Automatic and controlled processes and the development of addictive behaviors in adolescents: a review and a model

Mild or borderline intellectual disability as a risk for alcohol consumption in adolescents - A matched-pair study

BACKGROUND

Studies that investigate the association between mild or borderline intellectual disability (MBID) and alcohol use in adolescents have not examined whether MBID is an independent risk factor for drinking.

AIM

It is important to examine whether MBID is a risk factor for alcohol consumption by controlling concomitant factors in a matched-pair design.

METHOD

Overall, 329 students from two schools for children with MBID self-reported their drinking behavior via questionnaires, and 329 students from regular schools were matched to this group by gender, age, family composition, and parental drinking behavior. Matched pairs were compared based on alcohol consumption and motivation to drink.

RESULTS

MBID is a protective factor, as disabled adolescents drink less on average. This effect is mainly due to larger proportions of youth with MBID who are abstinent. When male adolescents with MBID begin to drink, they are at an increased risk for intoxication and subsequent at-risk behaviors. Motivations to drink were explained by an interaction between MBID and consumption patterns.

CONCLUSIONS

For male adolescents with MBID, there appears to be an "all-or-nothing" principle that guides alcohol consumption, which suggests a need for special interventions for this group.

Cognitive appraisals of alcohol use in early adolescence: Psychosocial predictors and reciprocal associations with alcohol use

Early adolescence is a dynamic period for the development of alcohol appraisals (expected outcomes of drinking and subjective evaluations of expected outcomes), yet the literature provides a limited understanding of psychosocial factors that shape these appraisals during this period. This study took a comprehensive view of alcohol appraisals and considered positive and negative alcohol outcome expectancies, as well as subjective evaluations of expected outcomes. Developmental-ecological theory guided examination of individual, peer, family, and neighborhood predictors of cognitive appraisals of alcohol and use. A community sample of 378 adolescents (mean age 11.5 years at Wave 1, 52% female) was assessed annually for 4 years. Longitudinal path analysis suggested that the most robust predictors of alcohol appraisals were peer norms. Furthermore, perceived likelihood of positive and negative alcohol outcomes prospectively predicted increases in drinking. There was limited support for appraisals operating as mediators of psychosocial risk and protective factors.

Implicit and Explicit Alcohol Cognitions: The Moderating Effect of Executive Functions

Aims

Research informed by dual-process models of addictions has clearly demonstrated an association between implicit and explicit alcohol-related cognitions and alcohol consumption. However, the literature is limited with respect to examination of the cognitive abilities that may moderate these associations across populations. This study examined relations among alcohol associations, inhibition and alcohol consumption in a sample of college students. It was hypothesized that the executive ability of response inhibition would moderate relations between alcohol-related cognitions and alcohol consumption, such that individuals with weaker response inhibition would demonstrate stronger relations between implicit cognitions and use, while individuals with stronger response inhibition would demonstrate more robust relations between explicit cognitions and use.

Methods

Research participants (N  = 205, age 19.0 years (standard deviation = 1.1)) mostly female (n  = 150, 73.2%) completed two implicit association tasks measuring alcohol-related positive/arousal and relaxation associations. In addition, participants completed questionnaires regarding alcohol expectancies, alcohol consumption and problems, and various measures of inhibition. We tested study hypotheses using structural equation modeling and probed significant interactions using simple slope analyses.

Results

We found support for a moderating effect of response inhibition on relations between implicit relaxation associations and alcohol consumption. We did not find a moderating effect of working memory capacity on relations between alcohol-related associations and use.

Conclusions

Findings from this study further our understanding of differential cognitive and inhibition factors that contribute to underage alcohol consumption with implications for preventive interventions to reduce alcohol misuse and consequences.

Short summary

We investigated whether the effect of implicit and explicit alcohol associations on alcohol consumption was moderated by response inhibition and working memory among college students. Response inhibition moderated the effect of implicit relaxation associations on consumption. We did not obtain support for moderation by working memory, or of explicit associations.

Meta-analysis of the relationship between impulsivity and substance-related cognitive biases

BACKGROUND

Evidence indicates that substance-related cognitive biases (attentional, memory, and approach bias) contribute to the maintenance and development of substance misuse. Impulsivity has been suggested to influence how cognitive biases contribute to substance misuse, possibly by biasing incentive salience attribution processes. However, the strength and moderators of the relationship between impulsivity and substance-related cognitive biases has yet to be empirically examined.

METHODS

A meta-analysis using random-effects models was completed assessing 19 studies that reported a quantitative relationship between an impulsivity measure and a substance-related cognitive bias. Two-component conceptualisation of impulsivity, impulsivity measurement type, gender, and age were assessed as moderators.

RESULTS

A small, significant positive relationship (r=0.10) was observed between impulsivity and substance-related attentional, memory, and approach biases. No moderators examined had a significant influence on this relationship.

CONCLUSIONS

Results are consistent with incentive sensitisation theories of addiction and suggests a weak synergistic relationship between impulsivity and substance-related cognitive biases. This relationship holds across different measures and components of impulsivity. Results provide some support for the viability of impulsivity and cognitive bias interaction models which may warrant further investigation of these factors in relation to predicting addiction treatment outcomes.

Alcohol-cue exposure decreases response inhibition towards alcohol-related stimuli in detoxified alcohol-dependent patients

The induction of alcohol craving and the cognitive processing of alcohol-related stimuli in alcohol-dependent patients have been reported to compete with inhibitory control and contribute to alcohol relapse. The aim of the present study is to investigate whether the induction of a craving state, using an alcohol cue exposure paradigm, influences response inhibition towards both neutral stimuli and alcohol-related stimuli in alcohol-dependent patients. Thirty-one detoxified alcohol-dependent patients were exposed to either their preferred alcoholic beverage or to a glass of water. They then performed a modified stop signal task, which used alcohol-related words, neutral words and non-words, and a lexical decision as the Go response. The alcohol-cue exposure group reported significantly higher alcohol craving and showed higher percentages of commission errors towards alcohol-related words than the control group. All participants, but especially those of the alcohol-cue exposure group, showed also shorter reaction times when alcohol words were used as targets in go trials. The induction of alcohol craving in detoxified alcohol-dependent patients increases the motivational salience value of alcohol stimuli, leading them to automatically approach alcohol-related cues and therefore impairing response inhibition towards those stimuli.

Development of stimulus material for research in alcohol use disorders

The availability of appropriate stimulus material is a key concern for an experimental approach to research on alcohol use disorders (AUDs). A large number of such stimuli are necessary to evoke relevant alcohol-related associations. We report the development of a large stimulus database consisting of 457 pictures of alcoholic beverages and 398 pictures of neutral objects. These stimuli were rated by 18 inpatients hospitalized due to severe AUD and 18 healthy controls along four dimensions: arousal, valence, alcohol-relatedness, and craving. Physical parameters of the pictures were assessed. After outlier removal, 831 stimuli that were characterized as either alcohol-related or neutral were retained in the final stimulus pool. Alcohol-related pictures (versus neutral pictures) evoked higher arousal, more craving and were judged to have higher alcohol-relatedness and a more negative valence. Group comparisons indicated that in patients, neutral pictures evoked more craving and had higher alcohol-relatedness than they did in controls. Physical parameters such as visual complexity, luminance, and color were extracted from these pictures, and extreme values were normalized to minimize mean differences between alcoholic and neutral stimuli. The pictures met the qualitative requirements for (neurophysiological) research. A data file containing rating values and physical parameters will be provided upon request.

