Roger E. Meyer

“Never Believe an Alcoholic”? On the Validity of Self-Report Measures of Alcohol Dependence and Related Constructs

A study of 114 male and female alcoholics was conducted to evaluate the validity of information obtained by means of self-report questionnaires. Factor analysis was used to derive composite measures of alcohol dependence, withdrawal symptomatology, pathological intoxication, and alcoholic psychosis. Validation was conducted by comparing these measures with independent and external criteria; that is drinking estimates made by collateral informants, measures of general alcohol involvement, and drinking behavior 6 months after treatment. The results support each type of validity, and thereby contradict the assumption that the alcoholics self-reports were not accurate. The question of unreliable self-report data due to the demand characteristics of the situation under which the information is obtained is also addressed.

Antisocial Behavior, Psychopathology and Problem Drinking in the Natural History of Alcoholism

It is well known that alcoholism often occurs in persons having an antisocial personality. Conversely, the behavior of persons with alcoholism often appears to be antisocial in nature. Thus, the differentiation of alcoholism from antisocial personality can be quite difficult and lead to diagnostic confusion [27]. While these two disorders are similar in some respects, and may sometimes occur together, their natural histories probably differ.

The nature of alcoholism in patients with different family histories for alcoholism

1. The course and consequences of alcohol abuse were examined in male and female patients being treated for alcoholism. 2. Demographic characteristics, family history for alcoholism, psychopathology, drinking history and social and physical consequences of alcohol abuse were assessed. 3. Probands with alcoholism on both the maternal and paternal sides of their pedigree experience greater psychosocial and physical consequences of alcohol abuse than other alcoholic patients. 4. Sex of the proband and type of family pedigree for alcoholism were found not to be interactive but to contribute separate additive effects.

Alcohol Reinforcement: Biobehavioral and Clinical Considerations

When compared with stimulants, opioids, and barbiturates (Schuster and Thompson, 1969; Schuster and Villareal, 1968; Winger et al., 1983; Yanagita et al., 1969) in intravenous self-administration paradigms in monkeys and rats, ethanol is a relatively weak reinforcer. The delay in reinforcement associated with oral self-administration of ethanol further inhibits its reinforcing efficacy. A relatively prolonged period of exposure to frequent high doses of ethanol is necessary for the development of alcohol dependence in humans. In contrast, in vulnerable individuals, intravenous opiate self-administration, and intravenously self-administered or smoked cocaine are associated with the rapid development of dependence. The risk of developing alcohol dependence is strongly influenced by factors in the individual (e.g., genetics, temperament, psychopathology) and the environment (e.g., culture).

Psychobiology and the Treatment of Drug Dependence: The Biobehavioral Interface

In the past 15 years there has been an explosion of data on the multivariate nature of drug dependence. The complex relationship between addictive disorders and psychopathology has been better clarified. Certain Axis I and II diagnoses in DSM-III appear to occur more commonly in alcohol- and drug-dependent patients than in the general population, suggesting that they may serve as risk factors for the development of addictive disorders. Psychopathological symptoms also result during periods of chronic intoxication and may persist as secondary psychiatric disorders even in the absence of continued substance use. Behavioral research in human and animal models has begun to yield insights into the nature of dependence disorders and the importance of brain mechanisms of reinforcement to the addiction process. Inevitably, neural scientists are beginning to delineate the commonalities and differences in drug reinforcement across drug class. The research has begun to suggest pharmacological approaches to the treatment of drug dependence and withdrawal. This paper provides an overview of research on the psychobiology of drug dependence with implications for the clinician.

Alcohol dependence: a biobehavioral perspective.

The behaviorally based constructs of DSM-III have differentiated alcohol abuse and dependence, wherein the latter has been characterized by: a history of tolerance and physical dependence; and a history of pathological drinking patterns and/or problems consequent to drinking behavior (APA-DSM III 1980). In contrast, ICD-9 refers to an alcohol dependence syndrome which follows the model proposed by Edwards and Gross in 1976. The WHO memorandum on nomenclature and classification of drug and alcohol related problems has further proposed that alcohol dependence be defined along a continuum of severity, and that dependence be differentiated from severity of alcohol related disabilities (Edwards et al. 1981). In many respects, the alcohol dependence syndrome construct is consistent with Jellineks disease concept of alcoholism which had its antecedents in medical writings of the late eighteenth and early nineteenth centuries (Lender 1979). Commencing in the early 1960s, many behavioral and social scientists were critical of the disease model of alcoholism. Behavioral researchers found that the drinking behavior of alcoholic subjects could be controlled by its consequences in the laboratory, suggesting that drinking behavior was like any operant. Longitudinal studies of drinking practices suggested that relapse to dependent drinking did not appear to be inevitable. In general, these researchers have utilized behavioral and epidemiological data to prove the null hypothesis: that there was no biological disease behind alcohol addiction. In contrast to the operant studies which served to rebut the disease construct, Ludwig and associates employed a model of Pavlovian conditioning which suggested a relationship between an alcoholics desire to drink and an increase in autonomic arousal associated with the presence of alcohol (Ludwig et al. 1977).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of Opiates on Neuroendocrine Function Testosterone and Pituitary Gonadotropins

Among chronic opiate users, disturbances in sexual function are now commonly recognized clinical phenomena. In males, diminished libido, impotence, and delayed ejaculation have been described,(1) while amenorrhea and decreased fertility have been reported among female users of opiate drugs.(2) These observations have led to investigations of the effects of opiates on the pituitary gonadotropins, luteinizing hormone (LH), and follicle-stimulating hormone (FSH), and on the primary secretions of the end organs they influence (i.e., testosterone and estrogens). To date, most of these studies have utilized animal models. More recently some investigators have turned their attention to the effects of opiates in man.

Effect of Opiates on Neuroendocrine Function Plasma Cortisol, Growth Hormone, and Thyrotropin

In the mammalian brain the hypothalamus serves as a central switchboard in the integration and modulation of incoming messages from higher brain areas and peripheral organs. Signals from the hypothalamus itself are mediated through the synthesis and release of small peptides, which appear to possess behavioral as well as physiological activity. These hypothalamic releasing factors modulate pituitary function and thereby also affect peripheral endocrine activities, including adrenocortical and gonadal steroidogenesis. Narcotic drugs have long been known to interfere with normal neuroendocrine function, but only recently have experimental methods permitted critical investigations with human subjects.

Ward Management in a Research-Treatment Setting

For those who undertake the treatment of opiate-dependent individuals, continuing challenge and frustration are the rule. Retention of patients in meaningful treatment is challenged by the extreme impulsivity of this client population, their ambivalence about giving up drug use, and the ubiquity of stimuli that trigger drug-seeking behavior. Most drug treatment programs seek to gain some control over patient behavior. Inpatient therapeutic communities have increasingly shown a preference for clients entering treatment as a condition of probation or parole because the dropout rate of voluntary patients is unreasonably high. On the other hand, methadone maintenance programs boast an impressive retention rate because withdrawal from treatment is associated with a prolonged narcotic abstinence syndrome. The required daily dose of methadone serves as a powerful reinforcer in these programs and provides the treatment staff with some measure of control over client behavior.