Howard Rankin

Alcohol dependence and the priming effect

Abstract The concepts of loss of control and craving are reviewed and relevant experimental findings are discussed. Speed of drinking is proposed as a behavioural measure of craving and an experiment is described to test the hypothesis that craving is primed by a moderate dose of alcohol (45 gm). The hypothesis was confirmed, but only for the severely dependent alcoholics. The results indicated that the behavioural measure of craving and the assessment of severity of dependence were crucial. Failure to measure either of them would have resulted in failure to identify a priming effect.

The concept of craving and its measurement

Abstract By encouraging short periods of abstinence, conditions representing high and low craving were arranged in the homes of 10 alcoholic subjects on two separate occasions. The alcoholics subjective, physiological and behavioural responses and their interrelationships over a three and a half-hour response prevention period, were recorded in an attempt to define the concept of craving. A behavioural measure, speed of drinking a prescribed amount of alcohol, was validated as a correlate of craving.

Cue exposure and response prevention with alcoholics: A controlled trial

Abstract Ten severely alcohol-dependent subjects were divided into two groups, one of which received only 6 sessions of in-vivo cue exposure and response prevention and the other of which received 6 sessions of imaginal cue exposure, followed by 6 sessions of in-vivo cue exposure and response prevention. The in-vivo cue exposure produced significant decrements on behavioural and subjective measures for both experimental groups on Desire to Drink and Difficulty to Resist Alcohol. Imaginal cue exposure produced trivial changes on these measures. The implications for both theory and practice are discussed.

Alcohol dependence, beliefs and the priming effect

Abstract Twenty hospitalized alcoholics served as their own controls in a study which sought to compare psychophysiological and cognitive factors as mediating influences on the priming effect of alcohol. Ten subjects were independently assessed by a psychiatrist as being severely dependent on alcohol and ten as mildly or moderately alcohol dependent. Physiological, behavioural and subjective indices of the motivation to drink alcohol were employed 15 and 60 min after subjects had consumed beverages on four separate occasions corresponding to four priming conditions. These priming drinks contained either 60 ml vodka in heavy dilution or just tonic water, and in each of these conditions subjects were either led to believe that the beverages contained alcohol or they had no alcohol. The severely-dependent group displayed a degree of concordance between the indices of motivation to drink, and the levels of these tended to be significantly higher than in the less-dependent subjects. The results suggest that severely alcohol-dependent subjects were more disposed to drink 60 min after consuming alcoholic drinks than after soft drinks, regardless of whether they believed that the priming drinks had contained alcohol. Cognitive factors assumed greater importance for the drinking behaviour of less-dependent subjects, although there was evidence of discordance across behavioural, physiological and subjective measures for this group.

Personality and alcohol dependence

Abstract In this study, groups of ‘alcoholic’ subjects were independently rated as to their degree of dependence by a technique previously validated. The two groups of moderately and severely dependent subjects were then given the 101-item EPQ. In keeping with other similar studies, the data suggested that high N, high P and low E in men were related to the Clinical Alcohol Personality. Further analysis of these and other data suggest that whilst raised N scores may be a spurious artefact which is a consequence of heavy alcohol consumption, the E and P findings may reflect stable predispositions. There were no sex differences, but there was a major group difference on P, with both severely dependent men and women scoring significantly higher than their less dependent counterparts.

Cue Exposure and Relapse Prevention

Compulsions and addictions are very similar in many respects. In both, there is a strong urge to do something which is difficult to resist. They often lead to a reduction in anxiety but are sometimes difficult to stop, and then, if prolonged, they are associated with an increase in anxiety and a feeling of helplessness. Frequently, both compulsions and addictions are so powerful that family or work responsibilities are ignored, and both, when severe, involve repetitive stereotyped actions. Both addictions and compulsions are prime examples of the irrational self-destructive behavior which is part of the human condition, and both are generally considered to be among the most intractable of problems. If they are similar in so many ways, then there may be some advantage to be gained from applying a “compulsion model” to alcoholism, especially since there have been recent advances in the treatment of compulsive disorders (e.g., Meyer, 1966; Rachman & Hodgson, 1980; Rachman, Hodgson, & Marks, 1971). It has been clearly demonstrated in a number of studies that compulsions can be modified by an extinction procedure involving prolonged exposure to those cues which trigger, or at least influence, the compulsive ritual. The compulsive hand washer is persuaded to touch “contaminated” objects and then resist the urge to wash so that the imaginary contamination is spread to all and sundry. A person who feels compelled to check and recheck gas taps off as quickly as possible without checking.

Cue Exposure: One Approach to the Extinction of Addictive Behaviours

In recent years there has been growing dissatisfaction with the traditional treatment approach to alcoholism, the goal of total abstinence based on the hypothesis that alcoholism is an irreversible disease. Jellinek (1960) stressed that the disease concept of alcoholism should be only a “working hypothesis” to be discarded if disconfirmed by empirical evidence. Evidence against the disease model is gradually accumulating and many research workers believe that we are at this very moment in the throws of a rather violent paradigm shift, (Sobell, 1976). To this end, studies have demonstrated relatively poor outcome for all sorts of different approaches while others (e.g., Edwards and Guthrie, 1967) have been unable to demonstrate that the traditional in-patient approaches are at all effective. In these circumstances we must generate alternative working hypotheses as to the nature and treatment of addictive behaviours and then make sure that these working hypotheses do not become dogma but are adequately and repeatedly tested.

Craving and Loss of Control

At the heart of the disease model of alcoholism is a poorly understood and poorly defined concept usually called “loss of control” which, for most psychologists, is on its last legs if not actually down and out. Our aim in this paper is to try to bring it in from the cold, dust it down and generally make it more presentable to the behavioural scientist.

Loss of Control and Dependence on Alcohol

The concepts of loss of control and craving are reveiwed and relevant experimental findings are discussed. Speed of drinking is suggested as a behavioural measure of craving and an experiment is described to test the hypothesis that craving is primed by a moderate dose of alcohol (45 gms). The hypothesis was confirmed but only for the severely dependent alcoholics.

CONCORDANCE COEFFICIENT (W), CORRECTION FOR THE INEQUALITY OF INTERVAL IN THE UNDERLYING RHOS

The coefficient of concordance (W) was computed by two methods, (1) by arithmetic averaging of the underlying rhos (rs) and (2) by transforming the rss to an equal-interval scale before averaging. The first method is traditional, while the second method is, methodologically, more correct in that rs is not an equal-interval statistic. Method 2, for which a computer program had to be written (available from the authors), yielded Ws which were, on the average, 12% larger than those of Method 1. The magnitude of difference suggests that either method is satisfactory for indicating the gross degree of concordance. However, if a comparison between matched-groups is contemplated, then the more accurate method seems appropriate. Further, it was found that Method 2 was less affected by irregularities in the data, e.g., small number of atypical Ss, than was Method 1. Five sets of data, covering a wide range of Ws and Ns, were presented and the relationship between the corrected W, sample size, and the traditional W were also considered.