Samuel Pombo

The Alcoholic Phenotypes among Different Multidimensional Typologies: Similarities and Their Classification Procedures

AIM This detailed cross-sectional analysis, obtained from a sample of alcohol-dependent patients, attempts to compare multiple methods that have been created to classify or subtype alcoholics. METHODS The sample comprised 318 alcohol-dependent patients recruited from the alcoholism unit (NETER) of the Psychiatric Service of Santa Maria University Hospital in Lisbon (Portugal). All subjects were evaluated during the outpatient therapeutical programme for operationalized criteria, reported by each alcoholism typology. RESULTS Regarding concordance agreement (kappa values) for the three type I/II classifications, von Knorring versus Sullivan yielded the higher rate of agreement, followed by von Knorring versus Gilligan and Gilligan versus Sullivan criteria. Chi-square comparisons showed a significant overlap between Babor type A and Cloninger type I of von Knorring and Sullivan. Over-two-type classifications showed the following significant positive relations: Lesch type I versus NETER heredopathic subtype; Lesch type II versus NETER anxiopathic subtype and Babor type A; Lesch type III versus NETER tymopathic subtype; Lesch type IV versus Cloninger type II of von Knorring and Sullivan criteria; and NETER adictopathic subtype versus Cloninger type II of von Knorring, Sullivan and Gilligan criteria. CONCLUSIONS There is a significant overlap across many of the multivariate alcoholic subtypes purposed, in which much of the concordance is a function of common characteristics in subtype operationalization. Commonalities among these different subtyping classification systems offers the possibility of identifying important dimensions that better differentiate individuals among problem drinkers populations.

The burden of cyclothymia on alcohol dependence

BACKGROUND The relationship between cyclothymic temperament and alcoholism remains insufficiently explored. METHODS A sample of 125 alcohol-dependent patients diagnosed according to DSM-IV-TR criteria (APA, 2000) was recruited from a clinical setting. Cyclothymic temperament was diagnosed according to the Portuguese version of the Akiskal and Akiskal (2005) temperament scale. RESULTS Alcohol dependent patients who score positive (above mean) for CT present to some extent a more severe profile of alcohol-related problems. LIMITATIONS Correlational study CONCLUSIONS CT traits in alcohol dependents seems to influence whether subjects engage earlier in pathological alcohol use and present particular alcohol-related problems, in particular Cloninger type II alcoholism phenotype.

NETER alcoholic 5 subtypes: Validity with Lesch four evolutionary subtypes

Objective. To validate NAT (NETERs alcoholic typology), taking into account the differentiated distribution of the measures used as external criteria in alcohol-dependent sub-groups and its relationship with Leschs alcoholic typology (LAT). Method. A sample of 133 alcohol-dependent patients integrated in the alcoholism unit of the Psychiatric Service of Santa Maria University Hospital were included in the study. Results and Conclusions. Convergent validity was assured by the agreement between the subtypes of the two typologies (NAT and Lesch), considering the same underlying model of alcoholism development: anxiopathic subtype of NAT and Type II (model of anxiety, alcohol as conflict solution) of Lesch and the tymopathic subtype of NAT and type III (model of depression, alcohol as antidepressant) of Lesch. Discriminant analysis (external criteria) showed significant differences between the subtypes in the following variables: gender; tobacco; beer and whisky consumption; daily average of drinks; clinical conditions such as delirium tremens, alcoholic blackouts and seizures; severity of alcohol-related problems; psychological dimensions such as psychological maturity and extroversion; and suicidal ideation during the alcohol consumption period. A more exhaustive description of alcoholic sub-groups may improve genetic studies of alcoholism and provide the alcoholic patient with an adequate specific therapeutic protocol.

The role of 5-HTTLPR polymorphism in alcohol craving experience

The way in which genetic risk mediates the development of craving in alcohol dependence is still relatively unknown. The authors sought to clarify the extent to which alcohol craving could be predicted by a relevant polymorphism in the promoter region of the gene encoding the 5-HT transporter (5-HTTLPR). A sample of 101 alcohol-dependent patients admitted for alcohol treatment was recruited for the study. At admission, blood samples were taken for DNA extraction and alcohol craving information was collected with a composite measure. The 5-HTT polymorphism was genotyped. Alcohol dependent patients who were homozygous for the long allele (LL) self-reported higher scores of craving when compared to patients that were homozygous for the short allele (SS). However, the results were not statistically significant. Also, no significant associations were observed between the 5-HTTLPR genotype and other drinking variables. No 5-HTTLPR genotype effects were observed on alcohol craving experience in a sample of alcohol-dependent outpatients.

Alexithymia and alcohol dependence: Do different subtypes manifest different emotion regulations?