Do alcohol-dependent patients show different neural activation during response inhibition than healthy controls in an alcohol-related fMRI go/no-go-task?

RATIONALE

Alcohol dependence is associated with impaired response inhibition and heightened cue reactivity towards alcohol-related stimuli. Several brain areas, but mainly prefrontal structures, have been linked to response inhibition in addiction. This study aimed at combining both aspects: salience of drug-associated cues and response inhibition using a go/no-go task with alcohol-associated stimuli during functional magnetic resonance imaging (fMRI).

OBJECTIVES

Nineteen abstinent alcohol-dependent patients (ADP) and 21 healthy control subjects (HC) were compared on blood oxygen level-dependent (BOLD) responses during successful inhibition of no-go stimuli and successful reactions to go stimuli.

RESULTS

ADP and HC did not significantly differ in their behavioural performance in the task. However, both groups performed worse during the inhibition of alcoholic-associated stimuli compared to neutral stimuli. On the neural level, ADP displayed enhanced BOLD activity relative to HC during successful response inhibition in several areas involved in visual processing, cognitive and impulse control, including occipital structures, anterior cingulate gyrus, medial frontal gyrus and medial orbitofrontal cortex.

CONCLUSIONS

We interpret these findings as a possible compensation strategy for impaired cognitive processing. Furthermore, the results underline the impact of salience of alcohol-related stimuli on response inhibition, which seems to affect both ADP and HC.

Planning to be routine: habit as a mediator of the planning-behaviour relationship in healthcare professionals

Background

Gaps in the quality of care provided to people with type 2 diabetes are regularly identified. Healthcare professionals often have a strong intention to follow practice guidelines during consultations with people with type 2 diabetes; however, this intention does not always translate into action. Action planning (planning when, where and how to act) and coping planning (planning how to overcome pre-identified barriers) have been hypothesised to help with the enactment of intentions by creating mental cue-response links that promote habit formation. This study aimed to investigate whether habit helps to better understand how action and coping planning relate to clinical behaviour in the context of type 2 diabetes care.

Methods

The study utilised a prospective correlational design with six nested sub-studies. General practitioners and practice nurses (n = 427 from 99 UK primary care practices) completed measures of action planning, coping planning and habit at baseline and then self-reported their enactment of guideline-recommended advising, prescribing and examining behaviours 12 months later. Bootstrapped mediation analyses were used to test the indirect effect of action and coping planning on healthcare professionals’ clinical behaviour via their relationship with habit.

Results

Healthcare professionals who reported higher degrees of action or coping planning for performing six guideline recommended behaviours in the context of type 2 diabetes care were more likely to report performing these behaviours in clinical practice. All 12 bootstrapped mediation analyses showed that the positive relationship between planning (action and coping planning) and healthcare professionals’ clinical behaviour operated indirectly through habit.

Conclusions

These findings suggest that habit mediates the relationship between planning (action and coping planning) and healthcare professional behaviour. Promoting careful action and coping planning may support routinised uptake of guideline-recommended care by healthcare professionals in the primary care setting. Given the competing demands on healthcare professionals, exploring the behavioural processes involved in promoting more routinisation of behaviours where possible and appropriate could free up cognitive capacity for clinical behaviours that rely on more deliberation.

Electronic supplementary material

The online version of this article (doi:10.1186/s13012-017-0551-6) contains supplementary material, which is available to authorized users.

Addiction and the Brain: Development, Not Disease

I review the brain disease model of addiction promoted by medical, scientific, and clinical authorities in the US and elsewhere. I then show that the disease model is flawed because brain changes in addiction are similar to those generally observed when recurrent, highly motivated goal seeking results in the development of deep habits, Pavlovian learning, and prefrontal disengagement. This analysis relies on concepts of self-organization, neuroplasticity, personality development, and delay discounting. It also highlights neural and behavioral parallels between substance addictions, behavioral addictions, normative compulsive behaviors, and falling in love. I note that the short duration of addictive rewards leads to negative emotions that accelerate the learning cycle, but cortical reconfiguration in recovery should also inform our understanding of addiction. I end by showing that the ethos of the disease model makes it difficult to reconcile with a developmental-learning orientation.

Cue avoidance training and inhibitory control training for the reduction of alcohol consumption: a comparison of effectiveness and investigation of their mechanisms of action

RATIONALE

Both cue avoidance training (CAT) and inhibitory control training (ICT) reduce alcohol consumption in the laboratory. However, these interventions have never been directly compared and their mechanisms of action are poorly understood.

OBJECTIVES

We compared the effects of both types of training on alcohol consumption and investigated if they led to theoretically predicted changes in alcohol avoidance (CAT) or alcohol inhibition (ICT) associations and changes in evaluation of alcohol cues.

METHODS

Heavy drinking young adults (N = 120) were randomly assigned to one of four groups: (1) CAT (repeatedly pushing alcohol cues away with a joystick), (2) sham (control) CAT; (3) ICT (repeatedly inhibiting behaviour in response to alcohol cues); or (4) sham (control) ICT. Changes in reaction times and automatic evaluations of alcohol cues were assessed before and after training using assessment versions of tasks used in training and the implicit association test (IAT), respectively. Finally, participants completed a bogus taste test as a measure of ad libitum alcohol consumption.

RESULTS

Compared to sham conditions, CAT and ICT both led to reduced alcohol consumption although there was no difference between the two. Neither intervention affected performance on the IAT, and changes in reaction time did not suggest the formation of robust alcohol avoidance (CAT) or alcohol inhibition (ICT) associations after training.

CONCLUSIONS

CAT and ICT yielded equivalent reductions in alcohol consumption in the laboratory. However, these behavioural effects were not accompanied by devaluation of stimuli or the formation of alcohol avoidance or alcohol inhibition associations.

Bibi ergo sum: the effects of a placebo and contextual alcohol cues on motivation to drink alcohol

RATIONALE

Acute 'priming' doses of alcohol reliably increase alcohol-seeking behaviour in social drinkers. However, the effects of the anticipated (rather than pharmacological) effects of alcohol, and their interaction with contextual alcohol cues, are not well understood.

OBJECTIVES

This study aims to determine the extent to which an alcohol-placebo drink increases craving, subjective intoxication and beer consumption, while conjointly investigating the impact of contextual alcohol cues.

METHODS

On a within-subject basis, 64 undergraduate social drinkers consumed both a placebo (which they believed to contain alcohol) and a control drink (which they knew did not contain alcohol) in different sessions. Participants completed the study procedures in a bar laboratory designed to look like a 'pub' or a standard psychology lab containing no alcohol-related cues. Craving (Desires for Alcohol Questionnaire) and subjective intoxication were measured pre- and post-drink, and a bogus taste test to measure ad-lib alcohol consumption was completed at the end of each session.

RESULTS

Compared to the control drink, placebo significantly increased craving, ad-lib consumption and subjective intoxication, regardless of environmental context.

CONCLUSIONS

Increased craving and ad-lib alcohol consumption after consuming a priming dose of alcohol is at least partly attributable to the anticipated rather than the pharmacological effects of the priming dose.

