Heavy alcohol users Vs. Addicts – Stress response

January 4th, 2012

I can’t even count how many times I’ve talked about the difference between alcohol or drug users and alcoholics or addicts (see here, here, and here for some examples and keep reading). The quick summary: Many people use drugs and many abuse them at times, a small percentage meet criteria for addiction at some point in their life and an even smaller percentage is the type of addict we’ve been taught to think of – chronically relapsing and seemingly incapable of quitting no matter how crappy their life gets.

One of the main reasons we study drug and alcohol abuse is because of the huge health impact of this stuff – we spend billions and billions of dollars every year on health-care that is directly or indirectly related to the abuse of nicotine, alcohol, and pretty much every other drug on earth (marijuana can certainly help some conditions but heavy use of marijuana can bring its own consequences). One of the major players in these health problems is the effect of alcohol and drug use on stress in the body. Stress increases death rates in several ways including: Heart attacks, strokes, cancer, and more.

Well, a recent study in Amsterdam looked at alcohol (yes, you read that right, the Dutch care about more than weed) consumption, alcohol addiction (alcoholism) diagnosis, and effects on the body’s stress system, also known as the HPA (Hypothalamic-Pituitary-Adrenal) Axis. If nothing else, the study helped confirm that an alcoholism diagnosis is not necessarily the same as an indication of heavy drinking and that excessive drinking is no bueno, regardless of whether it meets addiction criteria or not.

Alcohol drinking, alcoholism, and stress regulation

I’m not going to go into this in detail (look here and here for more) but just as our brains and bodies have systems for decision making, they also have complex stress management systems. The latter rely heavily on hormones, including Cortisol, to keep our bodies in the right states whether those be fight, flight, or reading a book before sleep (see figure on left for over-simplified cortisol levels throughout the day in a normal person). We’re supposed to have the most cortisol right upon waking with constant reductions throughout the day until we fall asleep, and back again. Individuals with mental health disorders like anxiety and depression have substantially different cortisol level patterns throughout the day and are less effective at regulating cortisol (in case you needed another reason why our biology affects our states of being and behavior).

The dutch study tested cortisol levels at 7 different times throughout the day after giving their subjects a 4 hour battery of tests. They also assessed their cardiac functioning by assessing different measures related to heart beat regulation that allows for adapting across challenging situations by affecting the sympathetic nervous system (excitatory processes) and parasympathetic nervous system (inhibitory processes).

They looked at these measures as a way of assessing the relative functioning of the HPA Axes’ of different groups. Specifically, they looked at:

1. Non-drinkers
2. Moderate drinkers (less than 3 drinks per day)
3. Heavy drinkers (more than 3 drinks per day)
4. Non alcoholics
5. Remitted alcoholics (met criteria for alcoholism previously but not in past 12 months)
6. Current alcoholics.

One of the most interesting findings, as far as I’m concerned, was that among remitted alcoholics the average amount of drinking was around 1.3 drinks per day with a lot of variability, a little higher than that of moderate drinkers (0.8 drinks per day) but lower than that of heavy drinkers (4.0 drinks per day). I see this as a little more proof that people who met criteria for alcoholism at one point don’t necessarily abstain forever and don’t necessarily continue to have drinking problems (per Moderation Management, spontaneous remission, or some other means of stopping their alcoholic drinking).*

You can blame improper diagnostic criteria, a continuum of addiction severity, or anything else as far as I’m concerned but as I pointed out in my first paragraph, we’ve talked about this topic repeatedly and I see no end coming soon. The bottom line is that meeting criteria for alcoholism at one point in life tells me something, but far from everything, about a person’s drinking habits or drinking problems later in life.

But back to stress. As you might have already guessed, since it is heavy drinking that causes serious dysregulation of the body’s stress response, what the researchers found was that meeting criteria for alcoholism now, or in the past, didn’t have any major effect over their participants’ HPA functioning. Instead, all that mattered was how heavy their drinking was now. Heavy drinkers had higher waking cortisol levels, higher night-time cortisol, and increased sympathetic (excitatory) control. In short – heavy drinkers were less able to regulate their stress and excitation response, likely leading to increased stress on their bodies.

As a side note, this study also found that if anything, moderate drinking conferred health benefits when it came to stress over not-drinking at all – far from the first study to note this but another set of reinforcing evidence that drinking alcohol is not in itself bad for you while over-drinking is.

