conclusions: A 5-year prospective evaluation of bipolar patients with and without alcohol dependence confirmed previous investigations suggesting a more severe course of bipolar disorder in comorbid bipolar I individuals, whereas bipolar II individuals were less severely impaired by comorbid alcohol use disorder. While severity of alcohol dependence improved during this time in comorbid alcohol-dependent bipolar I patients, the unfavorable outcome for these individuals might be due to the higher comorbidity with personality and other substance use disorders which, together with alcohol dependence, eventually lead to poorer symptomatic and functional clinical outcomes.

A comparison of alcohol-induced and independent depression in alcoholics with histories of suicide attempts.

OBJECTIVE: Alcohol-dependent men and women are at high risk for two types of major depressive episodes and for suicide attempts. The aim of this study is to compare the characteristics of two groups: (1) alcohol-dependent subjects with histories of suicide attempts and independent mood disorders and (2) a similar population of alcoholics with histories of self harm but who have only experienced alcohol-induced depressions. METHOD: As part of the Collaborative Study on the Genetics of Alcoholism (COGA), semistructured detailed interviews were administered to 371 alcohol-dependent individuals (62% women) with histories of suicide attempts and major mood disorders. Of the total, 145 (39.1%) had ever had an independent depressive episode and 226 (60.9%) had experienced only alcohol-induced depressions. Information was obtained about socioeconomic characteristics, suicidal behavior, independent and induced psychiatric conditions, and aspects of alcohol dependence. RESULTS: Univariate and multivariate comparisons revealed that alcohol-dependent individuals with a history of suicide attempts and independent depression had a higher number of suicide attempts, were less likely to have been drinking during their most severe attempt, and were more likely to have an independent panic disorder. Univariate analyses indicated that these subjects reported a less severe history of alcohol dependence. CONCLUSIONS: The results indicate that a distinction between independent and alcohol-induced mood disorders in alcoholics with a history of suicide attempts may be useful.

Comparison of 3190 alcohol-dependent individuals with and without suicide attempts.

INTRODUCTION: Suicidal behaviors are often seen in alcohol-dependent individuals. The aim of this study is to identify and confirm risk factors for suicide attempts in a large, family-based sample of alcoholics. METHODS: Semistructured, detailed interviews were administered to 3190 alcohol-dependent individuals as part of the Collaborative Study on the Genetics of Alcoholism (COGA). Information about suicidal behavior, socioeconomic characteristics, psychiatric comorbidity, substance use disorders, and characteristics of alcohol dependence were obtained from alcohol-dependent probands, controls, and their relatives. RESULTS: As determined by both univariate comparison and multivariate logistic regression analysis, alcohol-dependent individuals with a history of suicide attempts were found to have a significantly more severe course of alcohol dependence and a higher prevalence of both independent and substance-induced psychiatric disorders and other substance dependence. First-degree relatives of subjects with suicide attempts showed a significantly higher rate of suicide attempts, even after controlling for additional relevant diagnoses. CONCLUSION: These results support the hypothesis that alcohol-dependent individuals with a history of suicide attempts are more severely impaired. Screening and subsequent treatment of alcohol use disorder, psychiatric comorbidity, and substance use disorders among alcoholics may be crucial in preventing suicide attempts and completions.

Gender and reported health problems in treated alcohol dependent Alaska natives.

OBJECTIVE: An ongoing study of phenotypes of alcohol dependence among Alaska Natives provides the opportunity to investigate gender differences in reported health-related problems among alcohol dependent clients in three residential programs in Anchorage, Alaska. METHOD: Clinical assessment information was obtained on 469 (263 male) subjects from consecutive admissions to each of three treatment programs. The average (SD) age of the sample was 33.7 (8.4) years. Patterns of substance use, comorbid psychopathology, overall health status, alcohol and other drug withdrawal symptoms, and psychological and physical consequences of alcohol and other drug use were examined. RESULTS: Male and female subjects reported similar experiences with alcohol-related health problems, including symptoms of withdrawal and the psychological and physical consequences of chronic alcohol abuse. However, women were significantly more likely to have lifetime diagnoses of major depression and cocaine dependence, whereas men were more likely to have lifetime diagnoses of antisocial personality disorder and marijuana dependence. Women reported a lower overall health status, more medication use and pain complaints, and more negative consequences of cocaine abuse and withdrawal than did men. CONCLUSIONS: Both men and women within this sample of inpatient alcohol-dependent Alaska Natives were found to have a similar early onset and rapid progression to DSM-III-R alcohol dependence, and to report a similar prevalence of alcohol-related psychological and physical problems. Reports by women of more pain symptoms, more medication use and more negative health consequences related to their cocaine abuse, compared with men in this alcohol dependent sample, suggests additional considerations for treatment planning and intervention.