Individual differences in voluntary alcohol intake in rats: relationship with impulsivity, decision making and Pavlovian conditioned approach

RATIONALE

Alcohol use disorder (AUD) has been associated with suboptimal decision making, exaggerated impulsivity, and aberrant responses to reward-paired cues, but the relationship between AUD and these behaviors is incompletely understood.

OBJECTIVES

This study aims to assess decision making, impulsivity, and Pavlovian-conditioned approach in rats that voluntarily consume low (LD) or high (HD) amounts of alcohol.

METHODS

LD and HD were tested in the rat gambling task (rGT) or the delayed reward task (DRT). Next, the effect of alcohol (0-1.0 g/kg) was tested in these tasks. Pavlovian-conditioned approach (PCA) was assessed both prior to and after intermittent alcohol access (IAA). Principal component analyses were performed to identify relationships between the most important behavioral parameters.

RESULTS

HD showed more optimal decision making in the rGT. In the DRT, HD transiently showed reduced impulsive choice. In both LD and HD, alcohol treatment increased optimal decision making in the rGT and increased impulsive choice in the DRT. PCA prior to and after IAA was comparable for LD and HD. When PCA was tested after IAA only, HD showed a more sign-tracking behavior. The principal component analyses indicated dimensional relationships between alcohol intake, impulsivity, and sign-tracking behavior in the PCA task after IAA.

CONCLUSIONS

HD showed a more efficient performance in the rGT and DRT. Moreover, alcohol consumption enhanced approach behavior to reward-predictive cues, but sign-tracking did not predict the level of alcohol consumption. Taken together, these findings suggest that high levels of voluntary alcohol intake are associated with enhanced cue- and reward-driven behavior.

Beyond associations: Do implicit beliefs play a role in smoking addiction?

BACKGROUND AND OBJECTIVES

Influential dual-system models of addiction suggest that an automatic system that is associative and habitual promotes drug use, whereas a controlled system that is propositional and rational inhibits drug use. It is assumed that effects on the Implicit Association Test (IAT) reflect the automatic processes that guide drug seeking. However, results have been inconsistent, challenging: (1) the validity of addiction IATs; and (2) the assumption that the automatic system contains only simple associative information. We aimed to further test the validity of IATs that are used within this field of research using an experimental design. Second, we introduced a new procedure aimed at examining the automatic activation of complex propositional knowledge, the Relational Responding Task (RRT) and examine the validity of RRT effects in the context of smoking.

METHODS

In two experiments, smokers performed two different tasks: an approach/avoid IAT and a liking IAT in Experiment 1, and a smoking urges RRT and a valence IAT in Experiment 2. Smokers were tested once immediately after smoking and once after 10 hours of nicotine-deprivation.

RESULTS

None of the IAT scores were affected by the deprivation manipulation. RRT scores revealed a stronger implicit desire for smoking in the deprivation condition compared to the satiation condition.

CONCLUSIONS

IATs that are currently used to assess automatic processes in addiction have serious drawbacks. Furthermore, the automatic system may contain not only associations but complex drug-related beliefs as well. The RRT may be a useful and valid tool to examine these beliefs.

Attentional Bias Modification With Serious Game Elements: Evaluating the Shots Game

Background

Young adults often experiment with heavy use of alcohol, which poses severe health risks and increases the chance of developing addiction problems. In clinical patients, cognitive retraining of automatic appetitive processes, such as selective attention toward alcohol (known as “cognitive bias modification of attention,” or CBM-A), has been shown to be a promising add-on to treatment, helping to prevent relapse.

Objective

To prevent escalation of regular use into problematic use in youth, motivation appears to play a pivotal role. As CBM-A is often viewed as long and boring, this paper presents this training with the addition of serious game elements as a novel approach aimed at enhancing motivation to train.

Methods

A total of 96 heavy drinking undergraduate students carried out a regular CBM-A training, a gamified version (called “Shots”), or a placebo training version over 4 training sessions. Measures of motivation to change their behavior, motivation to train, drinking behavior, and attentional bias for alcohol were included before and after training.

Results

Alcohol attentional bias was reduced after training only in the regular training condition. Self-reported drinking behavior was not affected, but motivation to train decreased in all conditions, suggesting that the motivational features of the Shots game were not enough to fully counteract the tiresome nature of the training. Moreover, some of the motivational aspects decreased slightly more in the game condition, which may indicate potential detrimental effects of disappointing gamification.

Conclusions

Gamification is not without its risks. When the motivational value of a training task with serious game elements is less than expected by the adolescent, effects detrimental to their motivation may occur. We therefore advise caution when using gamification, as well as underscore the importance of careful scientific evaluation.

An implicit pictorial methodology for measuring and retraining smokers' reactivity to pictures of pros and cons of smoking: development protocol

Objectives

The last decades, there has been increased interest in the application of implicit pictorial tasks (e.g. Visual Probe Task (VPT), Approach Avoidance Task (AAT)) to target addictive behaviors. The present study reports on the development of implicit pictorial assessment and modification tasks aimed at targeting cognitive biases underlying motivational smoking-related cognitions (i.e. the pros and cons of smoking).

Methods

Respondents were adult daily smokers not motivated to quit smoking within six months (N = 33). A cross-sectional four-step approach using qualitative and quantitative strategies was utilized to identify and match pictures of pros and cons of smoking.

Results

The study resulted in 30 pro-con picture pairs matched on valence, arousal and complexity: the picture pairs were used to develop a VPT assessment and training for attentional biases and an AAT assessment and training for approach-avoidance biases.

Conclusions

The developed measurement and training tasks will be used to explore and change cognitive biases regarding pros and cons of smoking. This may consequently influence the perceived pros and cons of smoking and yield positive effects with regard to the motivation to quit smoking.

Attentional retraining and cognitive biases in a regular cannabis smoking student population

Abstract. Aim Repeated drug use can lead to attentional bias and approach tendencies, which are thought to play an important role in problematic substance use and dependence. The aims of the current study were to 1) test an attentional retraining procedure in a sample of moderate and heavy cannabis using students and 2) compare baseline attentional and approach bias between the two groups with different implicit measures. Design and participants Attentional bias scores toward cannabis-related or neutral stimuli were determined with modified versions of the Visual Probe Task and the cannabis Stroop task. Approach and avoidance action tendencies toward cannabis-related and neutral stimuli were assessed with the cannabis Approach-Avoidance Task (AAT) and the Stimulus Response Compatibility task (SRC). Seventeen participants were assigned randomly to five sessions of an attentional retraining procedure or control training. Results Attentional retraining did not decrease the speeded detection of cannabis stimuli and the difficulty to disengage from those stimuli, no trainingseffects were revealed. Moderate cannabis users did not show an attentional bias for cannabis-related cues (measured with the cannabis Stroop task), whereas heavy cannabis users did show an attentional bias for cannabis-related stimuli that cannot be attributed to cognitive control deficits on the classical Stroop task. Moreover, heavy cannabis users, but not moderate users, were significant faster to approach cannabis images compared to neutral images, using the SRC task. Conclusion Seen the observed difference in cognitive biases towards cannabis stimuli between moderate and heavy cannabis users, this study supports the allegation that cognitive biases towards cannabis stimuli may be an important marker of problematic cannabis use.

