Reinout W. Wiers

Automatic and Controlled Processes and the Development of Addictive Behaviors in Adolescents: A Review and a Model

This paper presents a review and a model of the development of addictive behaviors in (human) adolescents, with a focus on alcohol. The model proposes that addictive behaviors develop as the result of an imbalance between two systems: an appetitive, approach-oriented system that becomes sensitized with repeated alcohol use and a regulatory executive system that is not fully developed and that is compromised by exposure to alcohol. Self-regulation critically depends on two factors: ability and motivation to regulate the appetitive response tendency. The motivational aspect is often still weak in heavy drinking adolescents, who typically do not recognize their drinking as problematic. Motivation to regulate use often develops only years later, after the individual has encountered serious alcohol-related problems. Unfortunately, at that point behavioral change becomes harder due to several neurocognitive adaptations that result from heavy drinking. As we document, there is preliminary support for the central elements of the model (appetitive motivation vs. self-regulation), but there is a paucity of research directly addressing these mechanisms in human adolescents. Further, we emphasize that adolescent alcohol use primarily takes place in a social context, and that therefore studies should not solely focus on intra-individual factors predicting substance use and misuse but also on interpersonal social factors. Finally, we discuss implications of the model for interventions.

Retraining Automatic Action Tendencies Changes Alcoholic Patients’ Approach Bias for Alcohol and Improves Treatment Outcome

This study tested the effects of a new cognitive-bias modification (CBM) intervention that targeted an approach bias for alcohol in 214 alcoholic inpatients. Patients were assigned to one of two experimental conditions, in which they were explicitly or implicitly trained to make avoidance movements (pushing a joystick) in response to alcohol pictures, or to one of two control conditions, in which they received no training or sham training. Four brief sessions of experimental CBM preceded regular inpatient treatment. In the experimental conditions only, patients’ approach bias changed into an avoidance bias for alcohol. This effect generalized to untrained pictures in the task used in the CBM and to an Implicit Association Test, in which alcohol and soft-drink words were categorized with approach and avoidance words. Patients in the experimental conditions showed better treatment outcomes a year later. These findings indicate that a short intervention can change alcoholics’ automatic approach bias for alcohol and may improve treatment outcome.

National differences in gender–science stereotypes predict national sex differences in science and math achievement

About 70% of more than half a million Implicit Association Tests completed by citizens of 34 countries revealed expected implicit stereotypes associating science with males more than with females. We discovered that nation-level implicit stereotypes predicted nation-level sex differences in 8th-grade science and mathematics achievement. Self-reported stereotypes did not provide additional predictive validity of the achievement gap. We suggest that implicit stereotypes and sex differences in science participation and performance are mutually reinforcing, contributing to the persistent gender gap in science engagement.

Working Memory Capacity and Self-Regulatory Behavior: Toward an Individual Differences Perspective on Behavior Determination by Automatic Versus Controlled Processes

In the present research, the authors investigated how individual differences in working memory capacity moderate the relative influence of automatic versus controlled precursors on self-regulatory behavior. In 2 studies, on sexual interest behavior (Study 1) and the consumption of tempting food (Study 2), automatic attitudes toward the temptation of interest had a stronger influence on behavior for individuals who scored low rather than high in working memory capacity. Analogous results emerged in Study 3 on anger expression in a provoking situation when a measure of the automatic personality trait of angriness was employed. Conversely, controlled dispositions such as explicit attitudes (Study 1) and self-regulatory goals (Studies 2 and 3) were more effective in guiding behavior for participants who scored high rather than low in working memory capacity. Taken together, these results demonstrate the importance of working memory capacity for everyday self-regulation and suggest an individual differences perspective on dual-process or dual-system theories of human behavior.

Impulsive versus reflective influences on health behavior: A theoretical framework and empirical review

Abstract Often, health behavior seems to be governed not only by reasoned attitudes and goal-directed behavior but also by impulsive influences. The notion of a conflict between reflective and impulsive processing which is incorporated in prominent dual-system accounts (e.g., Metcalfe & Mischel, 1999; Strack & Deutsch, 2004) may yield important benefits for the understanding and prediction of health-related behavior. In this article, we suggest a basic framework for the prediction of health-related behavior which combines (a) reflective influences (as measured via self-report), (b) impulsive influences (as measured via implicit measures), and (c) situational or dispositional moderators that shift the weight between reflective and impulsive influences. The practical utility of such a framework is demonstrated by drawing on recent evidence from several areas of health psychology such as eating, drinking, drug abuse, and sexual behavior. Implications for the understanding of health behavior and applied health interventions are discussed.

Implicit Cognition and Addiction: A Tool for Explaining Paradoxical Behavior

Research on implicit cognition and addiction has expanded greatly during the past decade. This research area provides new ways to understand why people engage in behaviors that they know are harmful or counterproductive in the long run. Implicit cognition takes a different view from traditional cognitive approaches to addiction by assuming that behavior is often not a result of a reflective decision that takes into account the pros and cons known by the individual. Instead of a cognitive algebra integrating many cognitions relevant to choice, implicit cognition assumes that the influential cognitions are the ones that are spontaneously activated during critical decision points. This selective review highlights many of the consistent findings supporting predictive effects of implicit cognition on substance use and abuse in adolescents and adults; reveals a recent integration with dual-process models; outlines the rapid evolution of different measurement tools; and introduces new routes for intervention.