Alcohol dependence among Alaska Natives entering alcoholism treatment: a gender comparison.

OBJECTIVE: An ongoing study of phenotypes of alcohol dependence among Alaska Natives provides an opportunity to investigate the nature and patterns of alcohol problems among Alaska Native men and women admitted to treatment in three residential programs in Anchorage, Alaska. METHOD: A comprehensive, standardized clinical assessment (including the SSAGA-I diagnostic interview, family history information, personality traits and cognitive functioning) of consecutive admissions to each of the three programs is being undertaken by trained interviewers. To date, 200 (103 male) subjects have been assessed. The mean (+/- SD) age of the sample is 32+/-8.5 years old. The development of alcohol problems, the psychological and physical consequences of chronic drinking, the flushing response, withdrawal symptoms and comorbid lifetime psychiatric conditions were examined. RESULTS: The sample was characterized by an early onset of drinking and an acute exacerbation and clustering of drinking problems during late adolescence, followed by the development of severe alcohol dependence. A high lifetime prevalence of DSM-III-R major depressive disorder was found, typically complicated by chronic drinking. The rates of other substance dependencies were relatively low, except for cannabis and cocaine dependence among female subjects. CONCLUSIONS: This sample of treatment-seeking Alaska Natives was found to have an early onset and severe form of DSM-III-R alcohol dependence, with few gender differences noted. While the prevalence of alcohol abuse and alcohol dependence among Native American populations has been reported to be quite high, the onset and patterning of symptoms among this sample of treated Alaska Natives has revealed more similarities with treated alcoholics from the majority population than important differences specific to Alaska Natives.

Alcoholism and subtypes of antisocial personality disorder.

The co-occurrence of alcoholism with other psychiatric conditions among treated samples is well known. One of the most prevalent comorbid conditions among both male and female alcoholics is antisocial personality disorder (ASPD). While ASPD is known to affect the development and severity of alcoholism, comparisons of subtypes of ASPD in relation to the etiology of alcoholism have not been reported. Male and female alcoholics (n = 321) with ASPD or DSM III subtypes [Conduct Disorder; Adult Onset ASPD] were compared to non-ASPD alcoholics on several etiological features of alcoholism and its clinical presentation immediately prior to treatment. The results show that alcoholics with a subtype of ASPD, even if it occurred predominately during childhood, have a form of alcoholism similar to ASPD alcoholics. Further, the severity of alcoholism among persons with ASPD may vary according to the severity of the ASPD.

Relationship of family history, antisocial personality disorder and personality traits in young men at risk for alcoholism.

Studies examining possible risk factors for the development of alcoholism have focused recently on a variety of personality factors, including those associated with risk-taking behaviors. Alcohol-seeking behavior leading to the abuse of alcohol may be associated with a variety of risk-taking behaviors that derive from certain personality traits. Further, there is evidence that personality traits are transmitted across generations. This study examined the relationship of a family history of alcoholism, antisocial personality disorder (ASP) and alcohol use to several personality traits including the Tri-dimensional Personality Questionnaire (TPQ) in a sample (N = 91) of nonalcoholic, young male volunteers. The men with ASP scored higher than the non-ASP men on the Novelty Seeking Scale of the TPQ, but not on the Harm Avoidance or Reward Dependence subscales. In addition, ASP men scored higher than non-ASP men on a measure of impulsivity and tended to score higher on measures of sensation seeking, psychopathy and monotony avoidance. A family history of alcoholism did not differentiate the young men on any of the childhood behavior problems, personality measures or alcohol-related variables.

Neuropsychological factors in individuals at high risk for alcoholism.

It has been postulated that deficits in certain areas of cognitive functioning among children of alcoholics may contribute to their increased risk for developing alcoholism and other substance abuse disorders. In this chapter, the recent evidence for this hypothesis is critically reviewed. Studies citing differences in cognitive functioning between persons at high risk versus those at low risk for alcoholism are presented as well as those studies that have failed to demonstrate differences in cognitive abilities. On balance, the evidence in support of variations in cognitive abilities at risk factors for the development of alcoholism is not strong. The equivocal nature of the literature may be due to a variety of issues related to the design of studies examining risk factors for alcoholism, to the variability of definitions of family history positive used, to the failure to adequately control potentially confounding subject variables, and to the improper analysis of data. Recommendations are made for future studies examining neuropsychological functioning in "at risk" samples.

Gender comparison of antisocial personality disorder and depression in alcoholism.