Evaluating the Relationship between Explicit and Implicit Drinking Identity Centrality and Hazardous Drinking

INTRODUCTION

Drinking identity strength (how strongly one views oneself as a drinker) is a promising risk factor for hazardous drinking. A critical next step is to investigate whether the centrality of drinking identity (i.e., the relative importance of drinking vs. other identity domains, like well-being, relationships, education) also plays a role. Thus, we developed explicit and implicit measures of drinking identity centrality and evaluated them as predictors of hazardous drinking after controlling for explicit drinking identity strength.

METHODS

Two studies were conducted (Ns = 360 and 450, respectively). Participants, who self-identified as full-time students, completed measures of explicit identity strength, explicit and implicit centrality, and the Alcohol Use Disorders Identification Test (AUDIT). Study 1a evaluated two variants of the implicit measure (short- vs. long-format of the Multi-category Implicit Association Test); Study 1b only included the long form and also assessed alcohol consumption.

RESULTS

In Study 1a, implicit and explicit centrality measures were positively and significantly associated with AUDIT scores after controlling for explicit drinking identity strength. There were no significant differences in the implicit measure variants, but the long format had slightly higher internal consistency. In Study 1b, results replicated for explicit, but not implicit, centrality.

CONCLUSIONS

These studies provide preliminary evidence that drinking identity centrality may be an important factor for predicting hazardous drinking. Future research should improve its measurement and evaluate implicit and explicit centrality in experimental and longitudinal studies.

A review of implicit and explicit substance self-concept as a predictor of alcohol and tobacco use and misuse

BACKGROUND

This paper provides an overview of the self-concept as it relates to substance use. Self-concept has a long history in psychological theory and research; however, substance self-concept (e.g., viewing one's self as a drinker or smoker) is an understudied area of research with the potential to expand existing conceptualizations of substance use, addiction, and prevention and treatment efforts, and should receive greater research attention.

OBJECTIVES

First, we review and provide a theoretical framework of substance self-concept that draws from dual process models and distinguishes between implicit and explicit self-concept. Next, we summarize key findings related to substance use in the extant literature, focusing on alcohol and tobacco (smoking).

RESULTS

Across both substances, there is converging evidence that substance self-concept is associated with substance use outcomes, including quantity and frequency of use and problems associated with use, and that change in substance self-concept is associated with recovery from substance misuse. Recommendations for the substance self-concept research agenda include routine assessment of substance self-concept, expanded use of implicit measures, investigation of moderators of substance self-concept, and targeting substance self-concept directly in prevention and intervention efforts.

CONCLUSION

Ultimately, we suggest that substance self-concept is a promising, but understudied, construct. Greater research attention to substance self-concept could clarify its potential as an important risk factor for hazardous use and addiction as well as its utility as a prevention and treatment target.

Prevalence of at-risk drinking among Brazilian truck drivers and its interference on the performance of executive cognitive tasks

BACKGROUND

Binge drinking (BD) has been associated with an increase in the risk of alcohol-related injuries. Alcohol continues to be the main substance consumed by truck drivers, a population of special concern, since they are often involved in traffic accidents. The aim of this study was to estimate the prevalence of BD and its interference in the executive functioning among truck drivers in Sao Paulo, Brazil.

METHODS

A non-probabilistic sample of 684 truck drivers was requested to answer a structured research instrument on their demographic data and alcohol use. They performed cognitive tests to assess their executive functioning and inventories about confounding variables. The participants were then divided according to their involvement in BD.

RESULTS

17.5% of the interviewees have reported being engaged in BD. Binge drinkers showed a better performance on one test, despite having done so at the expense of more mistakes and lower accuracy. More interestingly, binge drinkers took three seconds longer than non-binge drinkers to inhibit an inadequate response, which is worrisome in the context of traffic. Overall, the deleterious effect of BD on performance remained after controlling for the effects of confounding variables in regression logistic models.

CONCLUSIONS

As the use of alcohol among truck drivers may be as a way to get by with their work conditions, we believe that a negotiation between their work organization and public authorities would reduce such use, preventing negative interferences on truck drivers' cognitive functioning, which by its turn may also prevent traffic accidents.

Moderators of implicit and explicit drinking identity in a large US adult sample

Drinking identity (viewing oneself as a drinker) is a potential risk factor for problematic drinking in US undergraduate samples. Whether that risk extends to a broader, more general US sample is unknown. Additionally, there are critical, unanswered questions with respect to moderators of the drinking identity-problematic drinking relationship; an important issue for designing prevention efforts. Study aims were to assess the unique associations and interactive effects of implicit and explicit measures of drinking identity on problematic drinking, and to evaluate age and sex as potential moderators of the drinking identity-problematic drinking relationship. A sample of 11,320 adults aged 18-98 completed measures of implicit and explicit drinking identity and problematic drinking (the Alcohol Use Disorder Identification Test; AUDIT). Implicit and explicit drinking identity had positive, significant associations with AUDIT scores, as expected. Moderation analyses indicated small, but significant, interactions. There was an implicit by explicit identity interaction consistent with a synergistic effect: lower implicit and explicit identity was linked to a greater probability of being a non-drinker. Age moderated explicit but not implicit identity: lower drinking identity appeared to be more protective for younger individuals. Sex moderated implicit but not explicit identity: a weaker positive association with implicit identity and AUDIT scores was observed among men, potentially reflecting stigma against women's drinking. Findings suggest that drinking identity's potential as a risk factor for problematic drinking extends to a more general US sample and that both implicit and explicit identity should be targeted in prevention efforts.

Electrophysiological and Behavioral Effects of Combined Transcranial Direct Current Stimulation and Alcohol Approach Bias Retraining in Hazardous Drinkers

BACKGROUND

Cognitive bias modification (CBM) can be used to retrain automatic approach tendencies for alcohol. We investigated whether changing cortical excitability with transcranial direct current stimulation (tDCS) could enhance CBM effects in hazardous drinkers. We also studied the underlying mechanisms by including behavioral (craving, implicit associations, approach tendencies) and electrophysiological (event-related potentials) measurements.

METHODS

The analytical sample consisted of 78 hazardous drinkers (Alcohol Use Disorders Identification Test >8) randomly assigned to 4 conditions in a 2-by-2 factorial design (control/active CBM and sham/active tDCS). The intervention consisted of 3 sessions of CBM, specifically alcohol approach bias retraining, combined with 15 minutes 1 mA tDCS over the left dorsolateral prefrontal cortex. There was a pre- and postassessment before and after the intervention that included experimental tasks (Approach Avoidance Task, Implicit Association Task) and an electroencephalogram with an oddball and cue-reactivity task.

RESULTS

tDCS decreased cue-induced craving (but not overall craving) on postassessment. CBM did not induce an avoidance bias during assessment. During the training, active and control-CBM only differed in bias score during the first session. We found no enhancement effects of tDCS on CBM. Electrophysiological data showed no clear effects of active tDCS or CBM on the P300.

CONCLUSIONS

There were no electrophysiological or behavioral effects of repeated CBM and/or tDCS, except for an effect of tDCS on craving. Applied in these specific ways these techniques appear to have limited effects in a hazardous drinking population.

