Decision-making and alcoholism: what’s the risk?

By James R. Ashenhurst

Every day we are faced with decisions to make, both simple and complex: should I buy the bargain brand cereal or do I really want to pay more for those Cheerios? Sometimes, we’re faced with decisions that carry a bit more risk to our health and safety: should I jump out of this plane and skydive like I planned to, or is the risk that something might go wrong too high? In the addiction world, decisions must be made about the risks of buying and using drugs and alcohol: Should I really be driving home from the bar now, risking a DUI? What if the police catch me buying crystal meth?

People naturally vary in the amount of risk they are generally willing to take. Especially when potential rewards are great, some people will take rather extreme risks, while others are more hesitant. Clearly, the world needs risk-takers to brave the waters with new business ideas, or to risk rejection to gain romance. Risk-taking is by no means a uniformly bad trait. But, when it comes to drug use, how might having a risk-taking personality affect how people choose to use? Understanding how risk-taking relates to drug and alcohol dependence (alcoholism) might help clinicians and addiction treatment centers be more effective by making patients aware of how their own risk-propensity influences their disease.

The difficult part of answering these questions is deciding how you’re going to figure out exactly how risk-taking a person is. In the past, many researchers used simple self-report questionnaires that boil down to essentially asking participants how risk-taking they think that they are. However, there is a good deal of self-report bias when using these questionnaires; in other words, the accuracy of a person’s answer depends on how self-aware they are and how well they evaluate themselves compared to others (which also requires them to evaluate others objectively). To deal with this problem, Carl Lejuez developed an elegantly simple experimental task that avoids self-report bias: the Balloon Analogue Risk Task [1] (named the BART in honor of The Simpsons, they also made a task called the MRBURNS).

Balloon analog risk-taking taskIt works like this: you see a balloon on a computer screen and you can press a button to inflate it by a small amount. Every time you inflate it, you get a small amount of money. But, there is always a chance that when you inflate it, the balloon will pop and you’ll loose all the money you’ve accumulated for that balloon. You can also decide to “cash out” at any point and add the money you’ve earned to a guaranteed bank and move on to the next balloon to pump. Participants actually receive the money they’ve banked in the task. So, how far would you go?

As it turns out, how people behave in this task relates pretty well to how they behave in the world (this is known as external validity); a person who inflates a lot (and probably pops more than a few balloons) is more likely to not wear a seatbelt, practice unsafe sex and, yes, experiment with drugs and drink problematically [1] [2, 3]. Also, a twin study has shown that risk-taking in the BART is heritable in males [4] and I have demonstrated that behavior is heritable in a rat version of the task [5], suggesting that at least some of it is due to nature and some due to nurture. This is good news for medical research, because it means that there is some discoverable biological pathway that determines, in part, how people behave in the BART.

Still, this preliminary research about the BART and alcohol was gathered from young undergraduates who do not have long histories of alcoholism or drug dependence. Thus, for my research, I wanted to know how older folks who are diagnosably alcoholic might behave in the BART [6]. We invited 158 gracious volunteers from the Los Angeles community (who identified themselves as having problems with alcohol) to the lab and evaluated their dependency severity under the same guidelines used by psychiatrists in the DSM-IV. We also had them play the BART. My prediction was that participants with more severe alcoholism would also tend to be bigger risk-takers.

To my surprise, everything flipped around. People who were more risk-taking (inflated the balloons bigger) actually had fewer alcoholism symptoms. In other words, the more severe the case of alcoholism, the less risks they would take in the BART. How could this be, and what does this tell us about the role of risk-taking in alcoholism?

There are several possibilities. For one, it could be the case that while young risk-takers tend to drink problematically, as alcoholism develops, it is actually the problem-drinkers who are more risk-averse who tend to go on into more severe cases of alcoholism. This theory relies on the idea that risk-taking personality is fixed and doesn’t change much in adulthood; it might be a stable trait that influences the developmental course of alcoholism.