This study compared male and female alcoholics in terms of family history of alcoholism, Antisocial Personality (ASP), and depression on the course, consequences, and 1-year treatment outcome. The sample included 266 subjects (197 men and 69 women) who were hospitalized for treatment of alcoholism from three facilities in the greater Hartford area. Female alcoholics reported higher rates of alcoholism among their fathers than men across all diagnostic categories. Both male and female alcoholics who were diagnosed as having ASP reported higher alcoholism among their fathers than those with depression or no other diagnoses. Male alcoholics reported a longer duration of alcohol abuse and a higher number of lifetime alcohol-related problems than women. Subjects with ASP reported more childhood behavior problems, higher levels of alcohol consumption, and more affective and physical disturbances in the month prior to hospitalization whereas no gender differences were found on those variables. ASP alcoholics reported poorer 1-year treatment outcomes than non-ASP alcoholics. Males who were diagnosed as having depression tended to relapse, although the diagnosis of depression tended to modify the rate of relapse among women. The rate of depression was higher among women than men at the 1-year follow-up.

Effects of retesting with the Beck and Zung depression scales in alcoholics.

The present study assessed the presence of testing effects arising from the repeated administration of both the Beck and Zung depression scales to a group of 60 inpatient alcoholics. Thirty-seven men and 23 women were randomly assigned to one of three groups and administered the depression scales on one, two or three occasions, in successive weeks of treatment. Although the between group comparisons of initial test administration did not indicate a true change in depression, a within group comparison of initial with subsequent test administrations indicated a clear improvement in depression scores on both scales. Apparently the result of the reactive effects of testing, the within group differences could easily mislead a researcher into believing depression was alleviated when in fact it was not. This sizeable testing effect has obvious implications for studies which repeatedly assess depression.

Effect of major depression and antisocial personality on alcoholism: course and motivational patterns.

Major depression and antisocial personality are two diagnoses often associated with alcoholism. The relationship of these two diagnoses to the course of alcoholism and on the motivation for alcohol use was examined in a sample of 321 persons receiving inpatient treatment for alcoholism. Major depression did not alter the course of alcoholism in either men or women. However, patients with a history of major depression more frequently reported drinking to relieve symptoms related to depression than patients without a history of major depression. Patients with antisocial personality had an earlier onset of alcohol-related problems than patients without antisocial personality. The motivational patterns for drinking did not distinguish patients with antisocial personality from patients without antisocial personality. These findings indicate the etiological logical importance of antisocial personality for the development of alcoholism and highlight the patients' perception of depression as an explanation for their drinking.

Alcoholic typologies. A review of empirical evaluations of common classification schemes.

This chapter reviews literature examining two typological classifications of alcoholism: typologies derived empirically by employing multivariate statistical techniques and typological classification schemes formulated from theoretical frameworks. Most of the empirical classifications were based on personality measures such as the MMPI, 16PF, and others. Examinations of theoretically based typologies included gender, psychopathology, and family history. The usefulness and limitations of these typological approaches are discussed.

Psychopathology in hospitalized alcoholics.

This study utilized the DSM-III criteria and the National Institute of Mental Health Diagnostic Interview Schedule to assess the prevalence of lifetime psychopathology among hospitalized alcoholics. Antisocial personality (ASP) and substance-use disorder were common psychopathologies among male alcoholics and major depression and phobia were common among female alcoholics. The onset of most psychopathologies preceded the abuse of alcohol among women. In men, however, with the exception of ASP and panic disorder, the onset of psychopathology was subsequent to that of alcohol abuse and/or dependence. Diagnoses of ASP and substance abuse were characterized by early onset of regular intoxication and alcohol abuse. Gender and the presence of specific psychopathology appeared to modify the course and symptom picture of alcoholism. In general, alcoholic women showed a later onset of regular intoxication and a more rapid progression to alcohol abuse and dependence than alcoholic men.

Discriminative control of alcoholics' drinking by the drinking situation.

Implicit in what has come to be called the loss of control concept is the notion that the environment, or the context within which drinking occurs, exerts little influence on the quantity of alcohol consumed by an alcoholic. In contrast, recent formulations of the alcohol dependence syndrome have argued that dependence arises from an interaction among personality, pharmacological and contextual variables. The present study investigated the relationship between contextual factors and alcohol consumption in 231 men and 90 women alcoholics. Self-report questionnaire data were obtained describing social pressures to drink more or less than usual, and the usual quantity of drinking in a variety of situations (e.g., at home alone, in bars or in family settings). The findings indicate clear differences in the quantities that alcoholics drink when alone, with friends or with family. Even the dependent drinker is apparently able to discriminate the relative quantity of drinking that will be socially sanctioned in a given situation and modify consumption accordingly. In situations in which constraints are absent or minimal (e.g., alone), drinking tends to be greater than in situations in which social controls are more pronounced (e.g., with friends and family).

