Blunted autonomic responses to emotional stimuli in alcoholism: relevance of impulsivity

Authors

  • Martina Carmona-Perera Department of Personality, Assessment and Psychological Treatment. School of Psychology, University of Granada, Campus Cartuja s/n. 18071 Granada, Spain. Fundació Villablanca, Serveis Assistencials. Hospital Universitari Institut Pere Mata, Ctra. Bellissens s/n. 43204 Reus, Spain.
  • Xavier Sumarroca-Hernández Unitat de Conductes addictives (UCA). Hospital Nostra Senyora de Meritxell, C/ dels Escalls, s/n. AD700 Escaldes-Engordany, Andorra.
  • Angelina Santolaria-Rossell Unitat de Conductes addictives (UCA). Hospital Nostra Senyora de Meritxell, C/ dels Escalls, s/n. AD700 Escaldes-Engordany, Andorra.
  • Miguel Pérez-García Department of Personality, Assessment and Psychological Treatment. School of Psychology, University of Granada, Campus Cartuja s/n. 18071 Granada, Spain. Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC). University of Granada, Campus Cartuja s/n. 18071 Granada, Spain. Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). University of Granada, Av de Madrid nº 11, 18071 Granada, Spain.
  • Gustavo A. Reyes del Paso Department of Psychology. University of Jaén, Campus de las Lagunillas s/n. 23071 Jaén, Spain. http://orcid.org/0000-0002-2188-8673

DOI:

https://doi.org/10.20882/adicciones.1146

Keywords:

Alcohol-dependent individuals, Autonomic responses, Emotional experience, Impulsivity, Heart rate, Skin conductance.

Abstract

Alcohol dependence is associated with abnormalities in the processing of emotional signals and impulsive alcohol-seeking behaviours, and these alterations compromise the effectiveness of treatment approaches. However, there is a lack of studies linking the experience of emotions to everyday motivationally relevant stimuli in alcohol-dependent individuals using both autonomic and self-report measures. We analysed heart rate (HR), skin conductance (SC) and subjective emotional reactivity to everyday affective stimuli in alcohol-dependent individuals, and their associations with impulsivity and degree of alcohol consumption. SC and HR were continuously monitored in 28 alcohol-dependent individuals and in 31 non-alcohol healthy controls during passive viewing of pleasant, unpleasant, and neutral emotional pictures. Participants assessed the pictures for valence, arousal, and dominance and completed the Barratt Impulsiveness Scale. Alcohol-dependent individuals showed reduced HR and SC reactivity to both positive and negative emotional stimuli. In the case of SC, this blunted response was associated with impulsivity. Furthermore, alcohol-dependents displayed decoupled physiological and subjective responses, with blunted autonomic responses and normal subjective reports regarding emotional stimuli. Our findings indicate that alcohol-dependent individuals failed to use emotional autonomic feedback in response to natural, emotionally relevant stimuli, and provide initial evidence of the contribution of impulsivity to emotional processing deficits in this population. These results are in keeping with the proposed key role played by emotional experience and impulsivity in substance abuse.

Author Biography

Gustavo A. Reyes del Paso, Department of Psychology. University of Jaén, Campus de las Lagunillas s/n. 23071 Jaén, Spain.

Catedrático de Personalidad, Evaluación y Tratamiento Psicológico. Departamento de Psicología. Universidad de Jaén

References

Addolorato, G., Leggio, L., Ferrulli, A., Cardone, S., Vonghia, L., Mirijello, A., … Gasbarrini, G. (2007). Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study. Lancet, 370, 1915–1922. doi:10.1016/S0140-6736(07)61814-5.

Allen, J. P., Wurst, F. M., Thon, N. & Litten, R. Z. (2013). Assessing the drinking status of liver transplant patients with alcoholic liver disease. Liver Transplantation, 19, 369–376. doi:10.1002/lt.23596.

Askgaard, G., Tolstrup, J. S., Gerds, T. A., Hamberg, O., Zierau, L. & Kjær, M. S. (2016). Predictors of heavy drinking after liver transplantation for alcoholic liver disease in Denmark (1990-2013): a nationwide study with competing risks analyses. Scandinavian Journal of Gastroenterology, 51, 225–235. doi:10.3109/00365521.2015.1067903.

