Rewarding, stimulant, and sedative alcohol responses and relationship to future binge drinking

Abstract

Context: Excessive consumption of alcohol is a major problem in the United States and abroad. Despite many years of study, it is unclear why some individuals drink alcohol excessively while others do not. It has been postulated that either lower or greater acute responses to alcohol, or both, depending on the limb of the breath alcohol concentration curve, contribute to propensity for alcohol misuse.

Objective: To prospectively assess the relationship of acute alcohol responses to future binge drinking.

Design: Within-subject, double-blind, placebo-controlled, multidose laboratory alcohol challenge study with intensive follow-up. Each participant completed 3 randomized sessions examining responses to a high (0.8 g/kg) and low (0.4 g/kg) alcohol dose and placebo, followed by quarterly assessments for 2 years examining drinking behaviors and alcohol diagnoses.

Setting: Participants recruited from the community.

Participants: High-risk heavy social drinkers aged 21 to 35 years who habitually engage in weekly binge drinking (n = 104) and light drinker controls (n = 86).

Intervention: We conducted 570 laboratory sessions with a subsequent 99.1% follow-up (1506 of 1520).

Main outcome measures: Biphasic Alcohol Effects Scale, Drug Effects Questionnaire, cortisol response, Timeline Follow-Back, Drinker Inventory of Consequences-Recent, and DSM-IV alcohol abuse and dependence.

Results: Alcohol produced greater stimulant and rewarding (liking and wanting) responses and lower sedative and cortisol responses in heavy vs light drinkers. Among the heavy drinkers, greater positive effects and lower sedative effects after alcohol consumption predicted increased binge drinking frequency during follow-up. In turn, greater frequency of binge drinking during follow-up was associated with greater likelihood of meeting diagnostic criteria for alcohol abuse and dependence.

Conclusions: The widely held low level response theory and differentiator model should be revised: in high-risk drinkers, stimulant and rewarding alcohol responses even at peak breath alcohol concentrations are important predictors of future alcohol problems.

Trial registration: clinicaltrials.gov Identifier: NCT00961792.

Figures

Figure 1

Heavy and light drinkers’ breath alcohol concentrations (BrAC) (A) and Drug Effects Questionnaire (DEQ; range, 0.0–1.0) feel drug ratings (B) during the sessions. For feel drug, light drinkers had higher ratings during the high dose than did heavy drinkers at all time points; P<.001. The shaded bar indicates the alcohol drinking interval from time 0 to 15 minutes. Error bars indicate standard error.

Figure 2

Heavy and light drinkers’ subjective stimulant and rewarding responses, including the Biphasic Alcohol Effects Scale (BAES; range, 10–70) stimulation (A) and the Drug Effects Questionnaire (DEQ; range, 0.0–1.0) for like (B) and want more (C) during the sessions. Post hoc analysis of a significant group×dose×time interaction revealed that for stimulation at the high dose, heavy drinkers had higher ratings than light drinkers at 30 minutes (P<.05) and 60 minutes (P<.06). Post hoc analysis of a significant group×dose interaction for like at the high dose revealed that heavy drinkers had higher ratings than light drinkers at 30, 60, and 120 minutes (P<.01 for all), and a significant group×dose interaction for want more at the high dose and low dose revealed that heavy drinkers had higher ratings than light drinkers at all time points (P<.001 for all). The shaded bar indicates the alcohol drinking interval from time 0 to 15 minutes. Error bars indicate standard error.

Figure 3

Heavy and light drinkers’ Biphasic Alcohol Effects Scale (BAES; range, 10–70) sedation (A) and salivary cortisol (B) responses during the sessions. Post hoc analysis of a significant group×dose×time interaction revealed that for sedation at the high alcohol dose, light drinkers had higher ratings than heavy drinkers at 30, 60, and 120 minutes (P <.001 for all) and at the low dose, light drinkers had higher ratings than heavy drinkers at 60 minutes (P<.05). Post hoc analysis of a significant group×dose×time interaction for cortisol at the high dose revealed that the light drinkers had higher levels than heavy drinkers at 120 and 180 minutes (P<.01 for all). The shaded bar indicates the alcohol drinking interval from time 0 to 15 minutes. Error bars indicate standard error. (To convert cortisol to nanomoles per liter, multiply by 27.588).

Figure 4

Trajectory groups during the 2-year follow-up. Trajectory data were based on the self-reported frequency of past-month binge drinking days obtained at each quarterly interval. A discrete mixture modeling approach determined by the Bayesian Information Criterion for model selection revealed a 2-trajectory group (nonbinge and infrequent binge) model for the light drinkers and a 4-trajectory group (gradual maturing, moderate-frequency binge, high-frequency binge, and exacerbating) model for the heavy drinkers best described the data.

Figure 5

Heavy and light drinkers’ trajectory groups’ initial alcohol responses, including the Drug Effects Questionnaire (DEQ; range, 0.0–1.0) for like (A) and want more (B) and the Biphasic Alcohol Effects Scale (BAES; range, 10–70) for stimulation (C) and sedation (D). Alcohol responses are indicated as the mean for each trajectory group based on participants’ change score: high dose (60 minutes - baseline) – placebo (60 minutes -baseline). In light drinkers, there were no significant associations of alcohol response to trajectory group. In heavy drinkers, higher ratings for like (P <.001) and want more (P <.001) and lower ratings for sedation (P <.05) were significantly linearly associated with drinking trajectory group. Error bars indicate standard error.