Comorbidity of Alcoholism and Antisocial Personality Disorder

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Comorbidity of Alcoholism and Antisocial
Personality Disorder

• R.O. Pihl
• McGill University

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Alcoholism ASPD

• Lets avoid the definitional quagmire.
• Lets agree there is a significant correlation
  between Alcoholism and ASPD.
• Lets agree that the nature of the relationship
  is well understood.

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The Role of Different Motivational Systems

• Motivational system responding to threat
• The Cognitive Control System
• Motivational system responding to reward

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Behavior
(Behaviorally-linked) Sensory information
Aggression
Threatening or punishing behavior
Executive Cognitive Functions
Facilitory Cue for Reward
Inhibitory Cue for Punishment
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Behavior
(Behaviorally-linked) Sensory information
Inhibits
Aggression
Threatening or punishing behavior
Executive Cognitive Functions
Facilitory Cue for Reward
Inhibitory Cue for Punishment
Acute Alcohol Intoxication
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Behavior
(Behaviorally-linked) Sensory information
Inhibits
Aggression
Threatening or punishing behavior
Disorganizes
Executive Cognitive Functions
Facilitory Cue for Reward
Inhibitory Cue for Punishment
Acute Alcohol Intoxication
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Behavior
(Behaviorally-linked) Sensory information
Inhibits
Aggression
Threatening or punishing behavior
Disorganizes
Executive Cognitive Functions
Facilitory Cue for Reward
Inhibitory Cue for Punishment
Acute Alcohol Intoxication
Potentiates
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The Role of Different Motivational Systems

• Environmental triggers
• Threat, anxiety (novelty, cues of punishment,
  etc)
• Monotony (lack of immediate reinforcement)
• Genetically influenced susceptibility
• Anxiety
• Boredom
• Desired alcohol reinforcement
• Anxiolysis (serotonin GABA effects)
• Stimulation (Dopaminergic effects)

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Family Pedigree
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Subjects with a High Heart rate Response to
Alcohol Challenge

• Self-rate more of a positive response
• Drink more
• Remember more words learned before drinking
• Release more dopamine in the Ventral Striatum

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Positron Emission Tomography
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Alcohol Promotes Dopamine Release in the Human
Nucleus Accumbens
and this release is associated to an increased
HR response to alcohol
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Background

• Phenylalanine and tyrosine, two amino acids
  (AA)found in dietary protein, are the essential
  building blocks for the production of dopamine in
  the brain.
• Ingesting an AA mixture deficient in PT reduces
  DA production by 1)causes protein synthesis
  diminishing the bodys stores of these AA 2)
  increasing competition of other AAs for transport
  across the blood brain barrier.
• Peek effect of depletion occur 4-5 hours
  following the ingestion of the AA mixture

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APTD Change in Drinking and Ethanol Cardiac
Response
r.-658, p.006
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Figure 1 - Mean group differences ( SE) between
Low (n 19) and High (n 19) Heart Rate
Responders in the average of age 10 to 17
delinquency scores
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Figure 2 - Mean group differences ( SE) between
Low (n 18) and High (n 20) Heart Rate
Responders in Goldberg's Adjective Markers of the
Big Five assessed at age 19
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Figure 3 - Mean group differences ( SE) between
Low (n 20) and High (n 22) Heart Rate
Responders in Subjective High Assessment Scale
(SHAS) at age 19
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Apparatus Taylor Aggression Paradigm (TAP)
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TAP - Mean Shock Level Selected
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Commonalities Alcoholism ASPD

• Unusual high heart rate response to high dose of
  alcohol.
• High activation of the Cue for Reward System.
• A system that is dopamine mediated.
• Reduced ECF functioning.

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