So – Drinking a lot of alcohol causes disruptions to your body’s stress regulation system that will likely increase the likelihood of heart problems, depression, anxiety, and more. Those disruptions are there whether you meet criteria for alcoholism or not.

Obviously, there are many alcoholics who drink a lot of alcohol, but there are also people who meet (now or in the past) criteria for alcoholism who are binge drinkers and therefore don’t drink daily and have lower “drink numbers.” As we mentioned before, addiction is not about quantity, in fact, the criteria for addiction barely mentions quantity – when it states that addicts consume “more than intended” or that tolerance creates a state where an person needs greater quantity to reach the same effect of the drug. Drinking or using a lot of drugs or alcohol does not an addict make.

*Note: Given the variability in the remitted-alcoholics groups their is little doubt that some of them had stopped drinking while others drank to excess. Additionally, it should be pointed out that alcohol abuse was not assessed in this sample, so it could still be a problem for at least some of those now-drinking past-alcoholics.

Citations:

Lynn Boschloo, Nicole Vogelzangs, Carmilla M.M. Licht, Sophie A. Vreeburg, Johannes H. Smit, Wim van den Brink, Dick J. Veltman, Eco J.C. de Geus, Aartjan T.F. Beekman, Brenda W.J.H. Penninx (2011). Heavy alcohol use, rather than alcohol dependence, is associated with dysregulation of the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. Drug and Alcohol Dependence 116, 170–176.

Heather M. Burke, Mary C. Davis, Christian Otte, David C. Mohr, (2005).  Depression and cortisol responses to psychological stress: A meta-analysis, Psychoneuroendocrinology, Volume 30, Issue 9, Pages 846-856.

Posted in:  Alcohol, Education Tags: Alcohol, alcoholism, cortisol, criteria, criteria alcoholism, drinking, heavy drinkers, hypothalamic pituitary adrenal, stress

New Year’s Eve without drugs or drinking alcohol?

December 30th, 2011

For many people all around the world, New Year’s Eve celebrations mean a lot of partying. Often, that partying includes drinking alcohol, doing drugs, and generally engaging in one last night of “things you’ll forget about” in the year that has passed. I know the ritual and I took part in it often. Hell, the virtual symbol of NYE is the Champagne toast (talk about a trigger).

Since high-school, NYE celebrations meant little more than getting so &#@$-faced that I wouldn’t be able to remember what happened the next morning. Actually that’s not true – I’ve only experienced one blackout in my life – I always remembered what I did on New Year’s Eve. From my early days of drinking as close to an entire bottle of vodka as I could along with some gravity bong hits for my CB1 and CB2 receptors to fully light up to later parties that involved acid (LSD), ecstasy (MDMA), cocaine, and finally crystal meth, it was all about excess in its rawest form.

Humans enjoy celebrations in a way that other animals simply don’t. It comes with our keen awareness of past, present, and future. It’s the way we mark special events that only have true meaning because we assigned it to them. It’s part of what makes us the most social of animals and is tightly connected to our brains and their massive supply of executive function. But none of that matters when you’re loaded on drugs or alcohol on New Year’s Eve. All that matters is that you’re having fun.

For most people, this sort of partying doesn’t cause any problems. As long as they don’t drive under the influence, getting a little messed up is just not that big a deal. Hey, getting high on drugs and alcohol has left us with some of the best art, music, and writing I can think of and out livers and kidneys can handle the stress pretty well. But for some people, that same seemingly innocent set of behaviors can lead to a far darker place.

For addicts who have become dependent on drugs or alcohol, or for those people teetering on the edge of addiction with drugs and alcohol as still fully functional crutches that make the world slightly more tolerable, that same partying can get dangerous. It can lead to memory loss and accidental death. It can lead to the destruction of property, relationships, and self-esteem. It can lead to handcuffs and metal bars that don’t go away when the effect of the drugs or alcohol wears off.

As I’ve talked about so often here, we’re still pretty bad at telling the difference between those who are simply partying hard and those who have a real problem. We can tell after the fact, looking back at how long someone struggled (hard-core addicts can spend decades struggling with addiction while the more tame abusers/addicts only last a few years) but that doesn’t do anyone much good now does it?

I’ve sat in many groups with addicts trying to plan for these holidays so that they can make it to the other end without throwing away everything they’ve worked so hard for. The temptation of shooting up, smoking a bowl, or drinking a fifth of your favorite liqueur (or 2 bottles of wine)  can be too much when everyone around you makes it seem like so much fun. Many make it through with little more than resolved anxiety and a sense of relief. But every year, a few get left behind, some to return a bit later with a little more of a war story than they had previously.

