Kenneth J. Sher

Characteristics of children of alcoholics: putative risk factors, substance use and abuse, and psychopathology.

A sample of 253 children of alcoholics (COAs) and 237 children of nonalcoholics (non-COAs) were compared on alcohol and drug use, psychopathology, cognitive ability, and personality. COAs reported more alcohol and drug problems, stronger alcohol expectancies, higher levels of behavioral undercontrol and neuroticism, and more psychiatric distress in relation to non-COAs. They also evidenced lower academic achievement and less verbal ability than non-COAs. COAs were given Diagnostic Interview Schedule alcohol diagnoses more frequently than non-COAs. The relation between paternal alcoholism and offspring alcohol involvement was mediated by behavioral undercontrol and alcohol expectancies. Although gender differences were found, there were few Gender X Family History interactions; the effects of family history of alcoholism were similar for men and women. When gender effects were found, they showed greater family history effects for women.

Personality and disinhibitory psychopathology: alcoholism and antisocial personality disorder.

: We discuss the relation between personality factors and two adult forms of disinhibitory psychopathology--alcohol abuse or dependence and antisocial personality disorder. First, we briefly review various methodological issues relevant to research in this area. Next, we review empirical findings relating three broad-band personality trait dimensions neuroticism/emotionality, impulsivity/disinhibition, extraversion/sociability) to both alcohol abuse and dependence and antisocial personality disorder. Finally, theoretical models of the relationship between personality and each of these two disorders are presented. We conclude that although no single personality description is likely to be both a sensitive and specific indicator of either alcoholism or antisocial personality disorder, personality variables are important components of etiological models of these disorders.

Children of alcoholics : a critical appraisal of theory and research

This study offers a comprehensive, critical look at what is known and not known about children of alcoholics, and also constructs a model for assessing existing theory and introducing new methodological rigor into this field.

Automatic and Controlled Processes and the Development of Addictive Behaviors in Adolescents: A Review and a Model

This paper presents a review and a model of the development of addictive behaviors in (human) adolescents, with a focus on alcohol. The model proposes that addictive behaviors develop as the result of an imbalance between two systems: an appetitive, approach-oriented system that becomes sensitized with repeated alcohol use and a regulatory executive system that is not fully developed and that is compromised by exposure to alcohol. Self-regulation critically depends on two factors: ability and motivation to regulate the appetitive response tendency. The motivational aspect is often still weak in heavy drinking adolescents, who typically do not recognize their drinking as problematic. Motivation to regulate use often develops only years later, after the individual has encountered serious alcohol-related problems. Unfortunately, at that point behavioral change becomes harder due to several neurocognitive adaptations that result from heavy drinking. As we document, there is preliminary support for the central elements of the model (appetitive motivation vs. self-regulation), but there is a paucity of research directly addressing these mechanisms in human adolescents. Further, we emphasize that adolescent alcohol use primarily takes place in a social context, and that therefore studies should not solely focus on intra-individual factors predicting substance use and misuse but also on interpersonal social factors. Finally, we discuss implications of the model for interventions.

Personality and substance use disorders : A prospective study

The personality systems of Cloninger (as measured by the Tridimensional Personality Questionnaire [TPQ]) and Eysenck (as measured by the Eysenck Personality Questionnaire [EPQ]) both have been linked to substance use and abuse. The current study examined the predictive utility of both systems for substance use disorder (SUD) diagnoses, both cross-sectionally and prospectively. Participants (N = 489 at baseline) completed the EPQ and TPQ and were assessed via structured diagnostic interview at baseline and 6 years later (N = 457 at follow-up). Both the EPQ and TPQ scales demonstrated bivariate cross-sectional and prospective associations with SUDs. Within each system, those dimensions marking a broad impulsive sensation-seeking or behavioral disinhibition trait were the best predictors prospectively, although the 2 systems were differentially sensitive to specific diagnoses. These relations remained significant even with autoregressivity, other concurrent SUD diagnoses, and multiple personality dimensions statistically controlled.

