Day: June 10, 2014

Alcoholics as secret overachievers!

Posted on by alcoholicsguide

A recent article suggests that  some people may have a genetic predisposition to alcoholism. Dr Alexander Niculescu  and his team, identified 11 “risk” genes (1) that can predict which people are more at prone to becoming alcoholic. For those with a family history of alcoholism, the danger is even greater. All of this can be detected with a simple genetic test.

“Having a family history already suggests that there is a genetic risk that’s being transmitted. Those people should not expose themselves to temptation and drink even small amounts, as they are more prone to go down a slippery slope of higher amounts of alcohol and full-blown alcoholism,” Dr Niculescu said.

Dr Niculescu said these gene variants also have a lot to do with drive and compulsions, which can be used for positive things like professional achievement. “What we are discovering at the biological level is that there is this physiological robustness and drive that goes hand in hand with predisposition or compulsion to alcoholism and if you manage to avoid getting sucked into alcoholism and just use your biological endowments and drive for other things, you might be an overachiever in other areas.”

In the conclusion to the article it states that  it is likely at its core a disease of an exogenous agent (alcohol) modulating different mind domains/dimensions (anxiety, mood and cognition) precipitated by environmental stress on a background of genetic vulnerability (2).

In simple language, this is what we have been suggesting in this blog. Alcohol acts on underlying mechanisms  relating to anxiety, mood, cognition, which we view under the umbrella term of emotional regulation and processing deficits.

It also shows how genetic vulnerability may overlap with other psychiatric disorders, overlap does not mean the same as.

 

 

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The oft cited co-morbidities which supposedly co-occur alongside alcoholism are in fact not co-morbidity in our view  but intrinsic to the condition. Although this argument and article at least acknowledges there is a growing debate about what constitutes co-morbidity and pathology in alcoholism.

For us alcoholism is these so-called “co-morbidities” mixed with the deleterious effects of chronic alcohol on these deficits and which are commonly exacerbated pre-morbidity or before the actual start of alcohol use by traumatising or distressing early childhood experiences which have been known to result in both stress and emotional dysregulation which in turns leads to a heightening of the rewarding effect of alcohol (or drugs) as stress chemicals increase dopamine in reward networks such as the nucleus accumbens. Alcoholics find a “solution” to their emotional difficulties in the the heightened, calming effects of alcohol and eventually find in the course of time and chronic use that they cannot do without it.

For us genetically, this research is showing what manifestly, in terms of emotional and behavioural problems, is being shown by cognitve, affective and clinical neuroscience.

It also explains why so many recovering alcoholics surprise us and themselves, especially those underachievers at school of which I am one, with their vigour, intelligence and achievements in recovery once they have climbed out of their own personal hell of active alcoholism.

It also explains how they physically survived ordeals which would have killed most. 

References

Levey, D. F., Le-Niculescu, H., Frank, J., Ayalew, M., Jain, N., Kirlin, B., … & Niculescu, A. B. (2014). Genetic risk prediction and neurobiological understanding of alcoholism. Translational psychiatry, 4(5), e391.

Niculescu AB 3rd, Schork NJ, Salomon DR. Mindscape: a convergent perspective on life, mind, consciousness and happiness. J Affect Disord2010; 123: 1–8. |

Don’t fight your thoughts!

Posted on by alcoholicsguide

The idea that abstinence will automatically also decrease alcohol-related intrusive thoughts has been dismissed by research and vast anecdotal evidence.

Practically all therapies for alcoholism e.g  AA, SMART and so on suggest that urges create automatic thoughts about drinking. This has been demonstrated in research that distress automatically gives rise to intrusive thoughts about alcohol. (1) This reflects emotional dysregulation as these intrusive thoughts are correlated to emotional dysregulation (2).

These thoughts to the recovering/abstinent individual can be seen as egodystonic which is a psychological term referring to behaviors, values, feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one’s self image.  Other conditions, such as OCD, have these egodystonic thoughts creating the distress that drives a compulsive need to act on them, rather than letting them pass. In other words, these thoughts are seen as distressing and threatening and compel one to act to reduce this escalating sense of distress. A similar process can happen to those in early recovery. Thoughts about drinking or using when you now wish to remain in recovery are egodystonic, they are contrary to the view of oneself as a person in recovery.  The main problem occurs when we think we can control these thoughts are that these thoughts mean we want to drink or are going to relapse!

Early recovery is a period marked by heightened emotional dysregulation and the proliferation of intrusive thoughts about alcohol .