The point – Making it through the holidays

The holidays, and New Year’s Eve in particular, are a bad time to try to figure out which of these groups you belong to exactly because everyone else is being excessive too. An addict can easily cross the line and seem no different. Until the next day that is. So this holiday, do yourself a favor and hold off on any grand experiment. Take it easy, spend some time with real friends who have your best interest at heart, and make it to the next year in style. You can always test yourself another day.

Posted in:  Education Tags: addicts, Alcohol, blackout, Drugs, drugs alcohol, handcuffs, jail, liquer, new year's, new year's eve, NYE, partying, wine, year's eve

Are violent drunks giving the rest of us a bad name? Alcohol consumption and violence

December 8th, 2011

We all know that drinking alcohol changes the way people think and can make them act strangely right? We also know that alcohol is involved in more than 50% of violent crimes and about 75% of partner violence. The question is, why the connection?

A recent paper I published suggests that drugs and alcohol can not themselves be thought to cause violence. Still, the relationship exists, so what gives?

(Before you go any further, if you’re unclear about the difference between causation and association, I suggest you read this article)

Your brain and alcohol abuse

The thought altering effects of consuming alcohol, and most drugs, can be said to affect something called executive functioning (EF). What exactly makes up this type of functioning is a source of some debate, but let’s just say that it refers to attention, strategic planning, reasoning, thought flexibility, and the ability to process information in working memory (an important type of memory used in learning).

You can probably already tell that this type of brain function is extremely important and that different people possess different levels of it. I can also tell you that alcohol consumption has  been shown to reduce overall executive functioning. If you drink alcohol, or have ever seen someone drink, this probably doesn’t come as a huge surprise.

The thing is that alcohol consumption messes up everyone’s EF, though obviously, the more you drink, the more affected you become. Still, given the fact that more than 50% of Americans report at least one binge drinking episode a year and less than 7% are involved in violent crime, something else must be at play, right?

Aggressive personality and irritability

As I mentioned earlier, I published a paper showing that aggressive personality, which I measured using 5 different tests, contributes far more to violent behavior than drug use alone. Still, a recent study found that irritability alone could account for some aggressive behavior. Still, the more interesting finding had to do with alcohol-related EF problems and irritability together. The experiment was pretty interesting, so let’s go over it for a bit.

Researchers at the University of Kentucky took more than 300 students and gave them a whole bunch of tests assessing their EF and their overall level of irritability. Afterward, half of the students were given alcohol to drink (about 3-4 drinks per person) and the other half was given a similar number of drinks that contained no alcohol but were sprayed before being handed to smell the same. The students were then asked to play a game that pitted them against another person. The secret was that there was no game and no other person, the winner and loser in each round was pre-determined. Every time the student “won” they got to give the other player a shock, but every time they lost, they themselves got shocked. As the game went on, the shocks the participants got increased in intensity. The researchers wanted to see how the students would react and how large the shocks they would give back would be.

The results showed that the more mistakes people made in their initial EF testing (and therefore the less overall EF capability they showed) the more aggressive they were. This makes sense, as people who are less able to plan, think ahead, and control their behavior would be more likely to engage in things that would hurt them, or misjudge events and think react inappropriately. Irritability was also shown to affect aggression, but this time only for men and intoxicated women.

The effect of alcohol abuse on aggression and violence

When the whole thing was put together the researchers found that for drunk men only, reduced EF and increased irritability worked together to generate even more aggression that was shown for all the other participants. For the simplest example think back to anyone you know who is pretty quick to react anyway and is a little too easily pissed-off. Chances are they become a pretty mean drunk who likes to get in fights.

Obviously this makes sense if you know someone like that, but in terms of helping us make decisions about who should be considered dangerous and who shouldn’t, especially when consuming alcohol, this research helps further explain why we see such a strong connection between alcohol abuse and violence or aggression.

The way I see it there’s a relatively small number of people (mostly men) who is normally pretty aggressive, irritable, and lacking in judgment and self-control, who often get violent when they drink alcohol. For them, many alcohol drinking episodes end badly, and since they’re the most visible of the aggressive drinkers, their behavior produces an association between alcohol consumption per se and violence. For the rest of us, alcohol consumption rarely leads to violence, but violence rarely occurs without drinking alcohol either, so we hardly ever enter the equation at all. That’s why the pattern holds.

Citations:

Godlaski, A. J., Giancola, P. R. (2009). Executive function, Irritability, and Alcohol-Related Aggression. Psychology of Addictive Behavior, 23, 391-404.