Effect of age, sex, drinking history and antisocial personality on neuropsychology of alcoholics.

The effects of age, sex, drinking history and the presence of antisocial personality (ASP) on the Wechsler Adult Intelligence Scale (WAIS) and Halstead-Reitan Neuropsychological Test Battery subtest scores of alcoholics were examined. Subjects (172 men and 72 women) were recruited from three inpatient alcoholism treatment facilities in the Hartford area and were evaluated approximately 1 week after admission. Brain Age Quotients (BAQ) were computed for each subject. The mean BAQ score for the total sample (84.1) was slightly more than one standard deviation below the normative value. Performance on the WAIS was within normal limits for both verbal and performance IQ. Scores on the Halstead-Reitan Battery showed evidence of moderate levels of impairment. Age was found to be the most significant factor affecting neuropsychological performance. It was observed that alcoholic subjects under 40 years of age performed at the lower end of the normal range of performance; older subjects showed mild to moderately severe levels of impairment. Significant interactional effects were observed between age, amount of alcohol consumed and sex for Tactual Performance Test total time. The presence of ASP interacted with sex to affect performance on Block Design and the Category Test such that ASP men performed at higher levels and ASP women at lower levels than their non-ASP counterparts. The ASP diagnosis also interacted with alcohol consumption to affect scores on Block Design. Possible explanations of these findings are discussed.

Power and coherence analysis of the EEG in hospitalized alcoholics and nonalcoholic controls.

EEG recordings from 56 alcoholics (20 women) and 9 nonalcoholic controls (15 women) were compared using power spectral density and coherence techniques. Alcoholics had more power in the delta frequency bands (1-4 Hz) and less power in alpha (9-13 Hz) from all regions of the skull. Interhemispheric coherence scores from homologous brain sites were greater for alcoholics in the delta band (1-4 Hz) but greater for nonalcoholics in the higher frequencies. Among alcoholics, power in the alpha bandwidth was positively correlated with Brain Age Quotient (BAQ) scores, whereas delta power was inversely related to BAQ scores. Increased power in the beta frequencies (14 + Hz) among alcoholics was a function of the time elapsed since the last drink and the use of chlordiazepoxide during detoxication. Issues relating to transient brain dysfunction in recently abstaining alcoholics are also discussed.

Alcoholism in men patients subtyped by family history and antisocial personality.

Alcoholism is known to be a familial disorder and the presence of a family history of alcoholism is recognized as an important variable in alcoholism research. The course and consequences of alcoholism in a group of men alcoholics are examined in relation to family pedigree for alcoholism. Consideration was also given to antisocial personality, a variable that may underlie and contribute to a positive family history of alcoholism. The presence of antisocial personality affected the course of alcoholism to a greater extent than having a positive pedigree for alcoholism. On the other hand, having a pedigree positive for alcoholism was more important in explaining the consequences of alcohol misuse than antisocial personality. The theoretical and methodological implications of these findings for future research are discussed.

Basic aspects of blood platelet monoamine oxidase activity in hospitalized men alcoholics.

Platelet MAO activity (tryptamine as substrate) was assessed in 44 hospitalized men alcoholics to examine the relationships between MAO levels and variables related to alcohol misuse and physiological status. Mean MAO levels were lower in this population than in normal controls and hospitalized psychiatric patients. MAO activity correlated with age but was independent of variables derived from self-reported drinking histories and scales of alcohol dependence. Similarly, platelet MAO activity was not related to the misuse of other drugs. Of the variance in MAO activity, 38% could be accounted for by age, and the values of Mg++, low density lipoproteins and eosinophil combined. The significance of low platelet MAO activity in alcoholics is discussed.

Minimal brain dysfunction and neuropsychological test performance in offspring of alcoholics.

Previous studies have indicated that alcoholics report a high frequency of problem behaviors in childhood. Additionally, certain neuropsychological deficits are often evident. Both childhood problem behavior and antecedent neuropsychological deficits have been suggested as risk factors for the later development of alcoholism. However, neither set of variables nor their interrelationship have been previously investigated in a sample at high risk for the development of alcoholism. In this study, unaffected offspring of an alcoholic parent and unaffected offspring of nonalcoholic parents were examined. Although attention deficit disorder/hyperactivity and conduct disorder prior to age twelve predicted the onset of drinking, the frequency of childhood behaviors was similar in both groups. Further, the neuropsychological performances of the high-risk and low-risk samples were also similar and within normal limits. The theoretical and methodological implications of these findings for future research are discussed.