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

描述（由申请人提供）：边缘型人格障碍（BPD）是非常衰弱和昂贵的个人和更大的社区。此外，BPD与酒精使用障碍高度共病，患病率估计约为50%，BPD患者出现酒精相关问题的比例甚至更高。这种合并症显著影响治疗结果。到目前为止，很少有研究探讨可能导致BPD和酒精相关问题的机制。拟议的项目研究了BPD的两个标志性特征，情感不稳定性和冲动性/去抑制性，这两个特征也被广泛研究与酒精问题有关，以测试两种途径，为什么BPD患者在饮酒时会大量饮酒并遇到更多问题。重要的是，酒精的去抑制和抗焦虑/减压作用已经在实验室中成功建模，我们目前的建议利用尖端的研究方法来研究这一重要课题。目的：目前的应用程序测试的假设之间的差异，酒精的反应，比较个人和没有BPD和个体内的差异，这些反应作为预测的重型酒精使用和酒精相关的问题。具体来说，我们假设BPD患者对酒精的抗焦虑作用的敏感性会提高，这反过来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，BPD的人对酒精的抑制作用更敏感， 急性反应将部分解释在这一人群中观察到的与酒精有关的问题的较高数量。此外，通过研究个体差异，在酒精的反应，我们能够检查这些结构的连续性，考虑到显着的异质性的个人和没有BPD。方法：我们将使用严格控制的受试者内实验室酒精给药来模拟从清醒到醉酒的应激反应和去抑制的变化。将从社区和治疗诊所招募有和无BPD诊断的年轻成年饮酒者（21-30岁; 50%女性）参加（N = 100; 50名BPD和50名非BPD）。所有参与者将完成轴I和轴II半结构化访谈，控制和酒精实验室会议，以及为期三个月的时间轴随访访谈，以使我们能够研究基于实验室的酒精反应如何与重度饮酒和酒精相关问题相关。根据NIAAA关于确定并发症机制的战略重点，拟议的工作通过增加我们对BPD和酒精相关问题高度相关的原因的理解迈出了关键的一步，并最终为未来旨在减少该人群问题饮酒行为的干预工作提供信息。

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.