Jaffe, A. et al., (2009). Drug Use, Personality and Partner Violence: A Model of Separate, Additive, Contributions in an Active Drug User Sample. The Open Addiction Journal, 2.

Posted in:  Alcohol, Education Tags: aggression, aggressive, aggressive personality, Alcohol, alcohol abuse, alcohol consumption, alcoholic, alcoholism, drinking, drug use, fight, irritability, irritablity, mean drunk, partner violence, violence

Amy Winehouse dead at 27 – Drug/alcohol overdose?

July 23rd, 2011

Amy Winehouse, the soulful singer with the amazing voice and the troubled drug and alcohol use history is dead at 27, according to London Police. Sadly, Amy Winehouse’s celebrity has for the past few years been tied more to her drug and alcohol use than to her music.

No one has reported on whether her death is directly related to drug or alcohol overdose but given Amy’s history with heroin, alcohol, crack, and other drugs, it would not be surprising. This is especially true given her recent cancellation of a European tour due to what seemed like serious drug and alcohol use issues that just didn’t allow her to perform.

This is a sad, sad, reminder that addiction and drug abuse can lead to tragic endings and hopefully will serve as a wake-up call to other addicts who may be close to a similar end but can find the courage and motivation to change in light of Amy’s death.

Posted in:  Education Tags: Alcohol, alcohol use, amy winehouse, amy's, celebrity, death, drug, drug alcoho use, drug alcohol, singer

Higher drug abuse among gay youth likely tied to rejection

July 17th, 2011

For a lesbian, gay, or bisexual youth, “coming out” is an extremely stressful, though important event that can result in improved self-esteem, social-support, and psychological adjustment.

However, a recent study found that the reactions to such a disclosure have a lot to do with the risk of those youths abusing alcohol and drugs.

Social rejection and drug abuse among gay youth

The results revealed that the more rejecting reactions a youth receives, the more likely they are to engage in drug abuse including alcohol, cigarette, and marijuana use. This was true even after researchers controlled for a number of other important variables like emotional distress and demographics (race, ethnicity, education, socioeconomic status, etc.).

This makes a lot of sense. After finally deciding to go through with such a monumental disclosure, harsh rejections likely cause some serious damage to a youth’s self-esteem, making escape by drugs an attractive option. Although coming out can eventually lead to increased self-esteem even for this youth, the road there is not an easy one.

The good news was that accepting reactions seemed to protect youths from the harmful effects of being rejected – Social support helps!

The researchers suggested that drug abuse prevention attempts with LGBT youths address the impact of rejecting reactions to sexual-orientation disclosure directly in order to hopefully reduce their negative impact.

Here’s a video about the difficulties of coming out in high-school:

Reference:

Rosario, Schrimshaw, & Hunter (2009). Disclosure of sexual orientation and subsequent substance use and abuse among lesbian, gay, and bisexual youths: Critical role of disclosure reactions. Psychology of Addictive Behaviors, 23, 175-184.

Posted in:  Alcohol, Education, For others, Marijuana, Tips Tags: abuse, accepting, Alcohol, bisexual, coming, drug abuse, Drugs, gay, lesbian, marijuana, out, pot, rejection, self-esteem, smoking, support, transexual, weed

Parenting advice – What’s important when it comes to teens, alcohol, and drugs

July 8th, 2011

Parents often ask us what they can do to prevent their children or teens from becoming alcoholics, drug addicts, criminals, and the likes. I’ve been all of these and more, and so I’d like to share my insight with you now that I’ve made it over to the other side:

You can’t prevent anything – but you can educate, inform, prepare, and support.

My family breaths success; it also breeds its. My father was a star athlete who turned into a star doctor and a star family man. He also never drank alcohol and couldn’t care less about drugs. My mother was a beauty queen who always helped me get the best grades in school, even if it meant that she ended up doing my art projects for me and keeping me up all night so I’d finish my work. I’m not sure if it was my perception or my parents’ actual wish, but I always felt like unless I saved the world, I would end up a nobody. Drinking enough alcohol to black-out and consuming every drug on earth was never supposed to be on my menu.

A recent article I read in a monthly psychology magazine (see my post on it here) talked about this sense of perfectionism in our culture and its effect on teen depression, anxiety, and alcohol and drug abuse. Did you know that these are highest among more affluent teens?

Advice #1 – Shooting for good performance is important, but focusing on it as a sole measure of success can lead to trouble.

