Skip to main content

Advertisement

SpringerLink
Log in

Elevated rate of alcohol consumption in borderline personality disorder patients in daily life

  • Original Investigation
  • Published:
Psychopharmacology Aims and scope Submit manuscript

Abstract

Rationale

Borderline personality disorder (BPD) is highly associated with alcohol use disorder, but little is known about how BPD individuals consume alcohol or the immediate effects of their consumption. There is therefore a need for research investigating drinking behavior in BPD.

Objectives

The current study examined rate of alcohol consumption in BPD (N = 54) and community individuals (COM; N = 59) within ecologically valid drinking episodes. We hypothesized that rate of consumption would be elevated in BPD individuals. We further hypothesized that rate of consumption would be positively associated with subjective stimulation, but not sedation, and that stimulation would be associated with increased positive affect (PA) and reduced negative affect (NA).

Methods

Ambulatory assessment was used to assess rate of consumption, subjective alcohol response, and affect in the moment (N observations = 3444). Rate of consumption was defined as change in estimated blood alcohol concentration (eBAC) relative to drinking episode start. Multilevel modeling was used to test hypotheses.

Results

As hypothesized, BPD individuals demonstrated a faster increase in eBAC than COM individuals. Rate of consumption was associated with subjective stimulation, but not sedation, in both groups. Stimulation was associated with increased PA in both groups and reduced NA in the BPD group.

Conclusions

BPD individuals consumed alcohol more rapidly than COM individuals. Faster consumption may serve as a means for BPD individuals to maximize the rewarding pharmacological effects of alcohol and to increase positive and reduce negative affect.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. Including this participant in the analyses did not significantly alter the results.

  2. Possible reasons for a discontinuity between extreme eBAC values and the actual BAC achieved include participant error and emesis.

  3. Results did not significantly differ depending on whether observations were binned by time point or not, but results from the binned model are substantially easier to interpret.

  4. Our approach, consisting of binning assessments and then fitting a model beginning with a free-curve, follows recent methodological recommendations for characterizing longitudinal trajectories (Grimm et al. 2016; Wang et al. 2015; Wood et al. 2015). We considered whether a simpler model might be preferred to the free-curve model in terms of parsimony. However, simpler models did not fit the data well (See Supplementary material and Table S1).

  5. The proportion of initial drink reports relative to other initial reports did not differ across groups (χ 2(1) = 0.01, p = .914).

  6. Mirroring effects reported in Lane et al. (2016), COM participants reported significantly more drinking episodes than BPD participants (M BPD = 6.80, SDBPD = 4.44; M COM = 9.08, SDCOM = 4.31, t(111) = 2.78, p = .007), but not more overall drinks (M BPD = 21.72, SDBPD = 15.99; M COM = 28.56, SDCOM = 22.62, t(111) = 1.65, p = .101).

  7. This was a result of the fact that loess regression considers local observations within a moving window, while linear regression takes every observation into account. Given the relatively fewer observations at times 5 and 6, linear regression produces lower estimates of eBAC at these time points than loess regression.

  8. To increase interpretability, effects for eBAC level and change were scaled to represent the amount of change in the dependent variable for an increase in eBAC of .010%.

  9. Note that we had no a priori hypotheses regarding rate and affect and that these analyses were post hoc. Additionally, the mediation models we tested are only two of many possible models through which effects may operate and should be interpreted with caution.

References

  • American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-5®): Am Psychiatr Publ

  • Baker TB, Piper ME, McCarthy DE, Majeskie MR, Fiore MC (2004) Addiction motivation reformulated: an affective processing model of negative reinforcement. Psychol Rev 111:33–51

    Article  PubMed  Google Scholar 

  • Carpenter RW, Trull TJ (2013) Components of emotion dysregulation in borderline personality disorder: a review. Curr Psychiatry Rep 15:335–342

    Article  PubMed  PubMed Central  Google Scholar 

  • Cleveland WS, Devlin SJ, Grosse E (1988) Regression by local fitting. J Econom 37:87–114

    Article  Google Scholar 

  • Connors GJ, Maisto SA (1979) Effects of alcohol, instructions, and consumption rate on affect and physiological sensations. Psychopharmacology 62:261–266

    Article  CAS  PubMed  Google Scholar 

  • Conrod PJ, Peterson JB, Pihl RO, Mankowski S (1997) Biphasic effects of alcohol on heart rate are influenced by alcoholic family history and rate of alcohol ingestion. Alcohol Clin Exp Res 21:140–149

    Article  CAS  PubMed  Google Scholar 

  • Conrod PJ, Peterson JB, Pihl RO (2001) Reliability and validity of alcohol-induced heart rate increase as a measure of sensitivity to the stimulant properties of alcohol. Psychopharmacol 157:20–30

    Article  CAS  Google Scholar 

  • Cooper ML, Frone MR, Russell M, Mudar P (1995) Drinking to regulate positive and negative emotions: a motivational model of alcohol use. J Pers Soc Psychol 69:990–1005

    Article  CAS  PubMed  Google Scholar 

  • Crowell SE, Beauchaine TP, Linehan MM (2009) A biosocial developmental model of borderline personality: elaborating and extending Linehan’s theory. Psychol Bull 135:495–510

