Madelon E. van Hemel-Ruiter

Appetitive and regulatory processes in young adolescent drinkers

Dual-process models of addiction propose that alcohol (mis)use develops because of an imbalance between a fast automatic appetitive system, in which stimuli are valued in terms of their emotional and motivational significance and a slower controlled regulatory system, which acts on deliberate considerations. This study focused on the automatic and regulatory processes that are involved in the early stages of young adolescent alcohol use. Participants were 43 young adolescent drinkers, who completed an explicit alcohol valence measure, two versions of an Affective Simon Task (AST), a working memory task and an alcohol use questionnaire. Alcohol use was associated with relatively positive self-reported valence of alcohol pictures, especially for adolescents with lower inhibition capacity. The Affective Simon Tasks did not show stronger automatic approach tendencies in heavier drinkers. This study suggests that in early stages of alcohol use appetitive valence is a more important stimulator for the initiation of alcohol use than automatic approach tendencies, and supports the view that young adolescents with low inhibition capacity are especially at risk for developing alcohol misuse. Prevention therefore should be focused on reducing the attractive valence of alcoholic drinks and strengthening the cognitive control of at-risk children.

Reward sensitivity, attentional bias, and executive control in early adolescent alcohol use

This study examined whether attentional bias for alcohol stimuli was associated with alcohol use in young adolescents, and whether the frequently demonstrated relationship between reward sensitivity and adolescent alcohol use would be partly mediated by attentional bias for alcohol cues. In addition, this study investigated the potential moderating role of executive control (EC), and tested whether the relationship between alcohol-related attentional bias and alcohol use was especially present in young adolescents with weak EC. Participants were 86 adolescents (mean age=14.86), who completed a Visual Probe Task (VPT) as an index of attentional bias, a flanker-task based Attention Network Task (ANT) as an index of EC, the sensitivity of punishment and sensitivity of reward questionnaire (SPSRQ) as an index of reward sensitivity, and an alcohol use questionnaire. High reward sensitivity, high alcohol-related attentional bias, and weak EC were all related to alcohol use. The relationship between reward sensitivity and alcohol use was not mediated by alcohol-related attentional bias. As hypothesized, attentional bias was only associated with alcohol use in participants with weak EC. Together, the present findings are consistent with the view that high reward sensitivity and low EC may be considered as risk factors for adolescent alcohol use. The independent contribution of reward sensitivity and attentional bias might suggest that adolescents who are highly reward sensitive and display an attentional bias for alcohol cues are at even higher risk for excessive alcohol use and developing alcohol abuse problems. Future research using a longitudinal approach would allow an examination of these risk factors on subsequent alcohol use. Treatment implications are discussed, including the importance of strengthening EC and reducing the rewarding value of alcohol use.

Reward and punishment sensitivity and alcohol use: The moderating role of executive control

Reward sensitivity and to a lesser extent punishment sensitivity have been found to explain individual differences in alcohol use. Furthermore, many studies showed that addictive behaviors are characterized by impaired self-regulatory processes, and that individual differences related to alcohol use are moderated by executive control. This is the first study that explores the potential moderating role of executive control in the relation between reward and punishment sensitivity and alcohol use. Participants were 76 university students, selected on earlier given information about their alcohol use. Half of the participants indicated to drink little alcohol and half indicated to drink substantial amounts of alcohol. As expected, correlational analyses showed a positive relationship between reward sensitivity and alcohol use and a negative relation between punishment sensitivity and alcohol use. Regression analysis confirmed that reward sensitivity was a significant independent predictor of alcohol use. Executive control moderated the relation between punishment sensitivity and alcohol use, but not the relation between reward sensitivity and alcohol use. Only in individuals with weak executive control punishment sensitivity and alcohol use were negatively related. The results suggest that for individuals with weak executive control, punishment sensitivity might be a protective factor working against substantial alcohol use.

Attentional bias and executive control in treatment-seeking substance-dependent adolescents: A cross-sectional and follow-up study

BACKGROUND Research in adults shows that substance dependent individuals demonstrate attentional bias (AB) for substance-related stimuli. This study investigated the role of AB in adolescents diagnosed with alcohol, cannabis, amphetamine or GHB dependency on entering therapy and six months later, and the role of executive control (EC) as a moderator of the relationship between problem severity and AB. METHODS Seventy-eight young substance-dependent (SD) patients (mean age=19.5), and 64 healthy controls (HC; mean age=19.0) were tested. Thirty-eight SD patients took part at 6-month follow-up (FU). AB was indexed by a visual probe task, EC by the attention network task, problem severity by the short alcohol (or drug) use disorder identification test and the severity of dependence questionnaire. RESULTS SD patients demonstrated an AB for substance stimuli presented for 500 ms and 1250 ms, with the latter related to severity of dependence. There was a nonsignificant tendency indicating that EC was higher in HC than SD participants, but EC did not moderate the relationship between AB and dependency. Substance use, dependency, EC and AB remained unchanged in the 6 month FU period. CONCLUSIONS Young SD patients showed a stronger relatively early as well as maintained AB toward substance cues. A stronger maintained attention was related to higher severity of dependence. Further, there were some indications that EC might play a role in adolescent substance use. The finding that at FU AB and problem severity were not decreased, and EC was not increased underlines the persistent character of addiction.

