Comorbidity of Alcoholism and Antisocial Personality Disorder R.O. Pihl McGill University

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 punishingbehavior

(Behaviorally-linked)

Sensory information

Executive Cognitive Functions

Facilitory:Cue for Reward

Inhibitory:Cue for Punishment

Behavior

Aggression


Acute Alcohol

Intoxication


Sensory information




Inhibits

Behavior

Aggression


Disorganizes

Acute Alcohol

Intoxication


Sensory information




Inhibits

Behavior

Aggression


Disorganizes

Acute Alcohol

Intoxication


Sensory information

Potentiates




Inhibits

The Role of Different Motivational Systems

• Environmental triggers1. Threat, anxiety (novelty, cues of punishment, etc…)

2. Monotony (lack of immediate reinforcement)

• Genetically influenced susceptibility1. Anxiety

2. Boredom

• Desired alcohol reinforcement1. Anxiolysis (serotonin & GABA effects)

2. Stimulation (Dopaminergic effects)

Family Pedigree

0

2

4

6

8

10

12

14

16*

Non-SOMAHea

rt R

ate

Res

pons

e to

Alc

ohol

Into

xica

tion

(Per

cent

Cha

nge)

SOMA

Low-Aggressive High-Aggressive

0

100

200

300

400

500

600

*

Non-SOMA

No.

of A

lcoh

olic

Bev

era

ges

per

year

SOMA

Low-Aggressive High-Aggressive

0

2

4

6

8

10

12

Alc

ohol

-Ind

uced

HR

Cha

nge

from

Bas

elin

e (B

PM

) 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)

Alcohol Induced Changes in BAES Stimulation

-30

-20

-10

0

10

20

30

40

50

pre-alcohol 30min 40min 60min 90min 120min 150min

HHRR

LHRR

-0.4-0.3-0.2-0.1

00.10.20.30.4

SP SR

Dimensions of the SPSRQ

Z s

core

s on

the

SPSR

Q Low HR responders

High HR responders

-0.5

-0.4-0.3

-0.2-0.1

0

0.10.2

0.30.4

0.5

H/I AS IMP SS

Dimensions of the SURPS

Z s

co

res o

n t

he 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 RateResponders

Low Heart RateRespondersZ

scor

e (N

umbe

r of

"R

isk

Tak

ing"

Res

pons

es)

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

MoreSameLess

Alcohol consumption

012345

High Low

Drin

ks

Balanced Depleted

APTD Change in Drinking and Ethanol Cardiac ResponseAPTD Change in Drinking and Ethanol Cardiac Response

r=.-658, p=.006r=.-658, p=.006

percent change in earned drinks

3002001000-100-200

pe

rce

nt

ch

an

ge

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

-0.8

-0.6

-0.4

-0.2

0.0

0.2

0.4

0.6

0.8

* p < 0.03

* **

** p < 0.02

**

Low Heart Rate Respondersto Alcohol Intoxication

High Heart Rate Respondersto Alcohol Intoxication

Zsc

ore

(Ave

rage

of 1

988

to 1

995

long

itudi

nal s

core

s) Physical Aggression Destruction of Property Theft

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

*



Zsc

ore

(Gol

dber

g's

Adj

ectiv

e M

arke

rs o

f the

Big

Fiv

e)

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



Zsc

ore

(Sub

ject

ive

Hig

h A

sses

smen

t Sca

le)

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

Zsc

ore

(M

ea

n S

ho

ck S

ele

cte

d) Sober

Intoxicated

TAP - Mean Shock Level Selected

-1.4-1.2-1.0-0.8-0.6-0.4-0.20.00.20.40.60.81.01.21.41.61.82.0

Zsc

ore

Tot

al E

rror

s (S

CA

LT &

NS

CA

LT &

SO

P)

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.

Documents

Comorbidity of Alcoholism and Antisocial Personality Disorder R.O. Pihl McGill University