It could be, however, that the trait is not always stable across a lifetime, and experience with alcohol changes one’s risk-taking personality. If we assume instability, it could be either social and/or biological factors that cause the change. Maybe people with more severe alcoholism face more problems in their personal life, and this changes their temperament to be more risk averse. Or, it could be that the continued exposure to a lot of alcohol changes the parts of the brain that evaluate risks and underlie the decision-making process. It is well-known that chronic exposure to alcohol at high levels for long periods of time changes the quantity and subtypes of neurotransmitter receptors in the brain as part of an adaptive process; the brain adjusts itself to tolerate the constant signals it’s getting from alcohol. Thus, it is a reasonable idea that decision-making parts of the brain could change too.

Lastly, it could also just be an observation that is specific to this task in this population. While the task has been shown to be externally valid in the college-aged sample, we didn’t reassess that here for older alcoholics. We’re talking about people taking small risks to earn relatively small amounts of money by the end of the task. Usually, participants are rewarded with somewhere between $5 to $20, depending on the study.

What if larger sums of money were at play? Or access to alcohol was at risk? Once a person is an active alcoholic, what feels risky and what’s not might change too. Acknowledging that you have a problem and starting to try to cut down or abstain might feel more risky than continuing as normal. Nevertheless, even if this flip is specific to behavior in a laboratory task, it means that the relationship between risk-taking and alcoholism is not as straightforward as we might expect.

So, what do you think? In your experience, are the more severely alcoholic people you’ve known not big risk-takers? If you’re an alcoholic in recovery, does it seem like your risk-taking personality changed over time? Hopefully, we’ll get more clues down the line and we’ll be better positioned to say which theory is correct, and this can then help alcoholics in their own pathway to addiction recovery.

 

1. Lejuez, C.W., et al., Evaluation of a behavioral measure of risk taking: the Balloon Analogue Risk Task (BART). Journal of Experimental Psychology: Applied, 2002. 8(2): p. 75-84.

2. Fernie, G., et al., Risk-taking but not response inhibition or delay discounting predict alcohol consumption in social drinkers. Drug and Alcohol Dependence, 2010. 112(1-2): p. 54-61.

3. Lejuez, C.W., et al., Differences in risk-taking propensity across inner-city adolescent ever- and never-smokers. Nicotine Tob Res, 2005. 7(1): p. 71-9.

4. Anokhin, A.P., et al., Heritability of risk-taking in adolescence: a longitudinal twin study. Twin Research and Human Genetics, 2009. 12(4): p. 366-71.

5. Ashenhurst, J.R., M. Seaman, and J. David Jentsch, Responding in a Test of Decision-Making Under Risk is Under Moderate Genetic Control in the Rat. Alcoholism: Clinical and Experimental Research, in press.

6. Ashenhurst, J.R., J.D. Jentsch, and L.A. Ray, Risk-Taking and Alcohol Use Disorders Symptomatology in a Sample of Problem Drinkers. Experimental and Clinical Psychopharmacology, 2011. 19(5): p. 361-70.

 

 

How much alcohol is too much drinking? Knowing your BAC can be key!

There has been some research suggesting that training people to better estimate their Blood Alcohol Content (BAC), can help reduce accidents and improve risk-taking while drinking among college students (see here and here respectively).

I’m including a recent piece from one of our readers, telling us about her first over-21 drinking experience in Las-Vegas. I think this story exemplifies that young adults may often consume more alcohol than they are aware of while underestimating its effects Continue reading “How much alcohol is too much drinking? Knowing your BAC can be key!”

Will you get addicted? Signs of drug abuse

Everyone wants to know if they can become addictedEveryone wants to know if they, or someone they love will get addicted to alcohol or drugs.

• Parents want to know if their children are likely to become addicts, especially if there is a family history of addiction.

• Teens wonder if trying a drug will lead to a life of crime and shame.

So what are the signs of drug abuse?!

Unfortunately, I have to start with the answer you probably don’t want to hear: no single factor can be said to fully predict substance abuse. Instead, the equation can be thought of as an interplay of risk-factors and protective-factors.

Having family members with alcohol- or drug-abuse problem is an example of a risk-factor. The more risk-factors a person has the more likely it is that person will become addicted. Some risk factors interact to make the likelihood of addiction much greater than either factors alone.

