Health Psychology

1
Health Psychology

• Alcohol Abuse Part 2
• Chapter 7
• PY 470 Hudiburg

2
How do psychological factors lead to alcohol
abuse? theories

• Tension-reduction theory drinking to cope with
  or regulate negative mood
• Rats isolated increase consumption of alcohol
  Roske et al. (1994)
• Carney et al. (2000) found that people who
  experienced more negative interpersonal events
  report more frequent alcohol use.
• Steele Josephs (1988) found a disinhibition
  effect for intoxicated students concerning an
  upcoming stressful speech.
• Mixed support for the theory
• Some people consume alcohol to reduce tension and
  some do not
• Participants who think they are drinking alcohol,
  whether they were or not, show greater loss of
  control F 7.9, p. 248 Lang et al. (1975)
• Some drinkers drink alcohol to enhance positive
  emotions- Carney et al. (2000)

3
How do psychological factors lead to alcohol
abuse? theories

• Social learning theory learning of norms by
  observing others (models) based on Banduras
  theory
• Models can be direct (parent, peer, or sibling)
  or indirect (through the media).
• Grube Wallach (1994) found that 5th and 6th
  graders were aware of beer TV ads and had more
  favorable beliefs about the consequences of
  drinking. Alcohol is included in G-rated animated
  movies
• Watching people drink creates the norms of
  behavior. It is a group process of in-group and
  out-group. Peers drinking behavior is a strong
  predicator of an individuals future drinking
  behavior.
• The mere belief of a heavy drinking norm is
  related to more positive attitudes toward alcohol
  use Box 7.11, p. 250 251
• Children model on their parents drink behavior
  and what is portrayed in the media. Table 7.3, p.
  252 list motives to use alcohol
• Positive expectations of alcohol use is related
  to an increased likelihood of drinking. Sher et
  al. (1996)

4
How do psychological factors lead to alcohol
abuse? theories

• Cognitive theory the affect of alcohol on
  psychological states is related to alcohols
  physiological effects
• Impaired cognitive functioning
• Reduces self-awareness and anxiety
• Self-rated IQ is related to alcohol consumption,
  participants with lower rated IQs drank more wine
  Bailey et al. (1983)
• Alcohol use increased antisocial and aggressive
  behavior
• Alcohol myopia making decision on the
  short-term and tend to ignore the long-term
  consequences unprotected sex is based on the
  situation not considering the long-term
  consequences of possible STD/AIDS
• Drunken self-inflation is a component of alcohol
  myopia persons see themselves in idealized ways.
  Ratings of most valued traits increase after
  drinking Banaji Steele (1989)

5
How do psychological factors lead to alcohol
abuse? theories

• Personality mostly correlation studies
• Alcohol use is associated with high rates of
  anxiety Kessler et al. (1997), and
  extroversion. There are problems with time-line
  in these types of studies.
• Longitudinal studies have indicated that
  personality traits can predict future alcohol use
  (i.e., Bates Labouvie, 1995)

6
Biological/ genetic factors

• Estimates of the percentage of variance in
  alcohol dependence attributable to genetic
  factors vary from 10 to 70 in males.
• Several studies demonstrate a weaker genetic
  influence in females.
• Family studies
• Cotton (1979) review of family studies
• Alcoholics were 6 times more likely than
  non-alcoholics to have alcoholic parents.
• However, 47-82 of alcoholics did not have
  alcoholic parents.
• Twin studies
• Ball Murray (1994) 4/5 twin studies report
  greater concordance for alcoholism in MZ than DZ
  twins.
• Adoption studies
• Goodwin et al. (1973) report a four-fold increase
  in alcoholism in male offspring of alcoholic
  parents

7
Biological/ genetic factors

• In addition to potential problems common to
  behavioral genetic research there are specific
  issues relating to alcoholism.
• Walters (2002) meta-analysis of behavioral
  genetics research
• Moderate and heavy drinking may have different
  genetic contributions.
• Need to consider genotype-environment
  correlations.
• For example, offspring of female alcoholics may
  be exposed to alcohol in utero.