Predicting dyscontrolled drinking with implicit and explicit measures of alcohol attitude

BACKGROUND A defining feature of alcohol addiction is dyscontrol - drinking despite intentions to restrain use. Given that dyscontrolled drinking involves an automatic (nonvolitional) element and that implicit measures are designed to assess automatic processes, it follows that implicit measures may be particularly useful for predicting dyscontrolled alcohol use. Although there is accumulating evidence for the benefit of using implicit measures to predict nonvolitional behaviors, relatively little research has examined such predictive validity for alcohol dyscontrol. The current study was designed to examine whether an implicit measure of alcohol attitude would predict variance of dyscontrol above that explained by typical drinking behavior and an explicit measure of alcohol attitude. METHODS A sample of 62 undergraduate students completed implicit and explicit measures of alcohol-positive (relative to alcohol-negative) valence associations and retrospective self-report measures of typical drinking behavior and difficulty in controlling alcohol consumption. RESULTS Both the implicit and explicit measures predicted alcohol dyscontrol. The implicit measure continued to predict dyscontrol when controlling for the explicit measure and typical drinking behavior. CONCLUSIONS These findings indicate that assessing the automaticity of alcohol-positive associations may be beneficial for predicting clinically relevant behaviors such as post-treatment outcome.

Attentional Bias for Reward and Punishment in Overweight and Obesity: The TRAILS Study

More than 80% of obese adolescents will become obese adults, and it is therefore important to enhance insight into characteristics that underlie the development and maintenance of overweight and obesity at a young age. The current study is the first to focus on attentional biases towards rewarding and punishing cues as potentially important factors. Participants were young adolescents (N = 607) who were followed from the age of 13 until the age of 19, and completed a motivational game indexing the attentional bias to general cues of reward and punishment. Additionally, self-reported reward and punishment sensitivity was measured. This study showed that attentional biases to cues that signal reward or punishment and self-reported reward and punishment sensitivity were not related to body mass index or the change in body mass index over six years in adolescents. Thus, attentional bias to cues of reward and cues of punishment, and self-reported reward and punishment sensitivity, do not seem to be crucial factors in the development and maintenance of overweight and obesity in adolescents. Exploratory analyses of the current study suggest that the amount of effort to gain reward and to avoid punishment may play a role in the development and maintenance of overweight and obesity. However, since the effort measure was a construct based on face validity and has not been properly validated, more studies are necessary before firm conclusions can be drawn.

Reward-Related Attentional Bias and Adolescent Substance Use: A Prognostic Relationship?

Current cognitive-motivational addiction theories propose that prioritizing appetitive, reward-related information (attentional bias) plays a vital role in substance abuse behavior. Previous cross-sectional research has shown that adolescent substance use is related to reward-related attentional biases. The present study was designed to extend these findings by testing whether these reward biases have predictive value for adolescent substance use at three-year follow-up. Participants (N = 657, mean age = 16.2 yrs at baseline) were a sub-sample of Tracking Adolescents’ Individual Lives Survey (TRAILS), a large longitudinal community cohort study. We used a spatial orienting task as a behavioral index of appetitive-related attentional processes at baseline and a substance use questionnaire at both baseline and three years follow-up. Bivariate correlational analyses showed that enhanced attentional engagement with cues that predicted potential reward and nonpunishment was positively associated with substance use (alcohol, tobacco, and cannabis) three years later. However, reward bias was not predictive of changes in substance use. A post-hoc analysis in a selection of adolescents who started using illicit drugs (other than cannabis) in the follow-up period demonstrated that stronger baseline attentional engagement toward cues of nonpunishment was related to a higher level of illicit drug use three years later. The finding that reward bias was not predictive for the increase in substance use in adolescents who already started using substances at baseline, but did show prognostic value in adolescents who initiated drug use in between baseline and follow-up suggests that appetitive bias might be especially important in the initiation stages of adolescent substance use.

The effectiveness of attentional bias modification for substance use disorder symptoms in adults: a systematic review

BackgroundAttentional bias modification (ABM) interventions have been developed to address addiction by reducing attentional bias for substance-related cues. This study provides a systematic review of the effectiveness of ABM interventions in decreasing symptoms of addictive behaviour, taking baseline levels of attentional bias and changes in attentional bias into account.MethodsWe included randomised and non-randomised studies that investigated the effectiveness of ABM interventions in heavy-using adults and treatment-seeking individuals with symptoms of substance use disorder to manipulate attentional bias and to reduce substance use-related symptoms. We searched for relevant English peer-reviewed articles without any restriction for the year of publication using PsycINFO, PubMed, and ISI Web in August 2016. Study quality was assessed regarding reporting, external validity, internal validity, and power of the study.ResultsEighteen studies were included: nine studies reported on ABM intervention effects in alcohol use, six studies on nicotine use, and three studies on opiate use. The included studies differed with regard to type of ABM intervention (modified dot probe task n = 14; Alcohol Attention Control Training Programme n = 4), outcome measures, amount and length of provided sessions, and context (clinic versus laboratory versus home environment). The study quality mostly ranged from low average to high average (one study scored below the quality cut-off). Ten studies reported significant changes of symptoms of addictive behaviour, whereas eight studies found no effect of ABM interventions on symptoms. However, when restricted to multi-session ABM intervention studies, eight out of ten studies found effects on symptoms of addiction. Surprisingly, these effects on symptoms of addictive behaviour showed no straightforward relationship with baseline attentional bias and its change from baseline to post-test.ConclusionsDespite a number of negative findings and the diversity of studies, multi-session ABM interventions, especially in the case of alcohol and when the Alcohol Attention Control Training Programme was used, appear to have positive effects on symptoms of addictive behaviour. However, more rigorous well-powered future research in clinical samples is needed before firm conclusions regarding the effectiveness of ABM interventions can be drawn.Systematic review registrationRegistration number PROSPERO: CRD42016046823