Barrio, P., Teixidor, L., Rico, N., Bruguera, P., Ortega, L., Bedini, J. L. & Gual, A. (2016). Urine Ethyl Glucuronide Unraveling the Reality of Abstinence Monitoring in a Routine Outpatient Setting: A Cross-Sectional Comparison with Ethanol, Self Report and Clinical Judgment. European Addiction Research, 22, 243–248. doi:10.1159/000445741.

Beresford, T. P. & Everson, G. T. (2000). Liver transplantation for alcoholic liver disease: bias, beliefs, 6-month rule, and relapse--but where are the data? Liver Transplantation, 6, 777–778.doi:10.1053/jlts.2000.19027.

Bradley, K. A. & Kivlahan, D. R. (2014). Bringing patient-centered care to patients with alcohol use disorders. JAMA, 311, 1861–1862. doi:10.1001/jama.2014.3629.

Bunzel, B. & Laederach-Hofmann, K. (2000). Solid organ transplantation: are there predictors for posttransplant noncompliance? A literature overview. Transplantation, 70, 711–716.

Burra, P., Senzolo, M., Adam, R., Delvart, V., Karam, V., Germani, G. & Neuberger, J. (2010). Liver transplantation for alcoholic liver disease in Europe: a study from the ELTR (European Liver Transplant Registry). American Journal of Transplantation, 10, 138–148. doi:10.1111/j.1600-6143.2009.02869.x.

Carbonneau, M., Jensen, L. A., Bain, V. G., Kelly, K., Meeberg, G. & Tandon, P. (2010). Alcohol use while on the liver transplant waiting list: a single-center experience. Liver Transplantation, 16, 91–97. doi:10.1002/lt.21957.

CDER. (2015). Alcoholism: Developing Drugs for Treatment Guidance for Industry. Retrieved at http://www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm433618.pdf.

Conn, V. S., Ruppar, T. M., Chase, J.-A. D., Enriquez, M. & Cooper, P. S. (2015). Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis. Current Hypertension Reports, 17, 94. doi:10.1007/s11906-015-0606-5.

Cuadrado, A., Fábrega, E., Casafont, F. & Pons-Romero, F. (2005). Alcohol recidivism impairs long-term patient survival after orthotopic liver transplantation for alcoholic liver disease. Liver Transplantation, 11, 420–426. doi:10.1002/lt.20386.

Dawwas, M. F., Gimson, A. E., Lewsey, J. D., Copley, L. P. & van der Meulen, J. H. P. (2007). Survival after liver transplantation in the United Kingdom and Ireland compared with the United States. Gut, 56, 1606–1613. doi:10.1136/gut.2006.111369.

de Beaurepaire, R., Lukasiewicz, M., Beauverie, P., Castéra, S., Dagorne, O., Espaze, R., … Molimard, R. (2007). Comparison of self-reports and biological measures for alcohol, tobacco, and illicit drugs consumption in psychiatric inpatients. European Psychiatry, 22, 540–548. doi:10.1016/j.eurpsy.2007.05.001.

De Gottardi, A., Spahr, L., Gelez, P., Morard, I., Mentha, G., Guillaud, O., … Dumortier, J. (2007). A simple score for predicting alcohol relapse after liver transplantation: results from 387 patients over 15 years. Archives of Internal Medicine, 167, 1183–1188. doi:10.1001/archinte.167.11.1183.

Di Martino, V., Sheppard, F. & Vanlemmens, C. (2012). Early liver transplantation for severe alcoholic hepatitis. The New England Journal of Medicine, 366, 478–479. doi:10.1056/NEJMc1114241#SA3.

DiMartini, A., Magill, J., Fitzgerald, M. G., Jain, A., Irish, W., Khera, G. & Yates, W. (2000). Use of a high-risk alcohol relapse scale in evaluating liver transplant candidates. Alcoholism, Clinical and Experimental Research, 24, 1198–1201.

Dom, G., Wojnar, M., Crunelle, C. L., Thon, N., Bobes, J., Preuss, U. W., … Wurst, F. M. (2015). Assessing and treating alcohol relapse risk in liver transplantation candidates. Alcohol and Alcoholism, 50, 164–172. doi:10.1093/alcalc/agu096.

EASL clinical practical guidelines: management of alcoholic liver disease. (2012). Journal of Hepatology, 57, 399–420. doi:10.1016/j.jhep.2012.04.004.

EASL Clinical Practice Guidelines: Liver transplantation. (2015). Journal of Hepatology, 64, 433–485. doi:10.1016/j.jhep.2015.10.006.