8
Genetic contributions

• Swedish temperance board records all instances of
  legal, medical or family difficulties related to
  drunkenness.
• Cloninger et al. (1981) studied data from 862 men
  adopted by non-relatives
• Identified two types using discriminant function
  analysis
• Type 1 (milieu limited)
• Associated with both mild severe abuse
• Influenced by genetic predisposition and
  postnatal environment
• Represented 76 of abusers
• Type II (Male-limited)
• Associated with moderate abuse
• Associated with severe alcoholism and criminality
  in fathers
• Represented 24 of abusers

9
Cloninger (1987) study

• Type I alcoholics show later onset but greater
  loss of control, occurs in both sexes.
• Type II alcoholics show earlier drinking and an
  inability to abstain, typically male.
• Links type I to high harm-avoidance and high
  reward dependence.
• Type II linked to high novelty seeking. Possess
  same personality traits as antisocial personality
  disorder (ASPD)

10
Possible criticisms of studies

• High rates of alcohol abuse in biological parents
  (35 of fathers, 6 of mothers)
• Data relate to recorded abuse, not alcoholism or
  dependence, may bias sample towards antisocial
  individuals
• Mild abuse one report for drunkenness
• Moderate abuse two or three reports
• Severe abuse four or more reports or treatment
  for alcoholism
• Is type II distinct from antisocial personality
  disorder?

11
Evaluation of Cloningers approach

• Of the personality traits Cloninger links to his
  two types only a link between novelty seeking and
  alcoholism has been strongly supported. Both type
  I and type II alcoholics show higher novelty
  seeking scores than controls, though type II are
  usually higher than type I.
• Nagoshi et al. (1992) report that novelty
  seeking (but not harm avoidance or reward
  dependence) correlated with substance abuse
  (though not alcohol use) in a community sample.

12
Two distinct personality types?

• Several studies show that most alcoholics do not
  fall into one of the two types
• e.g. Rubio et al. (1998)
• Only 39 fell into one of the two categories.
• 7.5 didnt meet criteria for either, while
  nearly 47 met criteria for both types.
• Better viewed as a dimension than discrete
  categories?
• Rubio et al. (1998) report some support for
  predictions
• Self-reported loss of control was confined to
  type I alcoholics
• However there were also contradictory findings
• The only children of alcoholic mothers (N3) were
  all type 2 alcoholics.

13
What is the genetic influence?

• High risk studies
• Studies using Cloningers personality dimensions
  have generally not found differences between sons
  of alcoholics and controls (Howard et al., 1995)
• This group also does not seem to show particular
  personality characteristics using other measures.
• Some studies imply that they may show a greater
  incidence of cognitive deficits, but there have
  been failures to replicate this finding.
• There is better, though still limited, evidence
  that their response to alcohol may vary from that
  of controls.
• For example, Schuckit (1984) administered alcohol
  to high risk subjects and controls. The high risk
  subjects reported feeling less intoxicated.

14
Problems with high risk studies

• Children of alcoholics are also at heightened
  risk of exposure to various environmental
  stressors.
• Risk might allow statistical prediction, but most
  high-risk individuals dont go on to become
  alcoholics.
• Comparable studies of long-term environmental
  predictors are rare.
• Studies, discussed in another session, examine
  predictors of adolescent use, but this may not
  relate well to adult abuse.

15
Co-morbidity issues

• A recent trend is research examining the evidence
  for common genetic (and environmental) factors
  influencing different characteristics.
• For example, Swan, Carmelli Cardon (1997)
  identified both genetic and unique environmental
  influences contributing to co-use of alcohol and
  nicotine.
• Kendler has produced evidence for genetic
  commonality between depression and both alcohol
  consumption and smoking.
• Slutske et al., (1988). Identified a common
  genetic risk for adult alcoholism and childhood
  conduct disorder.
• Contrary to Cloningers assertions they report
  that the association between the two disorders is
  stronger in women than in men, though their
  findings cant clarify whether this is due to
  stronger genetic or environmental common
  influences.

16
What are some strategies for preventing alcohol
abuse?

• Just say No?
• Which target population? usually college
  students
• Use of skills training Kiviland et al. (1990)
  found reduce alcohol consumption for those who
  received skills training (drinking moderately and
  relaxation) drank less in a year follow up as
  compared to two other groups (7.6 drinks/month v.
  16.8 drinks/month and 15.4 drinks/month)
• Challenging the alcohol users beliefs Darkes
  Goldman (1993) F 7.10, p. 256 expectancy
  group showed a decrease in alcohol use
• Early intervention and use of feedback concerning
  ones level of alcohol consumption
• Glanz et al. (2002) found that positive community
  level modelling presented to 11th graders help to
  reduce alcohol consumption
• Provide accurate norms about alcohol
  consumption lower level of consumption Borasi
  Carey (2000) Box 7.12. p. 257 Schroeder
  Prentice (1998)
• Public policy and laws to limit drinking lower
  BAC for persons under 21 and driving, no Sunday
  sales

