How Low Emotional Response Can Signal Later Alcohol Problems

How alcoholics respond emotionally to both unpleasant and pleasant events may explain how some of them became alcoholics in the first place. Research has revealed that if someone with a severe alcohol use disorder displays low emotional responsiveness to even events that cause physical and mental stress it may reflect a dysfunction in regions of the brain that govern how they related to their environment and make adaptive decisions.

If those brain regions are not functioning properly in childhood, children will be at high risk for developing conduct disorder, and later developing antisocial personality disorder, and eventually substance abuse disorders including alcoholism. The same brain dysfunction that causes low emotional responsiveness also leads to maladaptive, disinhibited behavior which can facilitate the development of alcoholism and other problems.

Symptoms of Antisocial Personality Disorder

People with antisocial personality disorder may:

  • Be able to act witty and charming
  • Be good at flattery and manipulating other people's emotions
  • Break the law repeatedly
  • Disregard the safety of self and others
  • Have problems with substance abuse
  • Lie, steal and fight often
  • Not show guilt or remorse
  • Often be angry or arrogant

Diminished Reactions to Life's Signals

"Despite their often subtle nature, emotional reactions hold a central position in determining how the brain regulates behavior," said Robert Miranda, Jr., a National Institute on Alcohol Abuse and Alcoholism postdoctoral fellow at Brown University and first author of the study.

"Through integration with cognitive processes, emotional reactions play an important role in learning and memory, evaluating variable environmental contingencies, and motivating adaptive behavior. There is considerable variability among individuals in terms of how emotionally reactive we are to different types of situations and events."

"These differences may indicate vulnerability to certain psychiatric conditions, such as mood and anxiety disorders and addictions," he said. "In the case of antisocial behavior and addictions, there may be diminished reactions to cues that signal aversive events, including punishment."

Vulnerable to Criminal, Drug Problems

Individuals who do not experience the appropriate amount of anxiety or negative emotion when threatened are unlikely to alter their behavior in response to the threat, said Peter R. Finn, professor of psychology at Indiana University, Bloomington.

"Psychopaths, for example, are a subset of people with antisocial personality disorder who show hyporesponsiveness to aversive stimuli. This study looks at reduced or 'hypo' reactivity to aversive stimuli as evidence for poor inhibition, which may result in increased vulnerability to a wide range of problems, including criminal, alcohol and/or drug problems. In other words, this hyporesponsivity may be manifesting itself in the antisocial behavior as well as the excessive use of alcohol."

Eye-Blink Startle Response Measured

The NIAAA researchers compared three groups: 24 were alcohol dependent; 17 were alcohol dependent and had an antisocial personality disorder, and 21 "controls" were neither alcohol dependent nor had antisocial personality disorder. All 62 participants completed self-report questionnaires, clinical interviews, and had their eye-blink startle response measured while viewing photographs rated as pleasant, neutral and unpleasant.

Blunted Emotional Responses

"We found that persons with co-existing alcoholism and antisocial personality disorder are different from alcoholics without antisocial personality disorder and non-antisocial personality disorder, non-alcoholic controls in their responsiveness to emotional cues," said Miranda. "The control and non-antisocial personality disorder alcohol-dependent groups showed the normal linear increase in the eyeblink component of the startle reflex from pleasant to neutral to unpleasant stimuli."

"In contrast, alcoholics with antisocial personality disorder did not show the typical increase of startle in response to the unpleasant stimuli or the decrease in response to pleasant stimuli," he said. "In short, their emotional responses appeared to be blunted. Importantly, all three groups rated the photographs similarly, ruling out the likelihood that response differences were due to altered subjective experiences of the photographs."

Alcoholics Tend to Get Into Trouble

Finn said these findings have both immediate and future applications. "Alcoholics tend to get into trouble a lot," he said. "Yet these individuals simply may not be as affected by the prospects of negative outcomes, and may, in fact, have problems inhibiting their behavior to avoid such outcomes."

"So, how are you going to provide treatment to antisocial alcoholics?" Future studies, he added, need to focus on "children who show evidence of behavioral problems but have yet to develop alcohol problems. We also need to understand what impact their environments may have on their emotional responsiveness," he said.

Miranda agrees. "Conduct disorder (CD), the childhood predecessor to antisocial personality disorder, is the most robust psychiatric risk factor for adolescent alcohol and drug use," he said. "Numerous studies point to a consistent relationship between conduct problems in early and middle childhood and later drug use; those who show more conduct problems have higher levels of drug use and higher rates of drug-related problems."

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  • Miranda, R et al. "Altered Affective Modulation of the Startle Reflex in Alcoholics With Antisocial Personality Disorder." Alcoholism: Clinical & Experimental Research December 2003.

  • U.S. National Library of Medicine. "Antisocial personality disorder." Medical Encyclopedia October 2014.