Transcript ISBRA World Congress on Alcohol Research Sidney 2006

ISBRA
World Congress on Alcohol Research
Sidney 2006
Symposium Alcohol and Nicotine Dependence
Cognitive Behavioral Aspects
…and some other considerations…
Prof. I. Pelc
Université Libre de Bruxelles – Belgium
Lab. Medical Psychology, Alcohol and Drug Dependence
University Hospital Brugmann
Bio-Psycho-Social approach
Drugs
Individual
Environment
ISBRA – Prof. I. Pelc, 2006
Introduction (1)
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Alcoholism, nicotine dependence =
major public health concern
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Association ALCOHOLISM/NICOTINE SMOKING
–
–
–
–
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80% : three times more than in general population
Alcoholics smoke more cigarettes per day
Alcoholics smoke more while detoxifying from alcohol
Infrequent spontaneous smoking cessation in alcoholics
Nicotine increases craving for alcohol / smoking triggers
drinking
– Smokers are less sensitive to alcohol (cross-tolerance for
nicotine and alcohol)
– Common biological substrate: both are mediated through
corticomesolimbic dopamine structures
ISBRA – Prof. I. Pelc, 2006
Introduction (2)
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Double detox
– Pro : tobacco cues increase alcohol relapse
– Cons : tobacco cessation increases stress
causing alcohol relapse
– Still a debated and controversial issue
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Need for a better characterization of
smoking vs. non-smoking alcoholics in detox
ISBRA – Prof. I. Pelc, 2006
Cross-sectional study (1)
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Brugmann University Hospital : Clinic of
Addiction/detoxification area, Brussels,
Belgium
205 recently detoxified alcoholics (in
treatment) : 146 males, 59 females
In treatment on a voluntary basis
Mean Age: 45 (20-80 of range)
81.5 % with tobacco dependence
(Fagerström score ≥5)
ISBRA – Prof. I. Pelc, 2006
Cross-sectional study (2)
Alcoholics in detox
(n=205)
Smokers : 81.5 %
Non-smokers : 18.5 %
67.9 % with Axis I
51.4 % with Axis I
Loss of Control of Alcohol
Loss of Control of Alcohol
29.2 Years
Antecedent
other drugs
32.4 Years
P<.05
Antecedent
other drugs
49.7 %
NO antecedent
other drugs
Loss of Control
50.3 %
Loss of Control
Of Alcohol
Loss of Control
Of Alcohol
27.1 Years
Of Alcohol
28.5 Years
30.5 Years
13 %
P<.001
NO antecedent
other drugs
87 %
Loss of Control
Of Alcohol
33.5 Years
ISBRA – Prof. I. Pelc, 2006
Cross-sectional study (3)
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Alcoholics/Smokers vs. Alcoholics/Non-smokers
(SmALC)
(NonSmALC)
– 49.7% with antecedent of other substance use vs. 13%
(p<.001)
– 67.9% with other axis I diagnosis vs. 51.4% (p=.05), not
due to the presence of an higher prevalence of antecedent
of other substances
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Age of alcohol loss of control
– SmALC (29.2 ± 10.3) < NonSmALC (32.4 ± 11.4) (p<.05)
– SmALC (no other drugs) (30.5 ± 11.2) = NonSmALC (no
other drugs) (33.5 ±12.1) (p=.22)
– ALC (with other drugs) (27.7 ± 9.0) < ALC (without other
drugs) (31.3 ± 11.5) (p=.01)
ISBRA – Prof. I. Pelc, 2006
Cross-sectional study (3)
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Alcoholics/Smokers vs. Alcoholics/Non-smokers
(SmALC)
(NonSmALC)
– 49.7% with antecedent of other substance use vs. 13% p<.001)

Age of alcohol loss of control
– SmALC (29.2 ± 10.3) < NonSmALC (32.4 ± 11.4) (p<.05)
ISBRA – Prof. I. Pelc, 2006
Cross-sectional study (4)
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SmALC with antecedent of other drugs are
distinct to
NonSmALC and SmALC
with no such antecedent
in term of age of loss alcohol control
 Maybe also in terms of psychological
and biological functioning ?
ISBRA – Prof. I. Pelc, 2006
Loss of control – Age of onset
It’s the
antecedent
of other
drug use
that makes
the
difference !
ISBRA – Prof. I. Pelc, 2006
Personality traits and the development of
alcohol, nicotine and illicit drug disorders
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Personality traits constraint: behavioral
undercontrol, reflecting difficulty in
inhibiting behavioral impulses or high
risk taking precipitate alcohol and illicit
drugs dependence (e.g., Cloninger et al., 1988)
Negative emotionality: a common factor
to the development of most addictions
(Elkins, King, McGue & Iacono, 2006)
ISBRA – Prof. I. Pelc, 2006
Executive Functions and
Relapse Prediction
45
40
35
30
25
20
R+
15
10
5
0
Control
Alcoholics (R-)
Alcoholics (R+)
R-
12
10
8
6
4
C
2
C
R-
R+
0
Alpha Span Score
Hayling Score
(Noël, Verbanck,Pelc 2002)
ISBRA – Prof. I. Pelc, 2006
Motivation to take drugs
A psychobiological approach (1)
(Robinson & Berridge, 1993)
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A motivation system
linked to dopaminergic
action in the ventral
striatum and common to
most of addictive drugs
Once sensitized by any
substance with addictive
properties, it may cause
long-lasting changes
responsible for abnormal
motivation to take
drugs, thus leading to
make drug use ‘wanted’,
more than ‘liked’
ISBRA – Prof. I. Pelc, 2006
Motivation to take drugs
A psychobiological approach (2)
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In parallel, frontal (regulatory) system may
be disrupted by drug action and/or may be
impaired prior to the first use of drug
– Leading to the loss of control and the lack of
flexibility (Noël et al., 2001)
– Leading to deal poorly with risky situation, that
is to say, to make biased decisions in considering
mainly short term consequences (Noël, Van der
Linden & Bechara, 2006)
 Greater impulsivity in alcoholics with
antecedent of other drugs use (e.g., earlier
loss of control)
ISBRA – Prof. I. Pelc, 2006
Clinical implications
E.B.M. Data and Good Practice Implies :
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To investigate drug use antecedent in
alcoholic smokers
– More drug use antecedents
– Earlier loss of control of alcohol
– More psychiatric disorders
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To deal with impulsivity as a specific
factor of earlier loss of control of
alcohol and negative emotionality as a
more general factor of addiction (CBT,
motivational interviewing)
ISBRA – Prof. I. Pelc, 2006
Acknowledgments
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I. Vandenabeele, MD ; Psychiatrist, Assistant
C. Hanak, MD ; Psychiatrist
X. Noël, Psychologist, PhD in Neurosciences
Prof. P. Verbanck, Psychiatrist, PhD,
Head Dept Psychiatry Brugmann Hospital
Prof. I. Pelc, Psychiatrist, PhD,
Head Lab. Med. Psych. Alcohol & Drugs
University of Brussels