1. ISBRA World Congress on Alcohol Research Sidney 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. Bio-Psycho-Social approach Drugs Individual Environment ISBRA – Prof. I. Pelc, 2006

3. Introduction (1) Alcoholism, nicotine dependence = major public health concern Alcoholism, nicotine dependence = major public health concern Association ALCOHOLISM/NICOTINE SMOKING 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 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 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 Brugmann University Hospital : Clinic of Addiction/detoxification area, Brussels, Belgium 205 recently detoxified alcoholics (in treatment) : 146 males, 59 females 205 recently detoxified alcoholics (in treatment) : 146 males, 59 females In treatment on a voluntary basis In treatment on a voluntary basis Mean Age: 45 (20-80 of range) Mean Age: 45 (20-80 of range) 81.5 % with tobacco dependence (Fagerström score ≥5) 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 Antecedent other drugs 49.7 % Loss of Control Of Alcohol 27.1 Years NO antecedent other drugs 50.3 % Loss of Control Of Alcohol 30.5 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 P<.001 P<.05 ISBRA – Prof. I. Pelc, 2006

7. Cross-sectional study (3) Alcoholics/Smokers vs. Alcoholics/Non-smokers (SmALC)(NonSmALC) 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 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) 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 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 antecedent in term of age of loss alcohol control SmALC with antecedent of other drugs are distinct to NonSmALC and SmALC with no such antecedent in term of age of loss alcohol control  Maybe also in terms of psychological and biological functioning ? ISBRA – Prof. I. Pelc, 2006

10. It’s the antecedent of other drug use that makes the difference ! Loss of control – Age of onset 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) 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) 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 (Noël, Verbanck,Pelc 2002) Hayling ScoreAlpha Span Score C C R- R+ ISBRA – Prof. I. Pelc, 2006

13. Motivation to take drugs A psychobiological approach (1) (Robinson & Berridge, 1993) A motivation system linked to dopaminergic action in the ventral striatum and common to most of addictive drugs 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’ 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 drugs A 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 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 To investigate drug use antecedent in alcoholic smokers 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) 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) E.B.M. Data and Good Practice Implies : ISBRA – Prof. I. Pelc, 2006

16. Acknowledgments I. Vandenabeele, MD ; Psychiatrist, Assistant I. Vandenabeele, MD ; Psychiatrist, Assistant C. Hanak, MD ; Psychiatrist C. Hanak, MD ; Psychiatrist X. Noël, Psychologist, PhD in Neurosciences X. Noël, Psychologist, PhD in Neurosciences Prof. P. Verbanck, Psychiatrist, PhD, Head Dept Psychiatry Brugmann Hospital Prof. P. Verbanck, Psychiatrist, PhD, Head Dept Psychiatry Brugmann Hospital Prof. I. Pelc, Psychiatrist, PhD, Head Lab. Med. Psych. Alcohol & Drugs University of Brussels Prof. I. Pelc, Psychiatrist, PhD, Head Lab. Med. Psych. Alcohol & Drugs University of Brussels