17
Factors that affect treatment success

• 75 recover on their own but some need help.
• Current level of dependence
• Medical Problems
• Treatment History
• Previous Quit Attempts
• Social Support Systems
• Personal resources
• Other psychological problems
• Attitudes about treatment
• Information http//www.addictioncareoptions.com/

18
Detoxification physical dependence

• Symptoms begin 5-12 hrs after drinking stopped
  and may last up to 72 hrs like D.T.s delirium
  tremors, rapid detox techniques controversy
• Benzodiazepines
• helps withdrawal
• 4 detoxification alternatives
• Inpatient medical
• Partial hospital medical
• Inpatient nonmedical
• Outpatient medical
• Examples http//www.thecolemaninstitute.com/
• http//www.summerhousedetoxcenter.com/
• Which to use? http//www.abcdetox.com/detoxliverna
  tural/
• A strange one? http//www.cleanse-usa.com/colon-2i
  .html

19
Treatments for Alcohol Abuse

• Self-help groups Alcoholics Anonymous AA and
  the 12 step program Table 7.4, p. 259 no
  systematic evaluation of the claimed 75 success
  rate of AA
• Individual treatment
• Group therapy
• Couples therapy
• Family therapy
• In most cases, can occur as inpatient or
  outpatient

20
Treatments for Alcohol Abuse

• Coping and Skills Training
• Drinking conceptualized in terms of deficits in
  interpersonal and coping skills
• Condition more adaptive responses to drinking
  cues
• Focus on new coping skills
• Functional analysis, relapse prevention, cue
  exposure, refusal skills
• Table 7.5, p. 261 handling pressures to drink
  Flectcher (2001)
• Community Reinforcement Approach
• Based in Cognitive/Behavioral theory
• Sobriety through use of support systems
• Examine interaction between environment
  drinking
• Uses skills training
• Functional analysis
• Mood monitoring
• Vocational counseling
• Drink refusal training
• Compliance monitoring
• Buddy systems

21
Treatments for Alcohol Abuse

• Motivational Enhancement
• Developed by William R. Miller (1983), from an
  experience outside a barber shop in Norway
• Brief intervention tradition
• Nonconfrontational
• Client-centered
• Focus on motivation/readiness to change
• Techniques include
• Feedback of risk/impairment
• Responsibility for change
• Advice to change
• Menu of alternative change options
• Therapist empathy
• Facilitation of client self-efficacy
• http//motivationalinterview.org/clinical/

22
Pharmacological treatments

• Disulfiram/Antabuse
• In pill form by prescription only
• Inhibits adelhyde dehydrogenase (ALDH) results in
  Acetaldehyde poisoning.
• Body cant break down alcohol
• When in system (lasts up to 3 days), alcohol use
  produces strong aversive physical reaction
• Must be taken daily
• Compliance is major drawback
• Some drinkers dont take pill because of its
  effect
• discourages drinking conditioned aversion (CC)
• It is not very effective in double blind studies.
  Problems with long-term compliance with aversive
  treatments in general F. 7.11, p. 260

23
Pharmacological treatments

• Naltrexone
• In pill form by prescription only
• Blocks ETOH induced release of dopamine which
  results in decreased euphoria. Effective in
  double blind studies. Side Effects are nausea,
  Headache and hepatotoxicity.
• 2 main effects
• Decreases rewarding experience of alcohol
• Reduces craving
• Must be taken daily
• Compliance is major drawback
• Acamproset - Glutamate antagonist, and agonist of
  GABA receptors. It is used for withdrawal and
  abstinence. Effective 60. Side effects include
  Diarrhea and headache. It is renally cleared.

24
Lingering issues

• Is there a genetic link to smoking?
• Researchers 60 inherited? Twins studies
• Influence age when one smokes
• Can alcoholics have controlled drinking?
• Controversy about social drinking
• Persons under 40 have better success for
  controlled drinking especially with stable
  marriage and short history of alcohol abuse (lt 10
  years) and not suffer severe withdrawal symptoms
  Miller Hester (1980)
• Abstinence leads to lower relapse rates (return
  to abuse levels) than controlled drinking.