Alcohol challenge responses predict future alcohol use disorder symptoms: a 6-year prospective study

Abstract

Background: Propensity for alcohol misuse may be linked to an individuals' response to alcohol. This study examined the role of alcohol response phenotypes to future drinking problems.

Methods: One hundred four young heavy social drinkers participated in a within-subject, double-blind, placebo-controlled laboratory alcohol challenge study with 6-year follow-up. Participants were examined for subjective responses before and after receiving an intoxicating dose of alcohol (.8 g/kg) or a placebo beverage, given in random order. Follow-up was conducted in 5 waves over 6 years after the sessions to assess drinking behaviors and alcohol use disorder (AUD) symptoms. Retention was high with 98% (509 of 520) of possible follow-ups completed.

Results: Greater sensitivity to alcohol, in terms of stimulation and rewarding effects (like, want more) and lower sensitivity to alcohol sedation predicted greater number of AUD symptoms through 6 years of follow-up. Cluster analyses revealed that for half the sample, increasing levels of stimulation and liking were predictors of more AUD symptoms with the other half divided between those showing like and want more and want more alone as significant predictors.

Conclusions: The findings extend previous findings and offer new empirical insights into the propensity for excessive drinking and alcohol problems. Heightened alcohol stimulation and reward sensitivity robustly predicted more alcohol use disorder symptoms over time associated with greater binge-drinking frequency. These drinking problems were maintained and progressed as these participants were entering their third decade of life, a developmental interval when continued alcohol misuse becomes more deviant.

Trial registration: ClinicalTrials.gov NCT00961792.

Keywords: Alcohol response; binge drinking; differentiator model; reward sensitivity; stimulation; subjective effects; trajectory.

Conflict of interest statement

Dr. King has provided consultation to Lundbeck and the Respiratory Health Association. Drs. Cao and Hasin and Mr. McNamara have no conflicts of interest or disclosures.

Copyright © 2014 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Baseline alcohol response factors in alcohol use disorder (AUD) trajectory subgroups. (A) Three trajectory groups were identified based on AUD symptoms (total alcohol abuse and alcohol dependence symptoms; 0–11 possible) over 6 years of follow-up occurring at Years 1, 2, 5, and 6. The symbols represent the mean AUD symptoms at each follow-up interval for each group with the dotted lines representing model fits. (B) Binge drinking frequency over follow-up in the AUD trajectory groups. (C–F). Stimulation, sedation, liking and wanting for alcohol, and placebo at 60 minutes (peak breath alcohol content) for the AUD symptom subgroups derived from trajectory analyses. Results on figures are mainly for visual purposes and were derived from linear trend analyses comparing groups on the net change score of alcohol response relative to placebo to be consistent with other analyses in this study, with p < .05 indicating a significant difference across groups. BAES, Biphasic Alcohol Effects Scale; DEQ, Drug Effects Questionnaire.

Figure 2

Cluster analysis results of the prospective relationship of B-BAES and DEQ derived alcohol response to alcohol use disorder (AUD) symptom count over time. Raw data for both alcohol response measures (x axes) and mean AUD symptoms (y axes) are displayed for ease of presentation. Cluster analyses were conducted on standardized scores for alcohol responses (to allow direct comparisons across measures), log-transformed mean AUD symptoms (to correct for skewness), and the increase in AUD symptoms during Years 5 and 6 relative to Year 0, 1, and 2 (to account for AUD changes over follow-up). Cluster analysis revealed three subgroups on the relationship of stimulation, sedation, liking, and wanting to AUD symptoms over time. Regression analyses were used to assess the relationship between these variables.