Aggression Disorder Linked to Greater Risk of Substance Abuse

 People with intermittent explosive disorder at five times greater risk for substance abuse than those who don’t display frequent aggressive behavior

Newswise, May 2, 2017 — People with intermittent explosive disorder (IED)—a condition marked by frequent physical or verbal outbursts—are at five times greater risk for abusing substances such as alcohol, tobacco and marijuana than those who don’t display frequent aggressive behavior, according to a new study by researchers from the University of Chicago.\

In the study, published Feb. 28, 2017 in the Journal of Clinical Psychiatry, Emil Coccaro, MD, and colleagues analyzed data from more than 9,200 subjects in the National Comorbidity Survey, a national survey of mental health in the United States.

They found that as the severity of aggressive behavior increased, so did levels of daily and weekly substance use. The findings suggest that a history of frequent, aggressive behavior is a risk factor for later substance abuse, and effective treatment of aggression could delay or even prevent substance abuse in young people.

IED affects as many as 16 million Americans, more than bipolar disorder and schizophrenia combined. It is often first diagnosed in adolescents, some of whom are as young as 11, years before substance abuse problems usually develop.

 IED runs in families and is thought to have a significant genetic component, although Coccaro said people tend to treat it as a social-behavioral issue instead of as a true neurobiological disorder.

“People don’t see this as a medical problem. They think of it as simply bad behavior they have developed over the course of their lives, but it isn’t. It has significant biology and neuroscience behind it,” said Coccaro, who is the Ellen C. Manning Professor of Psychiatry and Behavioral Neuroscience at UChicago.

Previous research has implied that aggressive behavior in IED is due to the presence of other psychiatric disorders, such as anxiety or depression. But the new UChicago study found no such relationship.

While substance abuse, like excessive drinking, can clearly make aggressive behavior worse, the onset of IED almost always precedes the development of chronic substance abuse. Coccaro and his team found that IED preceded substance abuse in 92.5 percent of the cases where subjects developed both disorders.

Coccaro emphasized that early psychological intervention, medication and cognitive therapy are the most effective treatments to prevent, or at least delay, substance abuse problems in adolescents diagnosed with IED.

“What you’re really treating is the emotional dysregulation that leads to aggression,” Coccaro said. “The earlier you treat this dysregulation, the more likely you are to offset other disorders that come later down the road.”

The study, “Intermittent Explosive Disorder and Substance Use Disorder: Analysis of the National Comorbidity Survey Replication Sample,” was supported by the National Institute of Mental Health. Additional authors include Jennifer Fanning, PhD, and Royce Lee, MD, both from the University of Chicago.

Anxiety Is a Stronger Harbinger of Alcohol Problems Than Stress

Newswise, March 20, 2017 — Stress and anxiety are widely believed to contribute to drinking. Alcohol is thought to reduce tension caused by stress (the “flight or fight” response) as well as alleviate the unpleasant symptoms of anxiety (anticipation of the unpredictable, impending threats).

Prior research, however, has yielded inconsistent findings as to the unique relations between stress and anxiety, on the one hand, and alcohol consumption and alcohol use disorders, on the other hand.

This study was designed to examine how differences in self-reported levels of anxiety, anxiety sensitivity, and perceived stress impact the frequency and intensity of drinking, alcohol craving during early withdrawal, and alcohol craving and stress reactivity.

Recent drinking was assessed in 87 individuals (70 men, 17 women) with alcohol use disorders (AUDs). Three distinct measures were used to evaluate anxiety, anxiety sensitivity, and perceived stress.

A subset of 30 subjects was admitted to a medical center to ensure alcohol abstinence for one week: measures of alcohol craving were collected twice daily. On day 4, subjects participated in a public speaking/math challenge, before and after which measures of cortisol and alcohol craving were collected.

In these heavy drinkers, measures of anxiety as compared with perceived stress were more strongly associated with a variety of alcohol-related measures.

While alcohol studies often use the terms anxiety, anxiety sensitivity, and stress interchangeably, this study showed the importance of differentiating among the three terms given their unique relationships with drinking, craving, and stress reactivity among individuals with AUDs.

Gambling Addiction Triggers the Same Brain Areas as Drug and Alcohol Cravings

Newswise, February 13, 2017 — Gambling addiction activates the same brain pathways as drug and alcohol cravings, suggests new research.

The study, by international scientists including researchers from Imperial College London, suggests targeting these brain pathways may lead to future treatments for the condition.

The findings, published in the journal Translational Psychiatry, also suggest connections between the parts of the brain that control our impulses may be weakened in people with gambling addiction.

This work provides vital clues into the biology of gambling addiction, which is still largely unknown, explained Dr Henrietta Bowden-Jones, co-author from the Department of Medicine at Imperial, and director of the National Problem Gambling Clinic, at Central and North West London NHS Foundation Trust.

"Gambling addiction can have a devastating effect not just on patients, but also their families. It can result in people losing their job, and leave families and children homeless.

"We know the condition may have a genetic component - and that the children of gambling addicts are at higher risk of gambling addiction themselves - but we still don't know the exact parts of the brain involved. This research identifies key brain areas, and opens avenues for targeted treatments that prevent cravings and relapse."

The study, funded by the UK Medical Research Council, found that two brain areas, called the insula and nucleus accumbens, are highly active when people with gambling addiction experience cravings.

Activity in these areas, which are found deep in the centre of the brain and involved in decision-making, reward and impulse control, has been previously linked to drug and alcohol cravings.

Problem gambling may affect up to 593,000 people in the UK. The condition can be treated by talking therapies, such as cognitive behavioural therapy, or medications that combat cravings.

In the research, which was conducted between Imperial and the National Problem Gambling Clinic, scientists studied 19 patients with gambling addiction, and 19 healthy volunteers.

The most commonly reported problematic forms of gambling among the patients were electronic roulette and sports gambling.

Each volunteer went into a magnetic resonance imaging scanner - which uses a powerful electromagnet to monitor brain activity - and were shown various images. These included pictures of gambling scenes, such as a roulette wheel or a betting shop.

All participants were asked to rate their level of craving when they saw the images.

The team, which included scientists from the University of British Columbia and the University of Cambridge, then assessed which brain areas were activated when the volunteers experienced cravings.

They found that, in problem gamblers, the insula and nucleus accumbens were highly active when they were shown an image associated with gambling, and experienced a craving.

Interestingly, the team also found that weaker connections between the nucleus accumbens and an area called the frontal lobe in problem gamblers were associated with greater craving.

The frontal lobe, which is involved in decision-making, may help keep the insula in-check by controlling impulses, explained Professor Anne Lingford-Hughes, co-author from the Department of Medicine at Imperial.

"Weak connections between these regions have also been identified in drug addiction. The frontal lobe can help control impulsivity, therefore a weak link may contribute to people being unable to stop gambling, and ignoring the negative consequences of their actions. The connections may also be affected by mood - and be further weakened by stress, which may be why gambling addicts relapse during difficult periods in their life."

Professor Lingford-Hughes added that monitoring activity and connections in the insula and nucleus accumbens in gambling addicts may not only help medics assess effectiveness of a treatment, but may also help prevent relapse - a common problem in addiction.

The group are now investigating which treatments may reduce activity in these areas, in an attempt to reduce cravings.

They would also like to compare the brain activity of problem gamblers with people who gamble but do not have an addiction, to investigate why the addiction escalates in some but not others.