    Article  PubMed  PubMed Central  Google Scholar 

  • Curran PJ, Bauer DJ (2011) The disaggregation of within-person and between-person effects in longitudinal models of change. Annu Rev Psychol 62:583–619

    Article  PubMed  PubMed Central  Google Scholar 

  • Dietary Guidelines Advisory Committee. U.S. Department of Agriculture, U.S. Department of Health and Human Services (2010) Dietary guidelines for Americans. U.S. Government Printing Office

  • First MB, Spitzer RL, Gibbon M, Williams JB (1995) Structured clinical interview for DSM-IV axis I disorders—patient ed. (SCID-I/P, version 2). New York: Biometrics Research Department, New York State Psychiatric Institute

  • Goodwin DW, Crane JB, Guze SB (1969) Alcoholic “blackouts”: a review and clinical study of 100 alcoholics. Am J Psychiatry 126:191–198

    Article  CAS  PubMed  Google Scholar 

  • Greenfield TK, Kerr WC (2008) Alcohol measurement methodology in epidemiology: recent advances and opportunities. Addiction 103:1082–1099

    Article  PubMed  PubMed Central  Google Scholar 

  • Grimm KJ, Ram N, Estabrook R (2016) Growth modeling: structural equation and multilevel modeling approaches. Guilford, New York

    Google Scholar 

  • Hendler RA, Ramchandani VA, Gilman J, Dommer DW (2013) Stimulant and sedative effects of alcohol. Curr Top Behav Neurosci 13:489–509

    Article  CAS  PubMed  Google Scholar 

  • Hustad JT, Carey KB (2005) Using calculations to estimate blood alcohol concentrations for naturally occurring drinking episodes: a validity study. J Stud Alcohol 66:130–138

    Article  PubMed  Google Scholar 

  • Jones BM, Vega A (1972) Cognitive performance measured on the ascending and descending limb of the blood alcohol curve. Psychopharmacologia 23:99–114

    Article  CAS  PubMed  Google Scholar 

  • Jones AW, Wigmore JG, House CJ (2006) The course of the blood-alcohol curve after consumption of large amounts of alcohol under realistic conditions. Can Soc Forensic Sci J 39(3):125–140

    Article  CAS  Google Scholar 

  • Laird RD, Weems CF (2011) The equivalence of regression models using difference scores and models using separate scores for each informant: implications for the study of informant discrepancies. Psychol Assess 23:388–397

    Article  PubMed  Google Scholar 

  • Lane SP, Carpenter RW, Sher KJ, Trull TJ (2016) Alcohol craving and consumption in borderline personality disorder: when, where, and with whom. Clin Psychol Sci 4:775–792. https://doi.org/10.1177/2167702615616132

    Article  PubMed  PubMed Central  Google Scholar 

  • Leeman RF, Heilig M, Cunningham CL, Stephens DN, Duka T, O'Malley SS (2010) Ethanol consumption: how should we measure it? Achieving consilience between human and animal phenotypes. Addict Biol 15:109–124

    Article  PubMed  PubMed Central  Google Scholar 

  • Lenzenweger MF, Lane MC, Loranger AW, Kessler RC (2007) DSM-IV personality disorders in the National Comorbidity Survey replication. Biol Psychiatry 62:553–564. https://doi.org/10.1016/j.biopsych.2006.09.019

    Article  PubMed  PubMed Central  Google Scholar 

  • Li TK, Hewitt BG, Grant BF (2007) The alcohol dependence syndrome, 30 years later: a commentary. Addiction 102:1522–1530

    Article  PubMed  Google Scholar 

  • Maclean JC, French MT (2014) Personality disorders, alcohol use, and alcohol misuse. Soc Sci Med 120:286–300

    Article  PubMed  Google Scholar 

  • Martin CS, Earleywine M (1990) Ascending and descending rates of change in blood alcohol concentrations and subjective intoxication ratings. J Subst Abus 2:345–352

    Article  CAS  Google Scholar 

  • Martin CS, Earleywine M, Musty RE, Perrine MW, Swift RM (1993) Development and validation of the biphasic alcohol effects scale. Alcohol Clin Exp Res 17:140–146

    Article  CAS  PubMed  Google Scholar 

  • Martin CS, Balaban CD, McBurney DH (2006) Tonic and phasic processes in the acute effects of alcohol. Exp Clin Psychopharmacol 14:209–218

    Article  CAS  PubMed  Google Scholar 

  • Matthews DB, Miller WR (1979) Estimating blood alcohol concentration: two computer programs and their applications in therapy and research. Addict Behav 4:55–60

    Article  CAS  PubMed  Google Scholar 

  • Moskowitz H, Burns M (1976) Effects of rate of drinking on human performance. J Stud Alcohol 37:598–605

    Article  CAS  PubMed  Google Scholar 

  • Perry PJ, Argo TR, Barnett MJ, Liesveld JL, Liskow B, Hernan JM, Brabson MA (2006) The association of alcohol-induced blackouts and grayouts to blood alcohol concentrations. J Forensic Sci 51:896–899