I got gifts for grades, and the best gifts came only with the best grades. Anything short of perfect was pretty much frowned upon and considered “less than my best.” It became impossible for me to actually enjoy anything but the school subjects I excelled in (math, physics, chemistry). It wasn’t until I graduated from college and did some of my own exploration that I learned to appreciate art, English, and history as worthwhile pursuits. It’s a well-know fact in developmental psychology that you don’t reward behaviors that are supposed to be appreciated in their own right. If you do reward them do so with small gifts, nothing large. Big gifts take away the perception that the activity itself brought about enjoyment.

Advice #2 – Parenting requires consistency and openness, but leave the preaching for church.

This constant need for perfectionism also lead to the repression of many issues in my family.

My parents fought often when I was a kid, screaming loud enough for me to take my sister away often and go play. We never talked about the fights so I never managed to learn about conflict, relationships, or resolution. We never talked about my stealing either, whether I was stealing from my family (mainly my father’s porn) or from the neighborhood toy store. The one time I got caught, my father sternly told me to return my new toy and to never be caught stealing again. I began stealing away from my neighborhood; it would be years before he’d hear about me stealing again. It probably would have been better to sit down and talk about what just happened.

Later on, when my mother would find my weed in my room, she would hide it so that my dad won’t find it because he would get mad. We call that enabling. When I was caught stealing at my work, my father didn’t want to tell my mom, so as not to upset her, so he never brought it up again. We call that denial. Neither of these work since they don’t teach a child anything except how to hide things properly and that even responsible adults lie.

But research shows us that preaching is not a good parenting technique so stay open and talk about struggles without being hypocritical and trying to teach lessons that are obviously forced. Kids and teens pick up on that very quickly but they’re ready to learn from their parents.

Advice #3 – Don’t let your sense of pride, or your ego, prevent you from dealing with real issues with your children. Parenting requires you to be the adult in the relationship with your children even when things don’t go your way.

By the time my parents were forced to confront reality, things in my life had spiraled way out of control. They received a call from my LA lawyer telling them that their son had been arrested for some pretty serious drug dealing. My bail was set at $750,000 and I was facing 18 years in prison. That’s pretty difficult to ignore.

Ironically, my arrest, court case, and the year I spent in jail brought my family closer together than we had even been during my teen years or my later drug addiction phase. Having to actually confront many of our issues allowed us to bring some actual intimacy into the family I had run away from so many years before. The important thing was that my parents didn’t pull out the “we told you so” card but rather helped me confront my demons and treat them. It was the best parenting I’d received in my life and it worked.

My parents did the best they could. I know that. Still, I can’t help to wonder if worrying a little less about how things “should be” and a bit more about the reality of parenting their deviant son may have prevented the latter part of this story. Then again, there’s no guarantee of that either. That’s the most important parenting advice I can give when it comes to teens and drugs…

Posted in:  Education, For others, Tips Tags: addiction, addiction help, Alcohol, best, best grades, caught stealing, drug abuse, Drugs, family, help, important, parenting, parenting advice, stealing, teen addiction, teen drug use, teens and drugs

Alcohol, sleep, and school work: College drinking and GPA

July 2nd, 2011

Co-authored by: Jamie Felzer

We all know that college students often party and sleep more than they actually study.  But do heavy alcohol use and poor sleep patterns cause poor grades?

A recently published study found that just altering bed times by 2 hours can throw off your sleepiness during the day.  Most students in the study did show a 2-4 hour difference in daily bed times between weekdays and the weekend, and most went to bed after midnight.

The average number of drinks for participants came in around 6 drinks a night (equal for men and women).

The big question is: can these heavy drinkers in college still perform well academically? (See here for influential factors in college drinking)

No matter what the cause, insufficient sleep causes poor academic consequences.  Interestingly, those students who reported much more sleep also had lower GPAs (oversleep was mostly assumed, by the researchers, to be caused by drinking and staying up too late, though it could have been due to other issues such as depression).

Overall, those that drank more often went to sleep later and also had bigger gaps between weekday and weekend bedtimes, all of which correlated very highly with a lower GPA.

Citation:

Singleton, Wolfson (2009). Alcohol Consumption, Sleep And Academic Performance Among College Students. Journal of Studies on Alcohol and Drugs. 70, 355-363)

Posted in:  Alcohol, Education, For addicts, Tips Tags: academics, Alcohol, bed, bed time, bedtime, college, college drinking, college students, drinking, GPA, school work, sleep, sleeping, students