What Happens When Alcohol Dependent Subjects
View Alcohol Associated Pictures
November 15, 2007
Several studies demonstrated that alcohol dependent patients show altered
responses to alcohol related cues. It is assumed that the regular association of
these cues with the ingestion of alcohol leads to conditioned reactions,
motivating reward or relief craving and instigating drug intake. A group of
German investigators has reported on this phenomenon in the current issue of
Psychotherapy and Psychosomatics. They used an innovative method for studying
this issue: the measurement of startle reflex, which is the eyeblink response to
a sudden loud noise, that is normally inhibited by a pleasant foreground and
potentiated when unpleasant stimuli are presented. Thus, it is a reliable method
to assess the affective valence of emotional stimuli without having to rely on
the self-report of patients. Previous investigations with alcohol dependent
patients have shown that an attenuation of the affect modulated startle reflex
was demonstrated when patients were viewing alcohol associated pictures
indicating an appetitive valence of the alcohol associated stimuli.
The hypothesis of the Authors is that startle reflex could help to understand
the association between conditioned appetitive characteristics of alcohol
associated cues and treatment outcome. They used the affect modulated startle
reflex to assess the effects of behavioral treatment on the emotional processing
of alcohol associated stimuli; and examined whether the affect modulated startle
reflex is a predictor of treatment success. Forty three alcohol dependent
patients (21 females, mean age 45.67 years, SD 9.45) were recruited
consecutively from an inpatient alcohol detoxification facility where patients
attended a 3 week detoxification program including cognitive behavioral
treatment to successfully handle high risk situations. The eye blink component
of the affect modulated startle response, self reported cue induced craving and
skin conductance responses to alcohol associated and control slides were
assessed before and after treatment. Changes were analyzed using repeated
measures analysis of variance. Drinking behavior was assessed in the 6 months
following treatment, and a regression analysis was performed to evaluate the
predictive validity of the affect modulated startle response for drinking
behavior. Drinking behavior as well as craving and skin conductance responses
decreased significantly over time.
The pattern of the affective modulation of the startle reflex was not altered
over time. However, startle modulation and relapse were related, and within the
group of relapsers, startle modulation was a significant predictor of drinking
behavior. The results suggest that the modulation of the startle reflex may
reflect more enduring and permanent processes of emotional responding to alcohol
related cues than autonomic arousal and self reported craving, and that startle
modulation by alcohol associated cues may be a better predictor of drinking
behavior for relapsers than other measures. Further studies including a control
condition are necessary to validate these findings.
PSYCHOTHERAPY AND PSYCHOSOMATICS
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