Pathways to Alcohol Problems in Borderline PD via Acute Response to Alcohol

描述(由申请人提供)：边缘性人格障碍(BPD)对个人和更大的社区来说是极其虚弱和昂贵的。此外，BPD与酒精使用障碍高度共存，患病率估计约为50%，BPD患者经历酒精相关问题的比例甚至更高。这种共病显著恶化了治疗结果。到目前为止，很少有研究研究BPD和酒精相关问题的潜在机制。这项拟议的项目考察了BPD的两个标志性特征，情感不稳定和冲动/去抑制，这两个特征也被广泛研究与酒精问题有关，以测试BPD患者为什么会更多地饮酒和饮酒时遇到更多问题的两条途径。重要的是，在实验室中已经成功地模拟了酒精的去抑制和缓解焦虑/压力的效果，我们目前的建议利用尖端的研究方法来研究这一重要的主题。目的：目前的应用测试了关于酒精反应差异的假设，既有组之间的差异，也有有和没有BPD的个体之间的差异，以及个体内这些反应的差异，作为大量饮酒和酒精相关问题的预测因素。具体地说，我们假设患有BPD的人对酒精的焦虑缓解作用有更高的敏感度，这反过来又会增加他们对大量饮酒行为的参与，以此来调节他们的情感不稳定性。我们还假设，与没有bpd的人相比，患有bpd的人对酒精的抑制作用更敏感，这一点 急性反应将在一定程度上解释这一人群中与酒精相关的问题数量较多。此外，通过研究个体对酒精反应的差异，我们能够检验这些结构的连续体，其中考虑到患有和不患有BPD的个体的显著异质性。方法：我们将使用受试者内部严格控制的实验室酒精给药来模拟从清醒到醉酒的应激反应和解除抑制的变化。患有和没有BPD诊断的年轻成年饮酒者(21-30岁；50%女性)将从社区和治疗诊所招募参与(N=100；50 BPD和50非BPD)。所有参与者将完成Axis I和Axis II的半结构化访谈、对照和酒精实验室会议，以及为期三个月的时间线跟踪访谈，以使我们能够研究基于实验室的酒精反应与酗酒和酒精相关问题的前瞻性关联。根据NIAAA关于确定共病机制的战略重点，拟议的工作迈出了关键的一步，增加了我们对BPD和酒精相关问题高度关联的理解，并最终将为未来旨在减少这一人群问题饮酒行为的干预努力提供信息。

DESCRIPTION (provided by applicant): Borderline personality disorder (BPD) is extremely debilitating and costly to the individual and larger community. Additionally, BPD is highly comorbid with alcohol use disorder with prevalence estimates around 50% and an even higher percentage of individuals with BPD experiencing alcohol-related problems. This comorbidity significantly worsens treatment outcomes. To date very little research has examined mechanisms that may underlie both BPD and alcohol-related problems. The proposed project examines two hallmark features of BPD, affective instability and impulsivity/disinhibition, which have also been widely studied in relation to alcohol problems to test two pathways for why individuals with BPD engage in heavier alcohol use and experience more problems while drinking. Importantly, the disinhibition and anxiolytic/stress reducing effects of alcohol have been modeled successfully in the laboratory and our current proposal utilizes cutting edge research methodology to examine this important topic. Aims: The current application tests hypotheses about differences in response to alcohol both between groups comparing individuals with and without BPD and intra-individual differences in these responses as predictors of heavy alcohol use and alcohol-related problems. Specifically, we are hypothesizing that individuals with BPD will have heightened sensitivity to the anxiolytic effects of alcohol which in turn will increase their engagement in heavy drinking behaviors as a way to regulate their affective instability. We are also hypothesizing that individuals with BPD will be more sensitive to the disinhibiting effects of alcohol compared to individuals without BPD and that this acute response will partially account for the higher number of alcohol-related problems seen in this population. Further, by examining individual differences in response to alcohol we are able to examine a continuum of these constructs which takes into account the notable heterogeneity of individuals with and without BPD. Approach: We will use a tightly controlled within-subjects laboratory alcohol administration to model change in stress response and disinhibition from sober to intoxicated. Young adult drinkers (21-30 years of age; 50% female) with and without a diagnosis of BPD will be recruited to participate (N = 100; 50 BPD and 50 non-BPD) from both the community and treatment clinics. All participants will complete Axis I and Axis II semi-structured interviews, a control and alcohol lab session, and a three-month timeline followback interview to allow us to examine how lab-based response to alcohol relates prospectively to heavy alcohol use and alcohol-related problems. In accordance with NIAAA strategic priorities on identifying mechanisms of comorbidity the proposed work takes a critical step by increasing our understanding of why BPD and alcohol-related problems are highly linked and will ultimately inform future intervention efforts designed to decrease problematic drinking behaviors for this population.