Protective-factors are life events or experiences that reduce or moderate the effect of exposure to risk factors. Some examples of protective factors are: parental-monitoring, self-control, positive relationships, academic competence, anti-drug use policies, and neighborhood attachment.

Risk Factors Vs. Protective factors – An implicit battle

There are five categories of risk and protective factors including individual, school, peer, community and family. Examples of protective factors within the individual category include social skills and responsiveness, emotional stability, positive sense of self, problem solving skills, flexibility, and resilience.

Other aspects of the individual category include the gender and ethnicity of a person. Men are generally more likely to become addicted (likely because they are less prone for internalizing issues like depression). American-Indians are genetically more sensitive to the effects of alcohol, while about 20% of the Jewish population may have genetic variations that protect them against alcoholism. Overall, estimates regarding the genetic influence on addiction risk range from 40% to 80%. Much of that genetic risk lies in changes related to the functioning of neurotransmitters that play a part in the development of addiction such as GABA, serotonin, dopamine, NMDA. Those with mental disorders of all types are at an increased risk for developing an addiction.

Some factors, like stress, can be considered part of multiple categories. Individual variability in stress response (via the HPA Axis) would be part of the individual category, while levels of environmental stress can be part of the other four categories.

questioning-terrierThe home and school life of a child (part of the non-individual categories) can play a large role as either risk-, or protective-factors. If a child sees elders using drugs, they may view drugs as harmless, but children who are well prepared by their parents may better resist peer-pressure to use drugs. As we stated before, the earlier a person begins to use drugs, the more susceptible they are to harmless effects on brain structures and other bodily functions.

Certain methods of using drugs can also be considered risk-factors. Smoking or injecting a drug causes it to be more quickly absorbed into the bloodstream, producing an almost instantaneous high when compared with eating or drinking a drug. However, the quick rush of euphoria may soon dissipate and leave the user feeling the “rebound effect” making them crave the high again. This quick, short lasting, cycle is believed to encourage the user to want to the drug again in hopes of reaching that high.

Overall there is no one thing that can predict or protect against addiction. Instead, a combination of factors are always at play and the more aware a person is of these factors the more able they are to protect themselves.

Co-authored by: Jamie Felzer

Citations:

http://www.psychiatry.ufl.edu/aec/courses/501/risk%20and%20protective%20factors.pdf

http://www.drugabuse.gov/scienceofaddiction/addiction.html

http://www.aadac.com/documents/profile_youth_risk_protective_factors.pdf

 

420, smoking weed, and drug problems : Marijuana facts

Co-authored by: Jamie Felzer

It’s April 20th, or 4-20, and anyone who smokes marijuana knows what that means – It’s time to smoke weed- a lot of weed!

In honor of this “stoner” holiday, or perhaps in reverence of its implications, I wanted to put together a post that explored some recent findings having to do with the most commonly used illegal substance in the U.S.
These two studies deal specifically with smoking weed, teenagers, and drug problems.

Study 1 – Misconceptions of marijuana use prevalence

An article in the Journal of Studies on Alcohol and Drugs has revealed that most young adults greatly overestimate how many of their peers smoke weed. Teens surveyed believed that 98% of their peers smoked marijuana at least once a year – In reality, only 51.5% off the teens reported actually ever smoking marijuana.

To make matters worse, even though only 15% of the teens reported using once a month or more, the estimate among peers was closer to 65%!!! Since we know that perception of peer behavior affects adolescents greatly, such misconceptions can easily lead to false peer-pressure towards marijuana use.

So next time instead of assuming everyone smokes weed, think again.It’s one of the most commonly used drugs but the notion that everyone smokes weed is simply wrong.

Reference: Kilmer, Walker, Lee, Palmer, Mallett, Fabiano, & Larrimer (2006). Misperceptions of College Students Marijuana use: Implications for Prevention. Journal of Studies on Alcohol and Drugs, 67, pp. 277-281.

Study 2 – Teens reducing use can reduce marijuana dependence risk

This next study dealt with early patterns of weed smoking as possible predictors of later problems use. They followed more than 1500 respondents from adolescence (ages 15-17) into young adulthood (ages 21-24).

