ISBRA World Congress on Alcohol Research Sidney 2006

1. ISBRA World Congress on Alcohol ResearchSidney 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

2. Individual Bio-Psycho-Social approach Drugs Environment ISBRA – Prof. I. Pelc, 2006

3. Introduction (1) • Alcoholism, nicotine dependence = major public health concern • Association ALCOHOLISM/NICOTINE SMOKING • 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

4. Introduction (2) • Double detox • Pro : tobacco cues increase alcohol relapse • Cons : tobacco cessation increases stress causing alcohol relapse • Still a debated and controversial issue • Need for a better characterization of smoking vs. non-smoking alcoholics in detox ISBRA – Prof. I. Pelc, 2006

5. Cross-sectional study (1) • 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

6. Cross-sectional study (2) Alcoholics in detox (n=205) Smokers : 81.5 % 67.9 % with Axis I Loss of Control of Alcohol 29.2 Years Non-smokers : 18.5 % 51.4 % with Axis I Loss of Control of Alcohol 32.4 Years P<.05 Antecedent other drugs 49.7 % Loss of Control Of Alcohol 27.1 Years Antecedent other drugs 13 % Loss of Control Of Alcohol 28.5 Years NO antecedent other drugs 87 % Loss of Control Of Alcohol 33.5 Years NO antecedent other drugs 50.3 % Loss of Control Of Alcohol 30.5 Years P<.001 ISBRA – Prof. I. Pelc, 2006

7. Cross-sectional study (3) • 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 • 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

8. Cross-sectional study (3) • 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

9. Cross-sectional study (4) • SmALC with antecedent of other drugs are distinct to NonSmALC and SmALC with no such antecedentin term of age of loss alcohol control  Maybe also in terms of psychological and biological functioning ? ISBRA – Prof. I. Pelc, 2006

10. Loss of control – Age of onset It’s the antecedent of other drug use that makes the difference ! ISBRA – Prof. I. Pelc, 2006

11. Personality traits and the development of alcohol, nicotine and illicit drug disorders • 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

12. Executive Functions and Relapse Prediction R+ R+ R- R- C C Alpha Span Score Hayling Score (Noël, Verbanck,Pelc 2002) ISBRA – Prof. I. Pelc, 2006

13. Motivation to take drugsA psychobiological approach (1) (Robinson & Berridge, 1993) • 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

14. Motivation to take drugsA psychobiological approach (2) • 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

15. Clinical implications E.B.M. Data and Good Practice Implies : • To investigate drug use antecedent in alcoholic smokers • More drug use antecedents • Earlier loss of control of alcohol • More psychiatric disorders • 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

16. Acknowledgments • 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