Egawa, H., Nishimura, K., Teramukai, S., Yamamoto, M., Umeshita, K., Furukawa, H. & Uemoto, S. (2014). Risk factors for alcohol relapse after liver transplantation for alcoholic cirrhosis in Japan. Liver Transplantation, 20, 298–310. doi:10.1002/lt.23797.

EMA. (2010). Development of medicinal products for the treatment of alcohol dependence. Retrieved at http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2010/03/WC500074898.pdf

EMCDDA. (2015). European Drug Report 2015: Trends and Developments.

Erim, Y., Böttcher, M., Dahmen, U., Beck, O., Broelsch, C. E. & Helander, A. (2007). Urinary ethyl glucuronide testing detects alcohol consumption in alcoholic liver disease patients awaiting liver transplantation. Liver Transplantation, 13, 757–761. doi:10.1002/lt.21163.

Erim, Y., Böttcher, M., Schieber, K., Lindner, M., Klein, C., Paul, A., … Helander, A. (2016). Feasibility and Acceptability of an Alcohol Addiction Therapy Integrated in a Transplant Center for Patients Awaiting Liver Transplantation. Alcohol and Alcoholism, 51, 40–46. doi:10.1093/alcalc/agv075.

Gual, A., Contel, M., Segura, L., Ribas, A. & Colom, J. (2001). The ISCA (Systematic Interview of Alcohol Consumption), a new instrument to detect risky drinking. Medicina Clínica, 117, 685–689.

Hill, S. & Kavookjian, J. (2012). Motivational interviewing as a behavioral intervention to increase HAART adherence in patients who are HIV-positive: a systematic review of the literature. AIDS Care, 24, 583–592. doi:10.1080/09540121.2011.630354.

Hjorthøj, C. R., Hjorthøj, A. R. & Nordentoft, M. (2012). Validity of Timeline Follow-Back for self-reported use of cannabis and other illicit substances--systematic review and meta-analysis. Addictive Behaviors, 37, 225–233. doi:10.1016/j.addbeh.2011.11.025.

Horrigan, T. J., Piazza, N. J. & Weinstein, L. (1996). The substance abuse subtle screening inventory is more cost effective and has better selectivity than urine toxicology for the detection of substance abuse in pregnancy. Journal of Perinatology, 16, 326–330.

Jensen, H. H., Mortensen, E. L. & Lotz, M. (2014). Drop-out from a psychodynamic group psychotherapy outpatient unit. Nordic Journal of Psychiatry, 68, 594–604. doi:10.3109/08039488.2014.902499.

Lligoña, A., Freixa, N., Bataller, R., Monràs, M. & Rimola, A. (2009). Clinical guideline for the evaluation of liver transplant candidates with addictions. Gastroenterología y Hepatología, 32, 155–161. doi:10.1016/j.gastrohep.2008.05.003.

Malinchoc, M., Kamath, P. S., Gordon, F. D., Peine, C. J., Rank, J. & ter Borg, P. C. (2000). A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology, 31, 864–871. doi:10.1053/he.2000.5852.

Martin, P., DiMartini, A., Feng, S., Brown, R. & Fallon, M. (2014). Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology, 59, 1144–1165.

Mathurin, P. & Bataller, R. (2015). Trends in the management and burden of alcoholic liver disease. Journal of Hepatology, 62, S38–S46. doi:10.1016/j.jhep.2015.03.006.

Melanson, S. E. F., Ptolemy, A. S. & Wasan, A. D. (2013). Optimizing urine drug testing for monitoring medication compliance in pain management. Pain Medicine, 14, 1813–1820. doi:10.1111/pme.12207.

Moeller, K. E., Lee, K. C. & Kissack, J. C. (2008). Urine drug screening: practical guide for clinicians. Mayo Clinic Proceedings, 83, 66–76. doi:10.4065/83.1.66.

Nanau, R. M., & Neuman, M. G. (2015). Biomolecules and Biomarkers Used in Diagnosis of Alcohol Drinking and in Monitoring Therapeutic Interventions. Biomolecules, 5, 1339–1385. doi10.3390/biom5031339.

Niemelä, O. (2016). Biomarker-Based Approaches for Assessing Alcohol Use Disorders. International Journal of Environmental Research and Public Health, 13, 166. doi:10.3390/ijerph13020166.

