Alcohol Stimulation and Sedation in Binge Drinkers

About This Grant

ABSTRACT Excessive alcohol use contributes to the deaths of over 100,000 Americans and costs the United States over $249 billion each year. Understanding factors that contribute to the development and persistence of excessive drinking is crucial for informing effective prevention, education, and intervention approaches. To date, the Chicago Social Drinking Project (CSDP) has contributed key insights into the role of subjective and physiologic responses to alcohol in the escalation and maintenance of excessive drinking and alcohol use disorder (AUD). Our unique integration of human laboratory alcohol challenge and longitudinal follow-up of drinking showed that young adult (ages 21-35 yrs) heavy social drinkers (HD) at risk for AUD show heightened sensitivity to alcohol stimulation and reward (liking, wanting) versus light drinkers (LD), and that these responses (versus low sensitivity to alcohol sedation) were more predictive of future drinking escalation and development of AUD in the transition to middle age and beyond. Importantly, this positive alcohol response phenotype was robust and reproducible in a second HD cohort. As a result, the CSDP has challenged conventional notions of vulnerability to AUD by showing that sustained and heightened sensitivity to alcohol stimulation and reward, rather than low level responses, are primary predictors of drinking escalations over time. Moreover, positive alcohol responses were maintained or magnified across a decade of re-examination testing in drinkers progressing on AUD symptom count over time. This proposed CSDP renewal award is timely, as we will expand our program of research across the lifespan and enroll very young adult drinkers (age 18-19), extend follow-up to middle-age in the second cohort, and conduct analyses examining alcohol responses in older chronic AUD and age-matched LD. In Aim 1, high-resolution ecological momentary assessment (HR-EMA) will be employed to provide the first real-time testing of alcohol sensitivity in 18-19-year-old high- and low-risk very young adult drinkers. This ambulatory assessment circumvents restrictions on providing alcohol to persons <21 yrs. We will also determine the prospective role of alcohol response phenotype (sensitivity vs. insensitivity) in predicting their future alcohol use and problems over two-year follow-up. In Aim 2, we will conduct a final 15- yr follow-up in our second cohort of HD (enrolled 2009-2011, now entering their 40s) to serve as a reproducibility sample and enhance robustness of our long-term predictive models of AUD risk. In Aim 3, we will conduct analyses of natural environment alcohol responses in our cohort of older adults with chronic AUD (ages 40-65 yrs, >20-year AUD duration) and age-matched LD to investigate if older AUD drinkers show sustained positive alcohol responses like young adult AUD drinkers, or the purported allostatic shift to reduced alcohol reward and drinking to relieve negative affect. The proposed work will further our understanding of subjective alcohol responses and drinking behaviors in individuals from late adolescence to older adulthood, enhancing our understanding of this critical factor in the vulnerability, severity, and maintenance of AUD.