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

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 (Nobservations = 3,444). 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.

Assessment of Alcohol Use in the Natural Environment

“…An early impediment to the adoption of EMA in alcohol research was concern that acute intoxication could interfere with drinkers’ ability to log user‐initiated assessments, respond to signaled prompts in a timely fashion, and provide reliable self‐report data (Collins et al., ; Tidey et al., ). Accumulating experience suggests drinkers can achieve good compliance with signaled prompts and log reports at high drink totals and eBACs (e.g., Carpenter et al., ; Trela et al., ). Nonetheless, this issue deserves systematic study.…”

“…Notably, these approaches generally incorporate assessments of ongoing alcohol consumption, permitting calculation of momentary eBACs (assuming availability of necessary supporting information about sex and body weight). Repeated measures of eBAC within an episode can be used to characterize drinking patterns (e.g., speed of consumption; Carpenter et al., ), to investigate dose‐dependent subjective responses to alcohol (e.g., Miranda et al., ; Ray et al., ; Trela et al., ), and to investigate potential limb‐specific effects (Piasecki et al., ).…”

“…These high‐resolution EMA designs have been used to study a variety of populations, including adolescents (e.g., Miranda et al., ,b), college students and young adults (e.g., Dvorak et al., ; Kashdan et al., ), psychiatric outpatients (e.g., Carpenter et al., ), and treatment‐seeking adult heavy drinkers (e.g., Collins et al., ; Tidey et al., ). The modal duration of EMA monitoring has been about 2 to 3 weeks, but this varies considerably across studies, ranging from just a few days (e.g., Mayhugh et al., ; Suffoletto et al., ) up to 8 weeks of daily recording (Collins et al., ).…”

“…The timed follow‐ups, drink bracketing, and episode bracketing approaches rely upon users to initiate an EMA assessment when drinking begins. Studies using timed follow‐ups have differed with respect to instructions, with some asking drinkers to initiate the timed follow‐up sequence either just before (e.g., Luczak et al., ; Swendsen et al., ) or just after the first drink (e.g., Carpenter et al., ; Piasecki et al., ). In the drink and episode bracketing designs, drinkers have generally been instructed to initiate a recording prior to the first drink.…”

“…As a potential fail‐safe, some studies have incorporated questions about recent alcohol use in other ongoing assessments, using affirmative responses to trigger the follow‐up sequence. This design feature may be a valuable way to increase coverage, as findings indicate that a substantial proportion (30 to 45%) of the drinking episodes captured in these studies were triggered by mechanisms other than user‐initiated first drink logs (Carpenter et al., ; Trela et al., ). The prevalence and interpretation of this phenomenon is likely to differ across studies owing to variation in the frequency and characteristics of other assessments and whether participants are tasked with logging the first drink before or after its completion.…”