Subjective Responses to Alcohol in the Development and Maintenance of Alcohol Use Disorder

Abstract

Objective: Alcohol use disorder (AUD) remains an urgent public health problem. Longitudinal data are needed to clarify the role of acute subjective responses to alcohol in the development and maintenance of excessive drinking and AUD. The authors report on 10 years of repeated examination of acute alcohol responses in the Chicago Social Drinking Project.

Methods: Young adult drinkers (N=190) participated in an initial alcohol challenge (0.8 g/kg of alcohol compared with placebo) that was repeated 5 and 10 years later. They were also assessed on drinking behavior and AUD symptoms at numerous intervals across the decade. Retention was high, as 184 of the 185 (99%) nondeceased active participants completed the 10-year follow-up, and 91% (163 of 179) of those eligible for alcohol consumption engaged in repeated laboratory testing during this interval.

Results: At the end of the decade, 21% of participants met criteria for past-year AUD. Individuals who reported the greatest alcohol stimulation, liking, and wanting at the initial alcohol challenge were most likely to have developed AUD 10 years later. Further, alcohol-induced stimulation and wanting increased in reexamination testing among those with the highest AUD symptoms as the decade progressed.

Conclusions: Initial stimulant and rewarding effects of alcohol predicted heavy alcohol use, and the magnitude of these positive subjective effects increased over a 10-year period in those who developed AUD compared with those who did not develop the disorder. The findings demonstrate systematic changes in subjective responses to alcohol over time, providing an empirical basis for prevention, early intervention, and treatment strategies.

Keywords: Alcohol Response; Allostasis; Incentive-Sensitization; Reward; Stimulation.

Figures

Figure 1:. Mean AUD symptom count and heavy drinking occasions per month over 10 years of follow-up for A) AUD+/− (as determined at Year 10) groups and B) AUD SX subgroups

Data are shown as mean (SEM), with the left panel depicting AUD symptoms at each follow-up interval for each group and the right panel depicting binge drinking frequency over follow-up. A) AUD+ and AUD− groups were identified based on AUD symptom counts per the DSM-5 at Year 10 follow-up. B) Three trajectory subgroups were identified based on symptom count from DSM-IV alcohol abuse and alcohol dependence; 0–11 possible) over 10 years of follow-up occurring at initial testing and years 1, 2, 4, 5, 6, 8, and 10 (dotted lines represent model fits). As the study began before the DSM-5 was developed, symptom counts for years 1–5 were based on the 11 criteria comprising DSM-IV alcohol abuse and dependence (First et al., 2002). For unity, these DSM-IV criteria were also used for follow-ups in years 6–10 for trajectory analysis. Notably, only 1 symptom is different between DSM-IV alcohol abuse and dependence criteria versus those for DSM-5 AUD.

Figure 2:. Subjective alcohol responses at initial, 5- and 10-year re-examinations in AUD+ and AUD− groups (as determined at Year 10)

Data are shown as means (±SEM) of change scores (alcohol session minus placebo session) for the four primary subjective response measures each time point and each testing phase. for AUD+ at Year 10 (n=39) and AUD− at Year 10 (n=145). AUD+ and AUD− groups were identified based on AUD symptom counts per the DSM-5 at Year 10 follow-up. Y-axis range for liking and wanting differ slightly given the range of values and that liking is based on a scale with mid-point as neutral. Details on the statistical testing are in Table 3.

Figure 3:. Subjective alcohol responses at initial, 5- and 10-year re-examinations for AUD SX trajectory subgroups

Data are shown as means (SEM) for low AUD sx count (n=103), intermediate AUD sx count (n=62), and high AUD sx count (n=19) trajectory groups at initial and re-examination phases. Subjective response data are change scores (alcohol session minus placebo session) at each time point. Y-axis range for liking and wanting differ slightly given the range of values and that liking is based on a scale with mid-point as neutral. Details on the statistical testing are in Table 3.