Paul Christiansen

Acute Alcohol Effects on Inhibitory Control and Implicit Cognition: Implications for Loss of Control Over Drinking

Alcohol impairs inhibitory control, and it alters implicit alcohol cognitions including attentional bias and implicit associations. These effects are seen after doses of alcohol which do not lead to global impairments in cognitive performance. We review studies which demonstrate that the effects of alcohol on inhibitory control are associated with the ability of alcohol to prime alcohol-seeking behavior. We also hypothesize that alcohol-induced changes in implicit alcohol cognitions may partially mediate alcohol-induced priming of the motivation to drink. Based on contemporary theoretical models and conceptualizations of executive function, impulsivity, and the motivational salience of alcohol-related cues, we speculate on other aspects of cognition that may underlie alcohols effects on alcohol seeking. Inconsistencies in existing research and priorities for future research are highlighted, including dose effects and the potential interactions between chronic heavy drinking and the acute effects of alcohol on these cognitive processes.

Multiple behavioural impulsivity tasks predict prospective alcohol involvement in adolescents

Aims We investigated reciprocal prospective relationships between multiple behavioural impulsivity tasks (assessing delay discounting, risk-taking and disinhibition) and alcohol involvement (consumption, drunkenness and problems) among adolescents. We hypothesized that performance on the tasks would predict subsequent alcohol involvement, and that alcohol involvement would lead to increases in behavioural impulsivity over time. Design Cross-lagged prospective design in which impulsivity and alcohol involvement were assessed five times over 2 years (once every 6 months, on average). Setting Classrooms in secondary schools in North West England. Participants Two hundred and eighty-seven adolescents (51.2% male) who were aged 12 or 13 years at study enrolment. Measurements Participants reported their alcohol involvement and completed computerized tasks of disinhibition, delay discounting and risk-taking at each assessment. Cross-sectional and prospective relationships between the variables of interest were investigated using cross-lagged analyses. Findings All behavioural impulsivity tasks predicted a composite index of alcohol involvement 6 months later (all Ps < 0.01), and these prospective relationships were reliable across the majority of time-points. Importantly, we did not observe the converse relationship across time: alcohol involvement did not predict performance on behavioural impulsivity tasks at any subsequent time point. Conclusions Several measures of impulsivity predict escalation in alcohol involvement in young adolescents, but alcohol use does not appear to alter impulsivity.

Components of behavioural impulsivity and automatic cue approach predict unique variance in hazardous drinking

RationaleHazardous drinking is associated with both increased impulsivity and automatic approach tendencies elicited by alcohol-related cues. However, impulsivity is a multi-factorial construct, and it is currently unclear if all components of impulsivity are associated with heavy drinking. Furthermore, emerging evidence suggests that the relationships between hazardous drinking and automatic alcohol cognitions may be moderated by individual differences in impulsivity.ObjectivesThe aim of this study was to investigate the independence of measures of impulsivity and their association with hazardous drinking, and to examine if the relationship between hazardous drinking and automatic alcohol approach tendencies would be moderated by individual differences in impulsivity.MethodsNinety-seven social drinkers (65 female) completed questionnaire measures of trait impulsivity, alcohol consumption and hazardous drinking. Participants also completed computerised measures of automatic alcohol approach tendencies (stimulus–response compatibility (SRC) task), and two behavioural measures of impulsivity (Go/No-go and delay discounting tasks).ResultsPrincipal component analysis revealed that the two measures of behavioural impulsivity were distinct from each other and from self-reported trait impulsivity, although self-reported non-planning impulsivity loaded on to two factors (trait impulsivity and delay discounting). Furthermore, all measures of impulsivity predicted unique variance in hazardous drinking as did automatic alcohol approach tendencies, although the latter relationship was not moderated by impulsivity.ConclusionsThese results indicate that multiple components of impulsivity and automatic alcohol approach tendencies explain unique variance in hazardous drinking.

Less than meets the eye: Reappraising the clinical relevance of attentional bias in addiction

Recent years have seen an explosion of interest in attentional bias in addiction, particularly its clinical relevance. Specifically, numerous articles claimed to demonstrate either that (1) attentional bias measured in treatment settings could predict subsequent relapse to substance use, or (2) direct modification of attentional bias reduced substance use and improved treatment outcomes. In this paper, we critically evaluate empirical studies that investigated these issues. We show that the evidence regarding both of these claims is decidedly mixed, and that many of the studies that appear to yield positive findings have serious methodological and statistical limitations. We contend that the available literature suggests that attentional bias for drug cues fluctuates within individuals because it is an output of the underlying motivational state at that moment in time, but there is no convincing evidence that it exerts a causal influence on substance use. Future research should make use of experience sampling methodology to characterise the clinical significance of fluctuations in attentional bias over time.

Commentary on Ataya et al. (2012), 'Internal reliability of measures of substance-related cognitive bias'

A recent paper published in Drug and alcohol dependence (Ataya et al., 2012) is the first systematic attempt to establish the internal reliability of measures of substance-related attentional bias, and it makes an important and long overdue contribution to this topic. The authors reported that the reliability of attentional bias indices derived from the visual probe task was very poor, and while the attentional bias index from the Stroop was a little better, it fell some way short of being acceptable, as α>0.70 in only two of six studies in which the task was used. In this commentary, we speculate on some of the factors that might have contributed to the poor reliability of the tasks, and how task reliability might be improved in future studies.

Electrophysiological responses to alcohol cues are not associated with Pavlovian-to-instrumental transfer in social drinkers.