A Developmental Perspective on Alcohol and Youths 16 to 20 Years of Age

Late adolescence (ie, 16–20 years of age) is a period characterized by escalation of drinking and alcohol use problems for many and by the onset of an alcohol use disorder for some. This heightened period of vulnerability is a joint consequence of the continuity of risk from earlier developmental stages and the unique neurologic, cognitive, and social changes that occur in late adolescence. We review the normative neurologic, cognitive, and social changes that typically occur in late adolescence, and we discuss the evidence for the impact of these transitions on individual drinking trajectories. We also describe evidence linking alcohol abuse in late adolescence with neurologic damage and social impairments, and we discuss whether these are the bases for the association of adolescent drinking with increased risks of mental health, substance abuse, and social problems in adulthood. Finally, we discuss both the challenges and successes in the treatment and prevention of adolescent drinking problems.

Understanding the construct of impulsivity and its relationship to alcohol use disorders

There are well‐established links between impulsivity and alcohol use in humans and other model organisms; however, the etiological nature of these associations remains unclear. This is likely due, in part, to the heterogeneous nature of the construct of impulsivity. Many different measures of impulsivity have been employed in human studies, using both questionnaire and laboratory‐based tasks. Animal studies also use multiple tasks to assess the construct of impulsivity. In both human and animal studies, different measures of impulsivity often show little correlation and are differentially related to outcome, suggesting that the impulsivity construct may actually consist of a number of more homogeneous (and potentially more meaningful) subfacets. Here, we provide an overview of the different measures of impulsivity used across human and animal studies, evidence that the construct of impulsivity may be better studied in the context of more meaningful subfacets, and recommendations for how research in this direction may provide for better consilience between human and animal studies of the connection between impulsivity and alcohol use.

BORDERLINE PERSONALITY DISORDER AND SUBSTANCE USE DISORDERS: A REVIEW AND INTEGRATION

The empirical literature on the comorbidity between borderline personality disorder (BPD) and substance use disorders (SUDs) is reviewed. BPD-SUD comorbidity data obtained from studies published from 1987 to 1997 document the frequent co-occurrence of these diagnoses. Methodological issues and theoretical models for understanding this co-occurrence are discussed. Finally, we present our conceptualization of the relations and interactions of the major factors influencing the development of BPD and contributing to the comorbidity between BPD and SUDs.

Revised NESARC Personality Disorder Diagnoses: Gender, Prevalence, and Comorbidity with Substance Dependence Disorders

We applied different diagnostic rules for diagnosing personality disorders to the NESARC epidemiological study of over 40,000 individuals. Specifically, unlike previous NESARC publications, we required that each personality disorder criterion be associated with significant distress or impairment in order to be counted toward a personality disorder (PD) diagnosis. Results demonstrated significant reductions in prevalence rates for PDs (9.1% versus 21.5% using original NESARC algorithms), and these revised prevalence rates were much more consistent with recent epidemiological studies in the U.S. and Great Britain. We also found gender differences in the prevalence rate for most PDs. Comorbidity analyses revealed strong associations between PDs and alcohol dependence, drug dependence, and tobacco dependence. PD diagnoses were also associated with scores on dysfunction and impairment, perceived stress and less social support, lifetime history of suicide attempts, interpersonal difficulties, and problems with legal authorities.

Assessing alcohol problems in college students.

Alcohol abuse among college students is prevalent, yet few instruments with sound reliability and validity are available to assess these problems in this population. As part of a large, baseline assessment battery for a prospective study of offspring of alcoholics, the 27-item Young Adult Alcohol Problems Screening Test (YAAPST) was given to 490 freshmen at a large midwestern university; approximately 9 months later, 482 subjects completed the scale again. In addition to asking about such traditional problems as experiencing blackouts and driving while intoxicated, the YAAPST included specific items relating to college experiences (eg, getting into sexual situations that were later regretted, missing classes, and receiving lower grades than usual). The YAAPST was designed to assess these drinking consequences over two different time frames, lifetime and past year, and also to indicate the frequency of occurrence during the past year. Results indicated that the YAAPST is a unidimensional scale with good psychometric properties (good internal consistency and test-retest reliability). Three different approaches were used to demonstrate the validity of the YAAPST. Findings supported criterion validity (with interview-based alcohol abuse/dependence diagnoses as the criterion), concurrent validity (comparing the YAAPST with other drinking measures), and construct validity (correlating the YAAPST with etiologically relevant personality, motivational, and peer influence variables). The YAAPST is a promising screening instrument for alcohol problems in college students. It has excellent psychometric properties and the potential to provide a range of useful information to the clinician or researcher.