Comorbidity of alcoholism and antisocial personality disorder
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Comorbidity of Alcoholism and Antisocial Personality Disorder. R.O. Pihl McGill University. Alcoholism & ASPD. Lets avoid the definitional quagmire. Lets agree there is a significant correlation between Alcoholism and ASPD.

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Comorbidity of Alcoholism and Antisocial Personality Disorder

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Comorbidity of alcoholism and antisocial personality disorder

Comorbidity of Alcoholism and Antisocial Personality Disorder

R.O. Pihl

McGill University


Alcoholism aspd

Alcoholism & ASPD

  • Lets avoid the definitional quagmire.

  • Lets agree there is a significant correlation between Alcoholism and ASPD.

  • Lets agree that the nature of the relationship is well understood.


The role of different motivational systems

The Role of Different Motivational Systems

  • Motivational system responding to threat

  • The Cognitive Control System

  • Motivational system responding to reward


Comorbidity of alcoholism and antisocial personality disorder

Behavior

(Behaviorally-linked)

Sensory information

Aggression

Threatening or punishing

behavior

Executive Cognitive Functions

Facilitory:

Cue for Reward

Inhibitory:

Cue for Punishment


Comorbidity of alcoholism and antisocial personality disorder

Behavior

(Behaviorally-linked)

Sensory information

Inhibits

Aggression

Threatening or punishing

behavior

Executive Cognitive Functions

Facilitory:

Cue for Reward

Inhibitory:

Cue for Punishment

Acute

Alcohol

Intoxication


Comorbidity of alcoholism and antisocial personality disorder

Behavior

(Behaviorally-linked)

Sensory information

Inhibits

Aggression

Threatening or punishing

behavior

Executive Cognitive Functions

Disorganizes

Facilitory:

Cue for Reward

Inhibitory:

Cue for Punishment

Acute

Alcohol

Intoxication


Comorbidity of alcoholism and antisocial personality disorder

Behavior

(Behaviorally-linked)

Sensory information

Inhibits

Aggression

Threatening or punishing

behavior

Executive Cognitive Functions

Disorganizes

Facilitory:

Cue for Reward

Inhibitory:

Cue for Punishment

Acute

Alcohol

Intoxication

Potentiates


The role of different motivational systems1

The Role of Different Motivational Systems

  • Environmental triggers

    • Threat, anxiety (novelty, cues of punishment, etc…)

    • Monotony (lack of immediate reinforcement)

  • Genetically influenced susceptibility

    • Anxiety

    • Boredom

  • Desired alcohol reinforcement

    • Anxiolysis (serotonin & GABA effects)

    • Stimulation (Dopaminergic effects)


Comorbidity of alcoholism and antisocial personality disorder

Family Pedigree


Subjects with a high heart rate response to alcohol challenge

Subjects with a High Heart rate Response to Alcohol Challenge

  • Self-rate more of a positive response

  • Drink more

  • Remember more words learned before drinking

  • Release more dopamine in the Ventral Striatum


Positron emission tomography

Positron Emission Tomography


Comorbidity of alcoholism and antisocial personality disorder

Alcohol Promotes Dopamine Release in the Human Nucleus Accumbens

…and this release is associated to an increased HR response to alcohol


Background

Background

Phenylalanine and tyrosine, two amino acids (AA)found in dietary protein, are the essential building blocks for the production of dopamine in the brain.

Ingesting an AA mixture deficient in P&T reduces DA production by 1)causes protein synthesis diminishing the body’s stores of these AA 2) increasing competition of other AAs for transport across the blood brain barrier.

Peek effect of depletion occur 4-5 hours following the ingestion of the AA mixture


Comorbidity of alcoholism and antisocial personality disorder

APTD Change in Drinking and Ethanol Cardiac Response

r=.-658, p=.006


Comorbidity of alcoholism and antisocial personality disorder

Figure 1 - Mean group differences (+ SE) between Low (n = 19) and High (n = 19) Heart Rate Responders in the average of age 10 to 17 delinquency scores


Comorbidity of alcoholism and antisocial personality disorder

Figure 2 - Mean group differences (+ SE) between Low (n = 18) and High (n = 20) Heart Rate Responders in Goldberg's Adjective Markers of the Big Five assessed at age 19


Comorbidity of alcoholism and antisocial personality disorder

Figure 3 - Mean group differences (+ SE) between Low (n = 20) and High (n = 22) Heart Rate Responders in Subjective High Assessment Scale (SHAS) at age 19


Apparatus taylor aggression paradigm tap

Apparatus: Taylor Aggression Paradigm (TAP)


Comorbidity of alcoholism and antisocial personality disorder

TAP - Mean Shock Level Selected


Commonalities alcoholism aspd

Commonalities Alcoholism & ASPD

  • Unusual high heart rate response to high dose of alcohol.

  • High activation of the Cue for Reward System.

  • A system that is dopamine mediated.

  • Reduced ECF functioning.


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