Applying the Implicit Association Test to Measure Intolerance of Uncertainty

Intolerance of Uncertainty (IU) is a key trans-diagnostic personality construct strongly associated with anxiety symptoms. Traditionally, IU is measured through self-report measures that are prone to bias effects due to impression management concerns and introspective difficulties. Moreover, self-report scales are not able to intercept the automatic associations that are assumed to be main determinants of several spontaneous responses (e.g., emotional reactions). In order to overcome these limitations, the Implicit Association Test (IAT) was applied to measure IU, with a particular focus on reliability and criterion validity issues. The IU-IAT and the Intolerance of Uncertainty Inventory (IUI) were administered to an undergraduate student sample (54 females and 10 males) with a mean age of 23 years (SD = 1.7). Successively, participants were asked to provide an individually chosen uncertain event from their own lives that may occur in the future and were requested to identify a number of potential negative consequences of it. Participants' responses in terms of cognitive thoughts (i.e., cognitive appraisal) and worry reactions toward these events were assessed using the two subscales of the Worry and Intolerance of Uncertainty Beliefs Questionnaire. The IU-IAT showed an adequate level of internal consistency and a not significant correlation with the IUI. A path analysis model, accounting for 35% of event-related worry, revealed that IUI had a significant indirect effect on the dependent variable through event-related IU thoughts. By contrast, as expected, IU-IAT predicted event-related worry independently from IU thoughts. In accordance with dual models of social cognition, these findings suggest that IU can influence event-related worry through two different processing pathways (automatic vs. deliberative), supporting the criterion and construct validity of the IU-IAT. The potential role of the IU-IAT for clinical applications was discussed.

Imaging the neural effects of cognitive bias modification training

Cognitive bias modification (CBM) was first developed as an experimental tool to examine the causal role of cognitive biases, and later developed into complementary interventions in experimental psychopathology research. CBM involves the "re-training" of implicit biases by means of multiple trials of computerized tasks, and has been demonstrated to change anxious, depressive and drug-seeking behavior, including clinically relevant effects. Recently, the field has progressed by combining CBM with neuroimaging techniques, which provides insight into neural mechanisms underlying how CBM affects implicit biases in anxiety, depression, and addiction, and potentially other pathologies. This narrative literature review summarizes the state of the art of studies on the neural effects of CBM and provides directions for future research in the field. A total of 13 published studies were found and discussed: n=9 in anxiety, n=2 in depressive behavior, and n=2 in addiction.

Not the same old thing: Establishing the unique contribution of drinking identity as a predictor of alcohol consumption and problems over time

Drinking identity-how much individuals view themselves as drinkers-is a promising cognitive factor that predicts problem drinking. Implicit and explicit measures of drinking identity have been developed (the former assesses more reflexive/automatic cognitive processes; the latter more reflective/controlled cognitive processes): each predicts unique variance in alcohol consumption and problems. However, implicit and explicit identity's utility and uniqueness as predictors relative to cognitive factors important for problem drinking screening and intervention has not been evaluated. Thus, the current study evaluated implicit and explicit drinking identity as predictors of consumption and problems over time. Baseline measures of drinking identity, social norms, alcohol expectancies, and drinking motives were evaluated as predictors of consumption and problems (evaluated every 3 months over 2 academic years) in a sample of 506 students (57% female) in their first or second year of college. Results found that baseline identity measures predicted unique variance in consumption and problems over time. Further, when compared to each set of cognitive factors, the identity measures predicted unique variance in consumption and problems over time. Findings were more robust for explicit versus implicit identity and in models that did not control for baseline drinking. Drinking identity appears to be a unique predictor of problem drinking relative to social norms, alcohol expectancies, and drinking motives. Intervention and theory could benefit from including and considering drinking identity. (PsycINFO Database Record

Evaluating the effectiveness of a smartphone app to reduce excessive alcohol consumption: protocol for a factorial randomised control trial

Background

Excessive alcohol consumption is a leading cause of death and morbidity worldwide and interventions to help people reduce their consumption are needed. Interventions delivered by smartphone apps have the potential to help harmful and hazardous drinkers reduce their consumption of alcohol. However, there has been little evaluation of the effectiveness of existing smartphone interventions.

A systematic review, amongst other methodologies, identified promising modular content that could be delivered by an app: self-monitoring and feedback; action planning; normative feedback; cognitive bias re-training; and identity change. This protocol reports a factorial randomised controlled trial to assess the comparative potential of these five intervention modules to reduce excessive alcohol consumption.

Methods

A between-subject factorial randomised controlled trial. Hazardous and harmful drinkers aged 18 or over who are making a serious attempt to reduce their drinking will be randomised to one of 32 (2⁵) experimental conditions after downloading the ‘Drink Less’ app. Participants complete baseline measures on downloading the app and are contacted after 1-month with a follow-up questionnaire. The primary outcome measure is change in past week consumption of alcohol. Secondary outcome measures are change in AUDIT score, app usage data and usability ratings for the app. A factorial between-subjects ANOVA will be conducted to assess main and interactive effects of the five intervention modules for the primary and secondary outcome measures.

Discussion

This study will establish the extent to which the five intervention modules offered in this app can help reduce hazardous and harmful drinking. This is the first step in optimising and understanding what component parts of an app could help to reduce excessive alcohol consumption. The findings from this study will be used to inform the content of a future integrated treatment app and evaluated against a minimal control in a definitive randomised control trial with long-term outcomes.

Trial registration

ISRCTN40104069 Date of registration: 10/2/2016

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3140-8) contains supplementary material, which is available to authorized users.

Re-training automatic action tendencies to approach cigarettes among adolescent smokers: a pilot study

BACKGROUND

This pilot study conducted a preliminary examination of whether Cognitive Bias Modification (CBM), a computerized task to retrain cognitive-approach biases towards smoking stimuli (a) changed approach bias for cigarettes, and (b) improved smoking cessation outcomes in adolescent smokers.

METHODS

Sixty adolescent smokers received four weeks of Cognitive Behavioral Therapy (CBT) for smoking cessation, with CBM (90% avoidance/10% approach for smoking stimuli and 10% avoidance/90% approach for neutral stimuli) or sham (50% avoidance/50% approach for smoking and neutral stimuli) training in the Netherlands (n = 42) and the United States (n = 18).

RESULTS

While we did not observe changes in action tendencies related to CBM, adolescents with higher smoking approach biases at baseline had greater decreases in approach biases at follow-up, compared to adolescents with smoking avoidance biases, regardless of treatment condition (p = 0.01). Intent-to-treat (ITT) analyses showed that CBM, when compared with sham trended toward higher end-of-treatment, biochemically-confirmed, seven-day point prevalence abstinence, (17.2% vs. 3.2%, p = 0.071). ITT analysis also showed that regardless of treatment condition, cotinine level (p = 0.045) and average number of cigarette smoked (p ≤ 0.001) significantly decreased over the course of treatment.

CONCLUSIONS

The findings from this pilot study suggests that re-training approach biases toward cigarettes shows promise for smoking cessation among adolescent smokers. Future research should utilize larger samples and increased distinction between CBM and sham conditions, and examine mechanisms underlying the CBM approach.