    Article  PubMed  Google Scholar 

  • Pfohl B, Blum N, Zimmerman M (1994) Structured interview for DSM-IV personality disorders. University of Iowa Hospitals and Clinics, Iowa City

    Google Scholar 

  • Piasecki TM, Jahng S, Wood PK, Robertson BM, Epler AJ, Cronk NJ, Sher KJ (2011) The subjective effects of alcohol–tobacco co-use: an ecological momentary assessment investigation. J Abnormal Psychol 120:557–571

    Article  Google Scholar 

  • Rolland B, Valin T, Langlois C, Auffret M, Gautier S, Deheul S, Cottencin O (2015) Safety and drinking outcomes among patients with comorbid alcohol dependence and borderline personality disorder treated with high-dose baclofen: a comparative cohort study. Int Clin Psychopharmacol 30:49–53

    Article  PubMed  Google Scholar 

  • Ryback RS (1970) Alcohol amnesia: observations in seven drinking inpatient alcoholics. Q J Stud Alcohol 31:616–632

    CAS  PubMed  Google Scholar 

  • Saha TD, Stinson FS, Grant BF (2007) The role of alcohol consumption in future classifications of alcohol use disorders. Drug Alcohol Depend 89:82–92

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • SAS Institute (2014) SAS/STAT 9.4 user’s guide. Cary:Author

  • Shiffman S, Stone AA, Hufford MR (2008) Ecological momentary assessment. Ann Rev Clin Psychol 4:1–32

    Article  Google Scholar 

  • Tomko RL, Trull TJ, Wood PK, Sher KJ (2014) Characteristics of borderline personality disorder in a community sample: comorbidity, treatment utilization, and general functioning. J Personal Disord 28:734–750. https://doi.org/10.1521/pedi_2012_26_093

    Article  Google Scholar 

  • Trela CJ, Piasecki TM, Bartholow BD, Heath AC, Sher KJ (2016) The natural expression of individual differences in self-reported level of response to alcohol during ecologically assessed drinking episodes. Psychopharmacology 233:2185–2195

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Trull TJ, Ebner-Priemer U (2013) Ambulatory assessment. Annu Rev Clin Psychol 9:151–176

    Article  PubMed  Google Scholar 

  • Trull TJ, Sher KJ, Minks-Brown C, Durbin J, Burr R (2000) Borderline personality disorder and substance use disorders: a review and integration. Clin Psychol Rev 20:235–253. https://doi.org/10.1016/S0272-7358(99)00028-8

    Article  CAS  PubMed  Google Scholar 

  • Trull TJ, Jahng S, Tomko RL, Wood PK, Sher KJ (2010) Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. J Personal Disord 24:412–426

    Article  Google Scholar 

  • Trull TJ, Solhan MB, Brown WC, Tomko RL, Schaefer L, Mclaughlin KD, Jahng S (2016) Substance use disorders and personality disorders. In: Sher K (ed) Oxford handbook of substance use disorders: volume 2. Oxford University Press, New York, pp 116–148

    Google Scholar 

  • Wang T, Wood PK, Heath AC (2015) Can psychometric measurement models inform behavior genetic models? A Bayesian model comparison approach. In Dependent Data in Social Sciences Research (pp. 231–259). Springer, Cham

  • Watson D, Clark LA (1999) The PANAS-X: manual for the positive and negative affect schedule-expanded form. Unpublished manuscript, University of Iowa, Iowa City, IA

  • Weathermon R, Crabb DW (1999) Alcohol and medication interactions. Alcohol Res Health 23:40–54

    CAS  PubMed  Google Scholar 

  • Wechsler H, Davenport A, Dowdall G, Moeykens B, Castillo S (1994) Health and behavioral consequences of binge drinking in college: a national survey of students at 140 campuses. J Am Med Assoc 272:1672–1677

    Article  CAS  Google Scholar 

  • Wood PK, Steinley D, Jackson KM (2015) Right-sizing statistical models for longitudinal data. Psychol Methods 20(4):470–488

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO, 65211, USA

    Ryan W. Carpenter, Constantine J. Trela, Phillip K. Wood, Thomas M. Piasecki & Timothy J. Trull

  2. Department of Psychological Sciences, Purdue University, 703 Third Street, West Lafayette, IN, 47907-2081, USA

    Sean P. Lane

Authors
  1. Ryan W. Carpenter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Constantine J. Trela
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sean P. Lane
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Phillip K. Wood
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas M. Piasecki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Timothy J. Trull
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryan W. Carpenter.

Additional information

This research was supported by National Institute on Alcohol Abuse and Alcoholism Grants P60 AA11998 (Trull/Andrew C. Heath), F31 AA023447 (Carpenter), and T32 AA013526 (Kenneth J. Sher).

Electronic supplementary material

ESM 1

(DOCX 125 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Carpenter, R.W., Trela, C.J., Lane, S.P. et al. Elevated rate of alcohol consumption in borderline personality disorder patients in daily life. Psychopharmacology 234, 3395–3406 (2017). https://doi.org/10.1007/s00213-017-4727-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00213-017-4727-1

Keywords

Search

Navigation