In fact, empirical research demonstrates that alcohol-related thoughts can resemble obsessive-compulsive thinking (3,4).

In fact, one way to measure “craving” in alcoholics is by scale called the Obsessive Compulsive Drinking Scale (5) , thus highlighting certain similarities in pathomechanisms between alcohol and OCD.

This finding is also supported by clinical observation and leads to the expectation that among abstinent alcohol abusers, alcohol-related thoughts and intrusions are the rule rather than the exception (6)

Relatively little is known about how alcohol abusers appraise their alcohol-related thoughts. Are they aware that alcohol-related thoughts occur naturally and are highly likely during abstinence? Or do they interpret these thoughts in a negative way, for example, as unexpected, shameful, and bothersome? Answers to these questions obviously inform with implications for relapse prevention, because misinterpretations of naturally occurring thoughts may be detrimental for abstinence (7).

 

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A number of conceptual papers and empirical studies have shown that individuals’ appraisal of their intrusive thoughts as detrimental and potentially out of their control may lead them to dysfunctional and counterproductive efforts to control their thinking. Alcohol-related thoughts cause an individual to experience strong emotional reactions; however, alcohol abusers will increase their efforts to control their thinking only when they have negative beliefs about these thoughts. For instance, spontaneous positive memories about alcohol (‘‘It was so nice to hang out at parties and to drink with my buddies’’) may be appraised—and misinterpreted—as ‘‘the first steps toward a relapse’’.

Such an appraisal of one’s thoughts about alcohol as problematic may instigate thought suppression and other efforts to control the thoughts. Because these efforts must be assumed to be counterproductive (Fehm & Hoyer, 2004), they will increase rather than prevent negative feelings and thoughts, and they may even demoralize alcohol abusers who are trying to remain abstinent

If positive alcohol-related thoughts are not appraised as problematic but as a normal part of abstinence, the awareness of these thoughts might even lead to the selection of more adaptive coping responses, which could help to reduce the risk of relapse.

In the context of mental health, metacognition can be loosely defined as the process that “reinforces one’s subjective sense of being a self and allows for becoming aware that some of one’s thoughts and feelings are symptoms of an illness.”

The assumption that metacognition mediates reactions to alcohol-related cues may help to explain why “craving” does not inevitably lead to relapse.

In one reported study (8), participants who reported on their thoughts about alcohol in the previous 24 hours, 92% reported experiencing at least some thoughts about drinking that ‘‘just pop in and vanish’’ without an attempt to eliminate them. This suggests that if both suppression and elaboration can be avoided, many intrusive thoughts will be relatively transient.

An “accept and move on’’ strategy provides an opportunity for the intrusion to remain a fleeting thought.

 

References

1. Zack, M., Toneatto, T., & MacLeod, C. M. (1999). Implicit activation of alcohol concepts by negative affective cues distinguishes between problem drinkers with high and low psychiatric distress. Journal of Abnormal Psychology, 108(3), 518.

2. Ingjaldsson, J. T., Laberg, J. C., & Thayer, J. F. (2003). Reduced heart rate variability in chronic alcohol abuse: relationship with negative mood, chronic thought suppression, and compulsive drinking. Biological Psychiatry, 54(12), 1427-1436.

3. Caetano, R. (1985). Alcohol dependence and the need to drink: A compulsion? Psychological Medicine, 15(3), 463–469

4. Modell, J. G., Glaser, F. B., Mountz, J. M., Schmaltz, S., & Cyr, L. (1992). Obsessive and compulsive characteristics of alcohol abuse and dependence: Quantification by a newly developed questionnaire. Alcoholism: Clinical and Experimental Research, 16(2), 266–271.

5. Anton, R. F., Moak, D. H., & Latham, P. (1995). The Obsessive Compulsive Drinking Scale: A self-rated
instrument for the quantification of thoughts about alcohol and drinking behavior. Alcoholism:
Clinical and Experimental Research, 19, 92–99.

6. Hoyer, J., Hacker, J., & Lindenmeyer, J. (2007). Metacognition in alcohol abusers: How are alcohol-related intrusions appraised?. Cognitive Therapy and Research, 31(6), 817-831.

7. Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the
treatment of addictive behaviors. New York: Guilford Press

8. Kavanagh, D. J., Andrade, J., & May, J. (2005). Imaginary relish and exquisite torture: the elaborated intrusion theory of desire. Psychological review, 112(2), 446.