Daily associations between emotional functioning and alcohol involvement: Moderating effects of response inhibition and gender

BACKGROUND

Research has linked tonic and variable mood to problematic alcohol use, both between- and within-subjects. Indices of behavioral control have moderated these links, at least at the between-subjects level. The current study examines daily associations between indices of emotional functioning and alcohol involvement as a function of response inhibition.

METHODS

College student drinkers (n=74; 58.11% female) were enrolled in a study on emotion and alcohol use. Participants completed a stop-signal task as an index of response inhibition. They then carried a personal data device for 21 days, reporting daily on mood, alcohol use, and acute alcohol use disorder symptoms. Mood instability was the mean square of successive differences from daily mood assessments.

RESULTS

There were 1309 person days (622 drinking days) available for analysis. Pre-drinking mood instability was positively associated the likelihood of drinking and drinks consumed on drinking days. The former association was diminished among women with high response inhibition. Pre-drinking positive mood was positively associated the likelihood of drinking and drinks consumed on drinking days. The latter association was diminished among women with high response inhibition. Pre-drinking negative mood was positively associated with drinks consumed on drinking days among women with low response inhibition. Finally, pre-drinking positive mood was associated with acute alcohol use disorder symptoms among those with low response inhibition.

CONCLUSIONS

These results suggest that interventions targeting positive mood may be particularly important. Further, developing ways to improve response inhibition control may broadly influence negative drinking outcomes by affecting multiple mood-drinking associations.

Emotional self-control and dysregulation: A dual-process analysis of pathways to externalizing/internalizing symptomatology and positive well-being in younger adolescents

OBJECTIVES

There is little knowledge about how emotional regulation contributes to vulnerability versus resilience to substance use disorder. With younger adolescents, we studied the pathways through which emotion regulation attributes are related to predisposing factors for disorder.

METHODS

A sample of 3561 adolescents (M age 12.5 years) was surveyed. Measures for emotional self-control (regulation of sadness and anger), emotional dysregulation (angerability, affective lability, and rumination about sadness or anger), and behavioral self-control (planfulness and problem solving) were obtained. A structural model was analyzed with regulation attributes related to six intermediate variables that are established risk or protective factors for adolescent substance use (e.g., academic involvement, stressful life events). Criterion variables were externalizing and internalizing symptomatology and positive well-being.

RESULTS

Indirect pathways were found from emotional regulation to symptomatology through academic competence, stressful events, and deviance-prone attitudes and cognitions. Direct effects were also found: from emotional dysregulation to externalizing and internalizing symptomatology; emotional self-control to well-being; and behavioral self-control (inverse) to externalizing symptomatology. Emotional self-control and emotional dysregulation had independent effects and different types of pathways.

CONCLUSIONS

Adolescents scoring high on emotional dysregulation are at risk for substance dependence because of more externalizing and internalizing symptomatology. Independently, youth with better behavioral and emotional self-control are at lower risk. This occurs partly through relations of regulation constructs to environmental variables that affect levels of symptomatology (e.g., stressful events, poor academic performance). Effects of emotion regulation were found at an early age, before the typical onset of substance disorder.

The natural expression of individual differences in self-reported level of response to alcohol during ecologically assessed drinking episodes

RATIONALE

Low sensitivity to alcohol is a well-established risk factor for alcohol use disorder (AUD). However, little is known about how the low sensitivity phenotype is expressed on a fine-grained, momentary level in drinkers' daily experience.

OBJECTIVES

The objective of the study is to evaluate individual differences in subjective states and appraisals of alcoholic beverages during the ascending limb of real-world drinking episodes.

METHODS

Social drinkers (N = 398) with varying degrees of alcohol sensitivity as indexed by the Self-Rating of the Effects of Alcohol form (SRE; Schuckit et al. in Addiction 92:979-988, 1997a) recorded diary entries over a 3-week monitoring period (2576 drinking episodes containing 6546 moments). Hierarchical linear modeling was used to evaluate whether individual differences in alcohol sensitivity predicted differing intra-episode estimated blood alcohol concentration (eBAC) trajectories, ratings of subjective states, and drink appraisals.

RESULTS

Lower self-reported alcohol sensitivity was associated with consuming "too much, too fast," as indicated by a steeper slope of ascending eBAC. In models adjusted for momentary eBAC level, participants reporting lower alcohol sensitivity at baseline showed blunted subjective intoxication and drink-contingent punishment.

CONCLUSIONS

The results suggest that low sensitivity to alcohol is associated with a blunting of some forms of subjective feedback (i.e., perceptions of intoxication and punishment) that might typically encourage drinking restraint. This may 'tip the scales' toward excess consumption and could help to explain why a low alcohol sensitivity forecasts AUD.

Circuitry of self-control and its role in reducing addiction

We discuss the idea that addictions can be treated by changing the mechanisms involved in self-control with or without regard to intention. The core clinical symptoms of addiction include an enhanced incentive for drug taking (craving), impaired self-control (impulsivity and compulsivity), negative mood, and increased stress re-activity. Symptoms related to impaired self-control involve reduced activity in control networks including anterior cingulate (ACC), adjacent prefrontal cortex (mPFC), and striatum. Behavioral training such as mindfulness meditation can increase the function of control networks and may be a promising approach for the treatment of addiction, even among those without intention to quit.

Trajectories of drinking urges and the initiation of abstinence during cognitive-behavioral alcohol treatment

BACKGROUND AND AIMS

Drinking urges during treatment for alcohol use disorders (AUDs) are common, can cause distress and predict relapse. Clients may have little awareness of how their drinking urges might be expected to change during AUD treatment in general and in response to initiating abstinence. The aim of the present study was to test whether drinking urges change on a daily level during treatment and after initiating abstinence.

DESIGN

Secondary data analysis was performed using daily drinking urge ratings from two randomized clinical trials.

SETTING AND PARTICIPANTS

Women (n = 98) and men (n = 79) with AUDs in separate clinical trials of out-patient AUD-focused cognitive-behavioral therapy.

MEASUREMENTS

Daily dichotomous indicators of any drinking urges or acute escalations in urges (i.e. at least two more urges compared with the previous day) were examined using generalized linear mixed growth-curve modeling.

FINDINGS

Participants who initiated abstinence reported reductions in urges immediately thereafter (log odds ratios: women B = -0.701, P < 0.001; men B = -0.628, P = 0.018), followed by additional, gradual reductions over time (women B = -0.118, P < 0.001; men B = -0.141, P < 0.001). Participants who entered treatment abstaining from alcohol also reported significant reductions in urges over time (women B = -0.147, P < 0.001; men B = -0.142, P < 0.001). Participants who drank throughout treatment had smaller (women B = -0.042, P = 0.012) or no reductions in urges (men B = 0.015, P = 0.545). There was no evidence that urges increased systematically in response to initiating abstinence.

CONCLUSIONS

Drinking urges during out-patient behavioral treatment for alcohol use disorders may be maintained in part by alcohol consumption. Initiating abstinence is associated with reductions in drinking urges immediately and then more gradually over time.