The article revealed some interesting overall patterns, but I’ll keep the results short and simple, it is 4-20 after all…

The good news? Teens who reduced their use during the first phase of the study (the teens years) were at a significantly lower risk for marijuana dependence and regular use in early adulthood. This suggests that successful interventions may be effective at reducing later problem use.

The bad news? All marijuana smokers who used at least weekly showed the highest risk for later problems even if they reduced their use… This is not that surprising of a finding though since dependence usually involves regular use.

The bottom line? Reducing marijuana use at any stage will lower your risk for later problem use, but those who find themselves smoking often are most likely to end up in some trouble even if they try to cut down. Knowledge is power, so if you think you might be at risk and are concerned, talking to someone can’t hurt. Knowing marijuana facts can’t hurt either.

Reference: Swift, Coffey, Carlin, Degenhardt, Calabria & Patton (2009). Are adolescents who moderate their cannabis use at lower risk of later regular and dependent cannabis use? Addiction, 104, pp 806-814.

For a different view on 420, see this video:


Tobacco smoking alone isn’t enough: More than smoking important in lung cancer death

Christopher Russell and Adi Jaffe

The tobacco epidemic already kills 5.4 million people a year from lung cancer, heart disease and other illnesses. By 2030, the death toll will exceed eight million a year. Unless urgent action is taken tobacco could kill one billion people during this century. (The World Health Organization Report on the Global Tobacco Epidemic, 2008)

These are some scary numbers, right? Cigarette smoking, according to the WHO, is the single most preventable cause of death in the world today, and in conveying these deadly statistics to the general public, cigarettes have come to be alternatively referred to by smokers and non-smokers as “cancer sticks”, “nicotine bullets”, and “coffin nails”.

But does smoking really ‘kill’ anybody in the literal sense with which we use this word?  To an epidemiologist, tobacco smoking (nor many other drugs of abuse for that matter) does not “kill” a person or “cause” illness or death in the way the words “kill” and “cause” are typically understood by the media and general public. For example, if I shoot someone in the head, stab another in the heart, and strangle a third till he stops breathing, it is reasonable to say that my actions were the direct, sole, and sufficient causes of death – I would have killed them. Smoking, however, is often neither a sole nor sufficient ‘cause’ of lung cancer, coronary heart disease, or myocardial infarction because non-smokers die from these diseases, and for example, because only 1 in 10 heavy smokers die from lung cancer when one looks at the overall numbers. Continue reading “Tobacco smoking alone isn’t enough: More than smoking important in lung cancer death”

Proteins and cocaine: Addiction is a disease, not a question of morality.

While there are some people who still argue about whether drug addiction is a disease or a condition that results from the moral failing of an individual, most of the scientific community has long agreed that there are at least some influences on it that are far beyond a person’s control.

I’ve mentioned the genetic influences that have been shown to be associated with a risk for addiction before (look here). However, most of the research I’ve been involved in myself recently has more to do with the way that trying drugs changes your brain in ways that make it more likely that you’ll try them again.

Along these lines, a recently published study has shown that very specific molecular targets can have a huge impact on the probability that addicts will keep going after drugs. The molecules studied were common targets of cocaine that are altered after long-term use of coke.

The interesting thing is that the research found that deactivating each of these targets produced completely different effects:

Animals that had the GluR1 receptor subunit turned off were unable to stop themselves from searching for cocaine in a spot where it used to be long after normal mice gave up. I don’t know about you, but that sounds more than a little relevant for addiction given what I know, and have experienced. We’ve been studying this sort of stuff for a while, but the fact that a single molecule can make an animal pursue drugs in a way that is completely irrational is amazing!

Animals that had the NR1 receptor subunit turned off experienced a different effect. While normal mice relapse to drug use when they experience a drug after a long break, the NR1 deficient mice just wouldn’t go back to their addictive behavior when they got a little sample. Again, the implications for relapse preventions are promising to say the least.

In short, while some people may think there’s still a reason to argue whether people with addiction should simply be left to god’s mercy, ongoing work is showing us that we can uncover specific molecular mechanisms that may one day allow us to combat addiction with much more success. I for one welcome that.