Oslin, D. W., Pettinati, H. & Volpicelli, J. R. (2002). Alcoholism treatment adherence: older age predicts better adherence and drinking outcomes. The American Journal of Geriatric Psychiatry, 10, 740–747.

Page, T. F., Amofah, S. A., McCann, S., Rivo, J., Varghese, A., James, T., … Williams, M. L. (2015). Care Management Medical Home Center Model: Preliminary Results of a Patient-Centered Approach to Improving Care Quality for Diabetic Patients. Health Promotion Practice, 16, 609–616. doi:10.1177/1524839914565021.

Peles, E., Schreiber, S., Domany, Y. & Adelson, M. (2014). Impact of lifetime psychiatric diagnosis on long-term retention and survival of former opiate addicts in methadone maintenance treatment. The World Journal of Biological Psychiatry, 15, 629–635. doi:10.3109/15622975.2014.942359.

Piano, S., Marchioro, L., Gola, E., Rosi, S., Morando, F., Cavallin, M., … Angeli, P. (2014). Assessment of alcohol consumption in liver transplant candidates and recipients: the best combination of the tools available. Liver Transplantation, 20, 815–822. doi:10.1002/lt.23881.

Rehm, J., Gmel, G., Sierra, C. & Gual, A. (2018). Reduction of mortality following better detection of hypertension and alcohol problems in primary health care in Spain. Adicciones, 30, 9-18. doi:10.20882/adicciones.726.

Rustad, J. K., Stern, T. A., Prabhakar, M. & Musselman, D. (2015). Risk factors for alcohol relapse following orthotopic liver transplantation: a systematic review. Psychosomatics, 56, 21–35. doi:10.1016/j.psym.2014.09.006.

Sánchez Autet, M., Garriga, M., Zamora, F. J., González, I., Usall, J., Tolosa, L., … Arranz, B. (2017). Cribaje de trastornos por uso de alcohol en pacientes psiquiátricos ambulatorios: influencia de género, edad, y diagnóstico psiquiátrico. Adicciones. Advance publication online. doi:10.20882/adicciones.885.

Sansone, R. A., Bohinc, R. J. & Wiederman, M. W. (2015). Borderline personality symptomatology and compliance with general health care among internal medicine outpatients. International Journal of Psychiatry in Clinical Practice, 19, 132–136. doi:10.3109/13651501.2014.988269.

Staufer, K. & Yegles, M. (2016). Biomarkers for detection of alcohol consumption in liver transplantation. World Journal of Gastroenterology, 22, 3725–3734. doi:10.3748/wjg.v22.i14.3725.

Stewart, S. H., Koch, D. G., Burgess, D. M., Willner, I. R. & Reuben, A. (2013). Sensitivity and specificity of urinary ethyl glucuronide and ethyl sulfate in liver disease patients. Alcoholism, Clinical and Experimental Research, 37, 150–155. doi:10.1111/j.1530-0277.2012.01855.x.

Surman, O. S., Cosimi, A. B. & DiMartini, A. (2009). Psychiatric care of patients undergoing organ transplantation. Transplantation, 87, 1753–1761. doi:10.1097/TP.0b013e3181a754d4.

Telles-Correia, D., Barbosa, A., Mega, I. & Monteiro, E. (2009). Adherence correlates in liver transplant candidates. Transplantation Proceedings, 41, 1731–1734. doi:10.1016/j.transproceed.2009.02.067.

Webzell, I., Ball, D., Bell, J., Sherwood, R. A., Marsh, A., O’Grady, J. G. & Heaton, N. D. (2011). Substance use by liver transplant candidates: an anonymous urinalysis study. Liver Transplantation, 17, 1200–1204. doi:10.1002/lt.22370.

Wurst, F. M., Thon, N., Yegles, M., Schrück, A., Preuss, U. W. & Weinmann, W. (2015). Ethanol metabolites: their role in the assessment of alcohol intake. Alcoholism, Clinical and Experimental Research, 39, 2060–2072. doi:10.1111/acer.12851.

Wurst, F. M., Vogel, R., Jachau, K., Varga, A., Alling, C., Alt, A. & Skipper, G. E. (2003). Ethyl glucuronide discloses recent covert alcohol use not detected by standard testing in forensic psychiatric inpatients. Alcoholism, Clinical and Experimental Research, 27, 471–476. doi:10.1097/01.ALC.0000057942.57330.E2.

Published

2018-07-20

Issue

Section

Originals