Alcohol Challenge Responses Predict Future Alcohol Use Disorder Symptoms: A 6-Year Prospective Study

doi:10.1016/j.biopsych.2013.08.001

Biological Psychiatry

Volume 75, Issue 10, 15 May 2014, Pages 798-806

https://doi.org/10.1016/j.biopsych.2013.08.001 Get rights and content

Background

Propensity for alcohol misuse may be linked to an individuals’ response to alcohol. This study examined the role of alcohol response phenotypes to future drinking problems.

Methods

One hundred four young heavy social drinkers participated in a within-subject, double-blind, placebo-controlled laboratory alcohol challenge study with 6-year follow-up. Participants were examined for subjective responses before and after receiving an intoxicating dose of alcohol (.8 g/kg) or a placebo beverage, given in random order. Follow-up was conducted in 5 waves over 6 years after the sessions to assess drinking behaviors and alcohol use disorder (AUD) symptoms. Retention was high with 98% (509 of 520) of possible follow-ups completed.

Results

Greater sensitivity to alcohol, in terms of stimulation and rewarding effects (like, want more) and lower sensitivity to alcohol sedation predicted greater number of AUD symptoms through 6 years of follow-up. Cluster analyses revealed that for half the sample, increasing levels of stimulation and liking were predictors of more AUD symptoms with the other half divided between those showing like and want more and want more alone as significant predictors.

Conclusions

The findings extend previous findings and offer new empirical insights into the propensity for excessive drinking and alcohol problems. Heightened alcohol stimulation and reward sensitivity robustly predicted more alcohol use disorder symptoms over time associated with greater binge-drinking frequency. These drinking problems were maintained and progressed as these participants were entering their third decade of life, a developmental interval when continued alcohol misuse becomes more deviant.

Section snippets

Methods and Materials

The study was approved by the University of Chicago Institutional Review Board. The design was a double-blinded, placebo-controlled, within-subjects study of responses to alcohol challenge, with longitudinal follow-up of alcohol drinking behaviors and problems in 190 non-alcohol-dependent social drinkers. The laboratory phase (March 2004 to July 2006) included three sessions. After laboratory testing, each participant entered the longitudinal follow-up phase, with no participants lost to

Results

Including missing follow-ups of two participants who withdrew (2 men in Year 4) and one who died (a woman in Year 3), 98% (509 of 520) of follow-ups were successfully conducted at 1, 2, 4, 5, and 6 years. Table 1 presents demographic and drinking characteristics at baseline when the average age was 25.3 years (range 21–34) years and at year 6 when the average age was 31.4 years (range 27–40). From baseline to Year 6, alcohol drinking decreased for any drinking frequency (from 51% to 44% of

Discussion

Our results provide important evidence for the role of alcohol stimulation and reward sensitivity, in addition to lower sedation, in the development of future AUD symptoms and persistence and exacerbation of bingeing and other drinking behaviors. The study extends our previous findings (16) to a critical longer 6-year follow-up interval when most participants were entering their third decade of life and provides crucial and broader longitudinal evidence to reconcile theoretical debate about