Pavlovian to Instrumental Transfer (PIT) refers to the behavioral phenomenon of increased instrumental responding for a reinforcer when in the presence of Pavlovian conditioned stimuli that were separately paired with that reinforcer. PIT effects may play an important role in substance use disorders, but little is known about the brain mechanisms that underlie these effects in alcohol consumers. We report behavioral and electroencephalographic (EEG) data from a group of social drinkers (n = 31) who performed a PIT task in which they chose between two instrumental responses in pursuit of beer and chocolate reinforcers while their EEG reactivity to beer, chocolate and neutral pictorial cues was recorded. We examined two markers of the motivational salience of the pictures: the P300 and slow wave event-related potentials (ERPs). Results demonstrated a behavioral PIT effect: responding for beer was increased when a beer picture was presented. Analyses of ERP amplitudes demonstrated significantly larger slow potentials evoked by beer cues at various electrode clusters. Contrary to hypotheses, there were no significant correlations between behavioral PIT effects, electrophysiological reactivity to the cues, and individual differences in drinking behaviour. Our findings are the first to demonstrate a PIT effect for beer, accompanied by increased slow potentials in response to beer cues, in social drinkers. The lack of relationship between behavioral and EEG measures, and between these measures and individual differences in drinking behaviour may be attributed to methodological features of the PIT task and to characteristics of our sample.

Fluctuating disinhibition: implications for the understanding and treatment of alcohol and other substance use disorders.

Disinhibition is present in various maladaptive behaviors, including substance use disorders. Most previous research has assumed that disinhibition is a psychological construct that is relatively stable within individuals. However, recent evidence suggests that the ability to inhibit behavior fluctuates in response to environmental and psychological triggers. In this review we discuss some of the factors that cause (dis)inhibition to fluctuate, we examine whether these fluctuations contribute to subjective craving and substance consumption, and we ask if they might increase the risk of relapse in those who are attempting to abstain. The research that we discuss has furthered our understanding of the causal relationships between disinhibition and substance use disorders, and it also highlights opportunities to develop novel treatment interventions. We conclude that substance misusers and their therapists should be made aware of the triggers that can cause disinhibition to fluctuate, and we highlight the need for more research to investigate the effectiveness of inhibitory control training in clinical settings.

Alcohol expectancy moderates attentional bias for alcohol cues in light drinkers.

AIMS Theoretical models suggest that attentional bias for alcohol-related cues develops because cues signal the availability of alcohol, and the expectancy elicited by alcohol cues is responsible for the maintenance of attentional bias among regular drinkers. We investigated the moderating role of alcohol expectancy on attentional bias for alcohol-related cues. DESIGN Within-subjects experimental design. SETTING Psychology laboratories. PARTICIPANTS Adult social drinkers (n=58). MEASUREMENTS On a trial-by-trial basis, participants were informed of the probability (100%, 50%, 0%) that they would receive beer at the end of the trial before their eye movements towards alcohol-related and control cues were measured. FINDINGS Heavy social drinkers showed an attentional bias for alcohol-related cues regardless of alcohol expectancy. However, in light social drinkers, attentional bias was only seen on 100% probability trials, i.e. when alcohol was expected imminently. CONCLUSIONS Attentional bias for alcohol-related cues is sensitive to the current expectancy of receiving alcohol in light social drinkers, but it occurs independently of the current level of alcohol expectancy in heavy drinkers.

A comparison of the anticipated and pharmacological effects of alcohol on cognitive bias, executive function, craving and ad-lib drinking

Acute alcohol administration alters automatic processing of alcohol-related cues, impairs executive functions and increases alcohol seeking. Few studies have investigated the effects of expecting to receive alcohol on these measures. Thirty-one social drinkers completed three experimental sessions receiving either 0.65 g/kg alcohol, a placebo and a control beverage (which they knew was not alcoholic) before reporting craving and completing a test battery including a measure of automatic alcohol-approach tendencies (stimulus response compatibility task), a measure of executive function (Controlled Oral Word Association Task (COWAT)) and a taste test assessing ad-lib drinking. Results indicated that alcohol administration impaired performance on the COWAT and increased ad-lib drinking; however, there were no significant differences on these measures after administration of placebo versus control beverages. Craving was increased after alcohol and (to a lesser extent) after placebo. Automatic alcohol-approach tendencies were pronounced after both alcohol and placebo compared to the control beverage, with no difference between alcohol and placebo. Results suggest craving is sensitive to the anticipated and pharmacological effects of alcohol, alcohol-approach tendencies are particularly sensitive to the anticipated effects of alcohol, and measures of executive function and ad-lib drinking are affected by the pharmacological, but not the anticipated, effects of alcohol.

Reward expectancy promotes generalized increases in attentional bias for rewarding stimuli.

Expectations of drug availability increase the magnitude of attentional biases for drug-related cues. However, it is unknown whether these effects are outcome specific, or whether expectation of a specific reinforcer produces a general enhancement of attentional bias for other types of rewarding cues. In the present study, 31 social drinkers completed an eye-tracking task in which attentional bias for alcohol- and chocolate-related cues was assessed while the expectation of receiving alcohol and chocolate was manipulated on a trial-by-trial basis. Participants showed attentional bias for alcohol and chocolate cues (relative to neutral cues) overall. Importantly, these attentional biases for reward cues were magnified when participants expected to receive alcohol and chocolate, but effects were not outcome specific: The expectation of receiving either alcohol or chocolate increased attentional bias for both alcohol and chocolate cues. Results suggest that anticipation of reward produces a general rather than an outcome-specific enhancement of attentional bias for reward-related stimuli.