Testing the Implicit and Explicit Cognitions Underlying Behavioral Inhibition System-Related Drinking in Young Adults

BACKGROUND

There is great interest in the role of the behavioral inhibition system (BIS) and the behavioral approach system (BAS) in the etiology of alcohol use because of the strong links of these systems to neuroscience and cognitive models of addiction. The revised Reinforcement Sensitivity Theory suggests that the strength of the BIS and BAS jointly influences behavior, so-called the joint systems hypothesis. Yet, relatively little work has examined this hypothesis, particularly with respect to alcohol information processing. Grounded in dual-process theories of alcohol information processing, this study aimed to clarify the roles of implicit (i.e., automatic processes) and explicit (i.e., controlled processes) cognitions in BIS-related drinking. When anxious and presented with an alcohol (vs. neutral) cue, we expected those with an elevated BIS to have increased implicit and explicit alcohol cognitions related to tension reduction, but only at elevated BAS. Shifts in cognitions following cue exposure were expected to positively correlate with alcohol misuse.

METHODS

Students (N = 110) completed baseline measures followed by the Trier Social Stress Test. This was followed by a cue exposure (random assignment to alcohol or water cue), during which participants completed postmood assessments of implicit/explicit alcohol cognitions.

RESULTS

Overall, participants' implicit alcohol cognition was negative. The effect of BIS on implicit and explicit cognitions was moderated by BAS; however, results were not as hypothesized. In the alcohol condition only (when controlling for baseline implicit cognition), BIS predicted relatively weak implicit negative alcohol cognition, but only at low BAS. Interestingly, in the alcohol condition only, BIS predicted increased explicit reward (but not relief) expectancies, but only at high BAS. Changes in explicit reward expectancies positively correlated with alcohol misuse.

CONCLUSIONS

Our results suggest that explicit cognitions may be relevant to drinking among anxious individuals who are also reward responsive. Cognitive behavioral interventions should target reward expectancies to reduce anxiety-related drinking.

Development of an adolescent alcohol misuse intervention based on the Prototype Willingness Model

Purpose

– The purpose of this paper is to report on the use of the Delphi method to gain expert feedback on the identification of behaviour change techniques (BCTs) and development of a novel intervention to reduce adolescent alcohol misuse, based on the Prototype Willingness Model (PWM) of health risk behaviour.

Design/methodology/approach

– Four BCTs based on the PWM were identified and incorporated into a draft intervention that aimed to change alcohol prototypes and enable adolescents to deal with social pressure. Using the Delphi process, successive questionnaires were distributed to 20 international experts to build consensus on the theoretical validity of the intervention.

Findings

– In total, 15 experts completed round 1 and 11 completed round 2 of the Delphi study. A high level of consensus was achieved. Four priority areas were identified to improve the intervention: incorporating extra techniques to address social pressure; increasing intensity; providing incentives; and addressing credibility.

Research limitations/implications

– The sample of experts was self-selected and four participants were lost between the first and second round of the study.

Practical implications

– The effectiveness of the identified BCTs will be evaluated within an intervention to reduce alcohol misuse in adolescents. Further work should build towards a more unified approach to developing interventions based on the PWM. The Delphi method is likely to be particularly useful when there is no existing consensus about which BCTs to use that reflect certain theoretical constructs or that best target a specific population or behaviour.

Originality/value

– This paper is the first to address the identification of specific BCTs based on the PWM and thus makes an important contribution to the application of this model to interventions. This novel application of the Delphi method also makes a useful addition to the growing field of intervention development and design.

The Association of Level of Internet Use with Suicidal Ideation and Suicide Attempts in South Korean Adolescents: A Focus on Family Structure and Household Economic Status

OBJECTIVE

To examine the association between the level of Internet addiction and suicidal ideation and suicide attempts in South Korean adolescents, focusing on the roles of family structure and household economic status.

METHODS

Data from 221 265 middle and high school students taken from the 2008-2010 Korea Youth Risk Behavior Web-based Survey were used in this study. To identify factors associated with suicidal ideation/attempts, multiple logistic regression analysis was performed. The level of Internet use was measured using the simplified Korean Internet Addiction Self-assessment Tool.

RESULTS

Compared with mild users of the Internet, high-risk users and potential-risk users were more likely to report suicidal ideation (nonuser, odds ratio [OR] 1.10, 95% confidence interval [CI] 1.05 to 1.15; potential risk, OR 1.49, 95% CI: 1.36 to 1.63; high risk OR 1.94, 95% CI 1.79 to 2.10) or attempts (nonuser, OR 1.33, 95% CI 1.25 to 1.42; potential risk, OR 1.20, 95% CI 1.04 to 1.38; high risk, OR 1.91, 95% CI 1.71 to 2.14). The nonuser group also had a slightly higher risk of suicidal ideation/attempts compared with mild users. This association appeared to vary by perceived economic status and family structure.

CONCLUSIONS

Our study suggests that it is important to attend to adolescents who are at high risk for Internet addiction, especially when they do not have parents, have stepparents, or perceive their economic status as either very low or very high.

Annual Research Review: On the developmental neuropsychology of substance use disorders

BACKGROUND

Adolescence represents a period of development during which critical biological, as well as social and cognitive, changes occur that are necessary for the transition into adulthood. A number of researchers have suggested that the pattern of normative brain changes that occurs during this period not only predisposes adolescents to engage in risk behaviours, such as experimentation with drugs, but that they additionally make the adolescent brain more vulnerable to the direct pharmacological impact of substances of abuse. The neural circuits that we examine in this review involve cortico-basal-ganglia/limbic networks implicated in the processing of rewards, emotion regulation, and the control of behaviour, emotion and cognition.

FINDINGS AND CONCLUSIONS

We identify certain neurocognitive and personality/comorbidity-based risk factors for the onset of substance misuse during adolescence, and summarise the evidence suggesting that these risk factors may be further impacted by the direct effect of drugs on the underlying neural circuits implicated in substance misuse vulnerability.

Implicit and explicit measures of spider fear and avoidance behavior: Examination of the moderating role of working memory capacity

BACKGROUND AND OBJECTIVES

Avoidance behavior is central to several anxiety disorders. The current study tested whether avoidance behavior for spiders depends on a dynamic interplay between implicit and explicit processes, moderated by the availability to exert control through working memory capacity (WMC).

METHODS

A total of 63 participants completed an approach-avoidance task, an implicit association test, a spider fear questionnaire and a behavioral avoidance test that included an assessment of approach distance as well as approach speed. WMC was measured by a complex operation span task. It was hypothesized that in individuals with low WMC, implicit avoidance tendencies and implicit negative associations predict avoidance behavior for a spider better than the explicit measure, whereas in high WMC individuals, the explicit measure should better predict avoidance behavior than the implicit measures.

RESULTS

Results revealed that WMC moderated the influence of implicit negative associations, but not implicit avoidance tendencies, on spider approach distance but not the speed of approaching. Although explicit spider fear directly influenced avoidance behavior, its impact was not modulated by WMC.

LIMITATIONS

Participants in our study were from a non-clinical sample, which limits the generalizability of our findings.

CONCLUSIONS

These findings suggest that implicit processes might become more pertinent for fear behavior as the ability to control such processes wanes, which may be particularly relevant for anxiety disorders given their association with lowered executive control functioning. As such, training procedures that specifically target implicit processes or control abilities might improve treatment outcomes for anxiety disorders.