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113 adults (54 with borderline personality disorder and 59 community participants; 77.9% female) completed ecological momentary assessment for 21 days, reporting momentary subjective stimulation and sedation throughout drinking episodes and momentary alcohol use after drink initiation (i.e., continued drinking).
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Drinking and drinking problems are complex phenomena. Understanding the etiology of alcohol use disorder requires consideration of biological, psychological, and social processes. It is our view that the last of these dimensions is just beginning to receive adequate scrutiny. In this selective review, we discuss the concept of a biopsychosocial analysis of the effects of alcohol. After briefly addressing biological and psychological research on alcohol's emotional effects, we bid to make a case for the vital role that social processes play in understanding why people drink. The bulk of the paper describes research illustrating the contributions that a social psychological perspective can make to advance understanding of the rewarding effects of alcohol. Overall, studies incorporating social contexts have revealed reliable evidence that alcohol enhances emotional experience in many social environments and have identified socio-contextual variables that moderate responses to alcohol. Further, these studies have broadened the scope of constructs thought to be socially rewarding, including social bonding, relationship functioning, and humor enjoyment. Our analysis concludes by identifying research areas we believe would profit from additional research.
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Citation Excerpt :
We also found an indirect effect from alcohol liking to initial testing hangover frequency and, in turn, follow-up hangover frequency, which is important as more frequent hangover can lead to worsening hangover severity over time (Verster et al., 2019). Our results suggest that individuals who are sensitive to alcohol’s hedonic effects may be at risk for AUD due to both proximal increases in drinking behavior and consequences (King et al., 2011, King et al., 2014, 2021) and exacerbating hangover severity that could impact work or other daily activities over time, even at levels of alcohol consumption commensurate to when they first started drinking (Ames et al., 1997; Kahler et al., 2008; Pidd et al., 2006; Ragland et al., 2002; Stockwell, 1998). Our results showing that alcohol use quantity-frequency mediated the association between alcohol wanting and hangover frequency at initial testing and 5-year follow-up highlight the potential sensitivity of alcohol wanting in predicting current and future alcohol-related consequences (MacKillop et al., 2010; King et al., 2014; Chavarria et al., 2020).
Background/Purpose: Acute subjective alcohol effects appear to play an important role in predicting alcohol hangover. However, no studies have used a laboratory-based alcohol challenge to examine the concurrent or longitudinal effects of subjective alcohol responses on hangover frequency. As such, we investigated the direct and indirect effects of alcohol stimulation, sedation, liking and wanting, as measured in a controlled setting, on hangover frequency over five years. Method: Participants were 294 young adult light-to-heavy social drinkers (aged 21–35 years, 42% female) enrolled in the Chicago Social Drinking Project. The study utilized a placebo-controlled, double blind, laboratory alcohol challenge and a battery of measures including the Biphasic Alcohol Effects Scale, Drug Effects Questionnaire, Hangover Symptom Scale, and alcohol use Quantity-Frequency Interview, with the latter two re-administered after five years. Results: Through the use of a path analysis, the present study found significant direct effects from alcohol liking to hangover frequency at initial testing. In addition, there were multiple significant indirect effects from greater alcohol liking and wanting to greater alcohol use quantity-frequency and, in turn, greater hangover frequency at initial testing and 5-year follow-up. Last, there were significant indirect effects from greater alcohol sedation to less alcohol use quantity-frequency and, in turn, less hangover frequency at initial testing and 5-year follow-up. Conclusion: This study highlights the role of the hedonic reward and motivational salience of alcohol as potential mechanisms of alcohol-related consequences (i.e., hangover) among light-to-heavy social drinking young adults.

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Archival ReportAlcohol Challenge Responses Predict Future Alcohol Use Disorder Symptoms: A 6-Year Prospective Study

Background

Methods

Results

Conclusions

Section snippets

Methods and Materials

Results

Discussion

Lancet

Life Sci

Brain Res Brain Res Rev

J Chronic Dis

Am J Clin Nutr

Prog Neuropsychopharmacol Biol Psychiatry

Neuropharmacology

Clin Psychol Rev

Modelling lifetime QALYs and health care costs from different drinking patterns over time: A Markov model

Int J Methods Psychiatr Res

The “gray area” of consumption between moderate and risk drinking

J Stud Alcohol Drugs

Is there a common molecular pathway for addiction?

Nat Neurosci

Subjective responses to alcohol: A paradigm shift may be brewing

Alcohol Clin Exp Res

Subjective response to alcohol: A critical review of the literature

Alcohol Clin Exp Res

Alcohol challenge with sons of alcoholics: A critical review and analysis

Psychol Bull

High risk groups often have higher levels of alcohol response than low risk: The other side of the coin

Alcohol Clin Exp Res

Low level of response to alcohol as a predictor of future alcoholism

Am J Psychiatry

An 8-year follow-up of 450 sons of alcoholic and control subjects

Arch Gen Psychiatry

Subjective response to alcohol challenge: A quantitative review

Alcohol Clin Exp Res

Self-rating of alcohol intoxication by young men with and without family histories of alcoholism

J Stud Alcohol

Men at high risk for alcoholism: The effect of alcohol on cardiovascular response to unavoidable shock

J Abnorm Psychol

A psychomotor stimulant theory of addiction

Psychol Rev

Rewarding, stimulant, and sedative alcohol responses and relationship to future binge drinking

Arch Gen Psychiatry

Incentive-sensitization and addiction

Addiction

The complexity of alcohol drinking: Studies in rodent genetic models

Behav Genet

Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Arch Gen Psychiatry

Binge drinking among US adults

JAMA

National Survey on Drug Use and Health

Helping Patients Who Drink Too Much: A Clinician’s Guide (NIH Publication No. 05-3769)

Risky single-occasion drinking: Bingeing is not bingeing

Addiction

American Drinking Practices: A National Study of Drinking Behavior and Patterns [monograph]

Alcohol Timeline Follow-Back Users’ Manual

Archival Report
Alcohol Challenge Responses Predict Future Alcohol Use Disorder Symptoms: A 6-Year Prospective Study