Retraining automatic action-tendencies to approach alcohol in hazardous drinkers

AIMS The main aim of this study was to test whether automatic action-tendencies to approach alcohol can be modified, and whether this affects drinking behaviour. DESIGN AND PARTICIPANTS Forty-two hazardous drinkers were assigned randomly to a condition in which they were implicitly trained to avoid or to approach alcohol, using a training variety of the alcohol Approach Avoidance Test (AAT). Participants pushed or pulled a joystick in response to picture-format (landscape or portrait). The pictures depicted alcoholic or non-alcoholic drinks. Participants in the avoid-alcohol condition pushed most alcoholic and pulled most non-alcoholic drinks. For participants in the approach-alcohol condition these contingencies were reversed. After the implicit training, participants performed a taste test, including beers and soft drinks. Automatic action tendencies at post-test were assessed with the AAT, including both trained and untrained pictures, and with a different test (Implicit Association Test, IAT). We further tested effects on subjective craving. RESULTS Action tendencies for alcohol changed in accordance with training condition, with the largest effects in the clinically relevant avoid-alcohol condition. These effects occurred outside subjective awareness and generalized to new pictures in the AAT and to an entirely different test using words, rather than pictures (IAT). In relatively heavy drinking participants who demonstrated changed action tendencies in accordance with their training condition, effects were found on drinking behaviour, with participants in the approach-alcohol condition drinking more alcohol than participants in the avoid-alcohol condition. No effect was found on subjective craving. CONCLUSIONS Retraining automatic processes may help to regain control over addictive impulses, which points to new treatment possibilities.

Clinical effectiveness of attentional bias modification training in abstinent alcoholic patients

A new training to decrease attentional bias (attentional bias modification training, ABM) was tested in a randomized controlled experimental study with alcohol-dependent patients as an addition to cognitive behavioral therapy. In alcohol dependence, attentional bias has been associated with severity of alcoholism, craving, treatment outcome, and relapse. Forty-three patients with DSM-IV diagnosis of alcohol dependence were randomly assigned to an ABM intervention or control training. The procedure consisted of five sessions in which patients were trained to disengage attention from alcohol-related stimuli (ABM condition) or in which they were trained on an irrelevant reaction-time test (control condition). We measured the effects of ABM on the visual-probe task, with stimuli that were presented in the ABM and with new stimuli. Craving was measured with the Desires for Alcohol Questionnaire. Follow-up data were gathered for overall treatment success, and relapse up to 3 months after the intervention. ABM was effective in increasing the ability to disengage from alcohol-related cues. This effect generalized to untrained, new stimuli. There were no significant effects on subjective craving. For other outcome measures there were indications of clinically relevant effects. Results indicate that ABM among alcohol-dependent patients was effective and that it may affect treatment progression. Large-scale trials are warranted to further investigate this new field.

Getting a Grip on Drinking Behavior: Training Working Memory to Reduce Alcohol Abuse

Alcohol abuse disrupts core executive functions, including working memory (WM)—the ability to maintain and manipulate goal-relevant information. When executive functions like WM are weakened, drinking behavior gets out of control and is guided more strongly by automatic impulses. This study investigated whether training WM restores control over drinking behavior. Forty-eight problem drinkers performed WM training tasks or control tasks during 25 sessions over at least 25 days. Before and after training, we measured WM and drinking behavior. Training WM improved WM and reduced alcohol intake for more than 1 month after the training. Further, the indirect effect of training on alcohol use through improved WM was moderated by participants’ levels of automatic impulses: Increased WM reduced alcohol consumption in participants with relatively strong automatic preferences for alcohol. These findings are consistent with the theoretical framework and demonstrate that training WM may be an effective strategy to reduce alcohol use by increasing control over automatic impulses to drink alcohol.

Resisting temptation: Decreasing alcohol-related affect and drinking behavior by training response inhibition

According to dual-process models, excessive alcohol use emerges when response inhibition ability is insufficient to inhibit automatic impulses to drink alcohol. This study examined whether strengthening response inhibition for alcohol-related cues decreases alcohol intake. Fifty-two heavy drinking students were randomly assigned to one of two conditions: In the beer/no-go condition, participants performed a go/no-go task that consistently paired alcohol-related stimuli with a stopping response, to increase response inhibition for alcohol-related stimuli. In the beer/go condition, in contrast, participants were always required to respond to alcohol-related stimuli during the go/no-go task. Before and after the go/no-go manipulation, we measured weekly alcohol intake and implicit attitudes toward alcohol. In addition, we measured alcohol consumption during a taste test immediately after the go/no-go manipulation. Following the manipulation, participants in the beer/no-go condition demonstrated significantly increased negative implicit attitudes toward alcohol, and a significant reduction in weekly alcohol intake, while participants in the beer/go condition showed a non-significant increase in implicit positive attitudes toward alcohol and a significant increase in weekly alcohol intake. This study demonstrates that repeatedly stopping prepotent responses toward alcohol-related stimuli can be an effective strategy to reduce excessive alcohol use.