Assessment of Tobacco-Related Approach and Attentional Biases in Smokers, Cravers, Ex-Smokers, and Non-Smokers

According to theories of addictive behaviors, approach and attentional biases toward smoking-related cues play a crucial role in tobacco dependence. Several studies have investigated these biases by using various paradigms in different sample types. However, this heterogeneity makes it difficult to compare and evaluate the results. The present study aimed to address this problem, via (i) a structural comparison of different measures of approach-avoidance and a measure of smoking-related attentional biases, and (ii) using within one study different representative samples in the context of tobacco dependence. Three measures of approach-avoidance were employed: an Approach Avoidance Task (AAT), a Stimulus Response Compatibility Task (SRC), and a Single Target Implicit Association Test (ST-IAT). To assess attentional biases, a modified Stroop task including smoking-related words was administered. The study included four groups: n = 58 smokers, n = 57 non-smokers, n = 52 cravers, and n = 54 ex-smokers. We expected to find strong tobacco-related approach biases and attentional biases in smokers and cravers. However, the general pattern of results did not confirm these expectations. Approach responses assessed during the AAT and SRC did not differ between groups. Moreover, the Stroop did not show the expected interference effect. For the ST-IAT, cravers had stronger approach associations toward smoking-related cues, whereas non-smokers showed stronger avoidance associations. However, no such differences in approach-avoidance associations were found in smokers and ex-smokers. To conclude, these data do not provide evidence for a strong role of implicit approach and attentional biases toward smoking-related cues in tobacco dependency.

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.

The development of automatic emotion regulation in an implicit emotional Go/NoGo paradigm and the association with depressive symptoms and anhedonia during adolescence

Impaired automatic emotion regulation (AER) is closely related to major depressive disorder. Our research in adults has identified two AER-related components, Go N2 and NoGo P3, in an implicit emotional Go/NoGo paradigm. However, it is unclear whether Go N2 and NoGo P3 reflect the development of AER in adolescents and the relationship of these components with subclinical depressive symptoms and trait anhedonia. We collected EEG data from 55 adolescents while they completed the implicit emotional Go/NoGo task. After the experiment, the subjects completed the Chinese version of the Temporal Experience of Pleasure Scale and the Beck Depression Inventory. Consistent with results in adults, we determined that Go N2 represents automatic top-down attention to emotions in Go trials, whereas NoGo P3 represents automatic response inhibition in NoGo trials. These AER components exhibited age-dependent improvement during adolescence. Additionally, NoGo P3 amplitudes elicited by viewing positive faces were positively correlated with trait anhedonia, whereas NoGo P3 amplitudes elicited by viewing negative faces were negatively correlated with depressive symptoms. Our observations provide further understanding of the neurodevelopmental mechanism of AER and yield new insight into dissociable impairments in AER in adolescents with major depressive disorder during positive and negative implicit processing.

•

We studied the development of automatic emotion regulation in adolescents.

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Go N2 reflects automatic top-down attention to emotions in Go trials.

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NoGo P3 reflects automatic response inhibition in NoGo trials.

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NoGo P3 amplitudes of positive faces correlate positively with anhedonia.

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NoGo P3 amplitudes of negative faces correlate negatively with depressive symptoms.

Toward Development of Enhanced Preventive Interventions for HIV Sexual Risk among Alcohol-Using Populations: Confronting the 'Mere Pause from Thinking'

The papers in this issue detail state-of-the science knowledge regarding the role of alcohol use in HIV/AIDS risk, as well as offer suggestions for ways forward for behavioral HIV prevention for at-risk alcohol-using populations. In light of recent evidence suggesting that the anticipated uptake of the newer biomedical HIV prevention approaches, prominently including pre-exposure prophylaxis, has been stalled owing to a host of barriers, it has become ever more clear that behavioral prevention avenues must continue to receive due consideration as a viable HIV/AIDS prevention approach. The papers collected here make a valuable contribution to "combination prevention" efforts to curb HIV spread.

Event-related potentials reflecting smoking cue reactivity and cognitive control as predictors of smoking relapse and resumption

RATIONALE

Given that most attempts to quit smoking fail, it is critical to increase knowledge about the mechanisms involved in smoking relapse and resumption (i.e., the increase in smoking over time after a quit attempt). Neurocognitive measures, such as event-related potentials (ERPs), may provide novel insights into smoking relapse and resumption.

OBJECTIVES

The objective of the present study is to investigate the association between smoking relapse and resumption and ERPs reflecting smoking cue reactivity (i.e., P300, LPP), inhibitory control (i.e., N2, P3), and error processing (i.e., error-related negativity (ERN), Pe).

METHODS

Seventy-two smokers viewed smoking and neutral pictures and performed a Go-NoGo and an Eriksen Flanker task, while ERPs were measured using electroencephalography. All smokers started a quit attempt in the week following the laboratory visit. Smoking behavior after the quit attempt was measured at 4, 8, and 12 weeks. Both relapse (i.e., 7-day point prevalence at 12 weeks) and smoking resumption (i.e., the number of cigarettes a day at 4, 8, and 12 weeks) were used as outcome measures.

RESULTS

Logistic regression analyses showed that smaller P3 amplitudes, reflecting brain activation associated with inhibitory control, are related to an increased relapse risk. Latent growth curve analyses showed that reduced post-error slowing, the main behavioral measure reflecting error processing, is associated with stronger smoking resumption. ERPs reflecting smoking cue reactivity were unrelated to smoking relapse or resumption.

CONCLUSIONS

The finding that smaller inhibitory control-related P3 amplitudes are associated with increased relapse risks suggests that strategies to increase inhibitory control in smokers are worth further investigation in the search for more effective smoking cessation interventions.

Research on the Effects of Alcohol and Sexual Arousal on Sexual Risk in Men who have Sex with Men: Implications for HIV Prevention Interventions

The purpose of this paper was to describe and appraise the research evidence on the effects of acute alcohol intoxication and sexual arousal on sexual risk behaviors in men who have sex with men (MSM) and to examine its implications for design of HIV prevention interventions that target MSM. Toward that end, the paper begins with a discussion of research on sexual arousal in men and alcohol and their acute effects on sexual behaviors. This is followed by a review of empirical evidence on the combined acute effects of alcohol and sexual arousal in heterosexual men (the large majority of studies) and then in MSM. The empirical evidence and related theoretical developments then are integrated to derive implications for developing effective HIV prevention interventions that target MSM.

Acute Effects of Intoxication and Arousal on Approach/Avoidance Biases Toward Sexual Risk Stimuli in Heterosexual Men

This study tested the effects of alcohol intoxication and physiological arousal on cognitive biases toward erotic stimuli and condoms. Ninety-seven heterosexual men were randomized to 1 of 6 independent conditions in a 2 (high arousal or control) × 3 (alcohol target BAC = 0.08, placebo, or juice control) design and then completed a variant of the Approach-Avoidance Task (AAT). The AAT assessed reaction times toward approaching and avoiding erotic stimuli and condoms with a joystick. Consistent with hypotheses, the alcohol condition exhibited an approach bias toward erotic stimuli, whereas the control and placebo groups exhibited an approach bias toward condom stimuli. Similarly, the participants in the high arousal condition exhibited an approach bias toward erotic stimuli and the low arousal control condition exhibited an approach bias toward condoms. The results suggest that acute changes in intoxication and physiological arousal independently foster biased responding toward sexual stimuli and these biases are associated with sexual risk intentions.