Abstract Objective: Alcohol abusers are vulnerable to emotional disabilities. Studies have shown that alexithymia is significantly associated with alcohol dependence and many other phenotypic descriptors. Given the high phenotypic heterogeneity that characterizes the alcohol dependence syndrome, the study aims to assess alexithymia features according to a multivariate classification scheme of alcoholism – the Lesch Alcoholism Typology (LAT). Methods: A total of 274 alcohol dependence outpatients (DSM diagnosis) were recruited from the Alcoholism Unit of the Psychiatric Service of Santa Maria University Hospital. After a detailed clinical observation, subjects were evaluated with the alcoholism classification system (LAT) and self-rated alexithymia with the Toronto Alexithymic Scale – 20 items (TAS-20). Results: Data showed that almost half of the alcohol-dependent individuals were defined as alexithymic cases (48.5%). “Organic” alcohol-dependent patients (type IV of Lesch classification) presented higher scores in TAS-20 when compared to other subtypes, even after controlling for potential confounding factors. Furthermore, the TAS-20 scores were related to educational level and family history of alcoholism. Conclusions: Results indicate that the alexithymia construct is an important psychological dimension in the characterization of alcohol dependence, especially the alcohol-dependent phenotypes that are more likely to present co-existing organic complications.

Are the binary typology models of alcoholism valid in polydrug abusers

OBJECTIVE To evaluate the dichotomy of type I/II and type A/B alcoholism typologies in opiate-dependent patients with a comorbid alcohol dependence problem (ODP-AP). METHODS The validity assessment process comprised the information regarding the history of alcohol use (internal validity), cognitive-behavioral variables regarding substance use (external validity), and indicators of treatment during 6-month follow-up (predictive validity). RESULTS ODP-AP subjects classified as type II/B presented an early and much more severe drinking problem and a worse clinical prognosis when considering opiate treatment variables as compared with ODP-AP subjects defined as type I/A. Furthermore, type II/B patients endorse more general positive beliefs and expectancies related to the effect of alcohol and tend to drink heavily across several intra- and interpersonal situations as compared with type I/A patients. CONCLUSIONS These findings confirm two different forms of alcohol dependence, recognized as a low-severity/vulnerability subgroup and a high-severity/vulnerability subgroup, in an opiate-dependent population with a lifetime diagnosis of alcohol dependence.

Multidimensional alcoholism typologies: could they guide clinical practice? Results from a 3-month prospective study

Abstract Objective. The current nosological classifications may describe a syndrome of “alcoholism” that is too heterogeneous to produce prognostic models for clinical management. Multidimensional alcoholism typologies (ATs) could represent a valuable paradigm in the search for targeted treatment. The main goal of this study was to evaluate the clinical implications of 3 empirically-validated ATs, focusing on various measures of clinical performance. Method. This was a 3-month naturalistic study in which drinking status, and participation in the clinical protocol and group psychotherapy were recorded and used as indicators of treatment performance. The clinical profiles of the subtypes were also compared and graphically presented. Alcohol-dependent outpatients were classified according to the Cloninger, Lesch, and NETER typologies. Results. The results showed that the type II (Cloninger), type IV (Lesch), and sociopathic and addictopathic (NETER) subgroups showed a worse outcome in terms of abstinence rates and clinical healthcare resource use. Conclusions. Our findings point to the need to differentiate multidimensional alcoholism subtypes before planning the clinical management of alcohol use disorders.

Predictors of Multiple Substance Use in Alcohol Dependence: The Role of Personality

Objective: The simultaneous use of several licit and illicit psychoactive substances is highly common among patients with mental health disorders. Relatively few studies have investigated the role of personality in the different patterns of multiple substance use among alcohol dependents. The authors aimed to access the association of several clinical, socio-demographic and personality predictors of nicotine and multiple substance use in alcohol dependents. Method: A sample of 178 alcohol-dependent patients was eligible for this study. The profiles of 3 groups of alcohol-dependent patients were compared: 1. alcohol dependents without nicotine use or other substances (“pure” alcohol-dependents; PAD); 2. alcohol-dependent smokers (ADS) without substances use and 3. alcohol-dependents with the use of multiple substances (ADMS). Results: Multiple regression analysis showed that age, educational background, occupational status, years of alcoholism and the personality trait of openness to experience were predictors of Multiple Substance Use (MSU) in alcohol dependent outpatients. Results of the mediation analyses/multivariate regression modelling using bootstrapping method confirmed the mediation role of educational level in the relation between openness to experience and substance use. Conclusion: In alcohol dependents, as in the general population, the personality trait openness to experience may constitute a vulnerability factor associated with polydrug use.

The role of affective temperament as a predictor of relapse in alcohol dependence

BACKGROUND Personality traits have been proposed as relapse risk factors in alcohol use disorders. So far, no study has assessed the association between affective temperamental traits and the prospective relapse risk. METHODS This was a 3-month prospective naturalistic study, designed to assess the impact of affective temperaments in relapse. A sample of 61 alcohol-dependent patients was collected from an ambulatory clinical setting. Socio-demographic information, drinking and substance use habits, drinking status, craving and affective temperament traits were assessed. RESULTS Age, age of onset of alcohol abuse and dependence and drug consumption correlate with drinking status. Male alcohol-dependent patients who relapsed presented higher scores on cyclothymic temperament than patients with an alcohol dependence diagnosis who remain sober. Hierarchical logistic regression indicates that cyclothymic temperament predicted relapse in a 3-month follow-up. However, the coefficient was marginally significant after controlling for all potential confounding predictors. CONCLUSIONS Our results provide new insights about the role of affective temperaments in alcohol use disorders, specifically in predicting short-term relapse in detoxified male alcohol-dependent patients. Copyright