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Presentations 2005: Alcoholism and Comorbidity

2005

Comorbidity of alcoholism and antisocialpersonality disorderR. O. PihlMcGill University

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Recommended CitationPihl, R. O., "Comorbidity of alcoholism and antisocial personality disorder" (2005). Presentations. Paper 3 Samuel B. Guze Symposiumon Alcoholism.http://digitalcommons.wustl.edu/guzepresentation2005/3

Comorbidity of Alcoholism and

Antisocial Personality Disorder

R.O. Pihl

McGill University

Alcoholism & ASPD

• Lets avoid the definitional quagmire.

• Lets agree there is a significant

correlation between Alcoholism and

ASPD.

• Lets agree that the nature of the

relationship is well understood.

The Role of Different

Motivational Systems

• Motivational system responding to threat

• The Cognitive Control System

• Motivational system responding to reward

Behavior

Aggression

Threatening or punishing

behavior

(Behaviorally-linked)

Sensory information

Executive Cognitive Functions

Facilitory:Cue for Reward

Inhibitory:Cue for Punishment

Behavior

Aggression

Threatening or punishing

behavior

AcuteAlcohol

Intoxication

(Behaviorally-linked)

Sensory information

Executive Cognitive Functions

Facilitory:Cue for Reward

Inhibitory:Cue for Punishment

Inhibits

Behavior

Aggression

Threatening or punishing

behavior

Disorganizes

AcuteAlcohol

Intoxication

(Behaviorally-linked)

Sensory information

Executive Cognitive Functions

Facilitory:Cue for Reward

Inhibitory:Cue for Punishment

Inhibits

Behavior

Aggression

Threatening or punishing

behavior

Disorganizes

AcuteAlcohol

Intoxication

(Behaviorally-linked)

Sensory information

Potentiates

Executive Cognitive Functions

Facilitory:Cue for Reward

Inhibitory:Cue for Punishment

Inhibits

The Role of Different

Motivational Systems

• Environmental triggers

1. Threat, anxiety (novelty, cues of punishment, etc…)

2. Monotony (lack of immediate reinforcement)

• Genetically influenced susceptibility

1. Anxiety

2. Boredom

• Desired alcohol reinforcement

1. Anxiolysis (serotonin & GABA effects)

2. Stimulation (Dopaminergic effects)

Family

Pedigree

0

2

4

6

8

10

12

14

16*

Non-SOMAHe

art

Ra

te R

espon

se to A

lcoho

l In

toxic

ation

(Perc

ent C

han

ge)

SOMA

Low-Aggressive

High-Aggressive

0

100

200

300

400

500

600

*

Non-SOMA

No. of A

lcoho

lic B

eve

rage

s p

er

year

SOMA

Low-Aggressive

High-Aggressive

0

2

4

6

8

10

12

Alc

ohol-In

duced H

R C

hange fro

m B

aselin

e (

BP

M)

NFH F (N = 49)

NFH M (N = 99)

UFH F (N = 17)

UFH M (N = 30)

MFH F (N = 20)

MFH M (N = 92)

ALC M (N = 12)

-0.4

-0.3

-0.2

-0.1

0

0.1

0.2

0.3

0.4

SP SR

Dimensions of the SPSRQ

Z s

core

s on

th

e S

PS

RQ

Low HR responders

High HR responders

-0.5

-0.4

-0.3

-0.2

-0.1

0

0.1

0.2

0.3

0.4

0.5

H/I AS IMP SS

Dimensions of the SURPS

Z s

co

res

on

th

e S

UR

PS Low HR responders

High HR responders

-0.6

-0.4

-0.2

0.0

0.2

0.4

0.6

High Heart Rate

Responders

Low Heart Rate

RespondersZscore

(N

um

ber

of

"Ris

k T

akin

g"

Responses)

Sober

Intoxicated

Subjects with a High Heart rate

Response to Alcohol Challenge

• Self-rate more of a positive response

• Drink more

• Remember more words learned before

drinking

• Release more dopamine in the Ventral

Striatum

Positron Emission

Tomography

Alcohol Promotes Dopamine Release in the

Human Nucleus Accumbens

…and this release is

associated to an

increased HR response

to alcohol

Background

Phenylalanine and tyrosine, two amino acids (AA)found in dietary protein, are the essential building blocks for the

production of dopamine in the brain.

Ingesting an AA mixture deficient in P&T reduces DA production by 1)causes protein synthesis diminishing the body’s stores of these AA 2) increasing competition of other AAs for transport across the blood brain barrier.

Peek effect of depletion occur 4-5 hours following the ingestion of the AA mixture

Drinks earned following APTD

0

5

10

15

Relative number of drinks compared to balanced

condition

Nu

mb

er o

f S

ub

ject

s

More

Same

Less

Alcohol consumption

0

1

2

3

4

5

High Low

Dri

nk

s

Balanced Depleted

APTD Change in Drinking and Ethanol Cardiac Response

r=.-658, p=.006

percent change in earned drinks

3002001000-100-200

pe

rce

nt

cha

ng

e in

he

art

ra

te

30

20

10

0

-10

Figure 1 - Mean group differences (+ SE) between Low (n

= 19) and High (n = 19) Heart Rate Responders in the

average of age 10 to 17 delinquency scores

Figure 2 - Mean group differences (+ SE) between Low (n = 18)

and High (n = 20) Heart Rate Responders in Goldberg's Adjective

Markers of the Big Five assessed at age 19

-0.8

-0.6

-0.4

-0.2

0.0

0.2

0.4

0.6

0.8

* p < 0.05

*

High Heart Rate Responders

to Alcohol Intoxication

Low Heart Rate Responders

to Alcohol Intoxication

Zsco

re (

Go

ldb

erg

's A

dje

ctive

Ma

rke

rs o

f th

e B

ig F

ive

) Agreeableness

Conscientiousness

Emotional Stability

Extraversion (Surgency)

Intellect

Figure 3 - Mean group differences (+ SE) between Low (n

= 20) and High (n = 22) Heart Rate Responders in

Subjective High Assessment Scale (SHAS) at age 19

-0.4

-0.2

0.0

0.2

0.4

0.6

0.8

*

* p = 0.052

High Heart Rate Responders

to Alcohol Intoxication

Low Heart Rate Responders

to Alcohol Intoxication

Zscore

(S

ubje

ctive H

igh A

ssessm

ent S

cale

)

Subjective effects of alcohol

"The worst that I have ever felt"

"The best that I have ever felt"

Apparatus: Taylor Aggression

Paradigm (TAP)

-0.6

-0.4

-0.2

0.0

0.2

0.4

0.6

High HR RespondersLow HR Responders

Zsco

re (

Me

an

Sh

ock S

ele

cte

d) Sober

Intoxicated

TAP - Mean Shock Level Selected

-1.4

-1.2

-1.0

-0.8

-0.6

-0.4

-0.2

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0Z

sco

re T

ota

l E

rro

rs (

SC

AL

T &

NS

CA

LT

&S

OP

) Non-SOMA & Non-Aggressive

Non-SOMA & Aggressive

SOMA & Non-Aggressive

SOMA & Aggressive

Commonalities Alcoholism & ASPD

• Unusual high heart rate response to high

dose of alcohol.

• High activation of the Cue for Reward

System.

• A system that is dopamine mediated.

• Reduced ECF functioning.