Varieties of impulsivity in males with alcohol dependence: the role of Cluster-B personality disorder.

BACKGROUND/RATIONALE: Impulsivity has been associated with alcohol dependence, but impulsivity in alcohol-dependent subjects with a Cluster-B personality disorder (PD) has not been well characterized. Using a variety of laboratory measures of impulsivity, we assessed whether alcohol-dependent patients (ADP) with borderline personality disorder (BPD) exhibited the same pattern of behavioral impulsivity than ADP with antisocial personality disorder (AntPD). Also, differences between ADP without PDs and healthy controls were assessed.

METHODS: A cross-sectional patient survey with a community comparison group. Diagnoses were made using the Structured Interview for DSM-IV. Sustained attention and rapid-response impulsivity were assessed using the continuous performance test. Inhibitory control was measured by the stop-signal task. Ability to delay reward task was assessed using differential reinforcement for low-rate responding (DRLR). A final sample of 247 males with alcohol-dependence recruited from 2 alcoholism treatment centers was compared with a matched nonsubstance-abusing comparison group (n = 96).

RESULTS: Alcohol-dependent patients with BPD made more omission errors than ADP with AntPD, but individuals with AntPD exhibited the poorest efficiency in DRLR. ADPs with a Cluster-B PD displayed more impairment across all behavioral measures than ADP without PD and than controls. In contrast, with respect to controls ADP without a Cluster-B PD showed more impairment only in DRLR.

CONCLUSIONS: Our findings support the suggestion of 2 paradigms in alcohol dependence. The first, based on inability to delay gratification, might be a vulnerability marker for alcohol dependence. The second was related to inhibitory control and might be specific for AntPD and BPDs.