Binge drinking and the differential influence of ethanol on cognitive control subprocesses: a novel field of neurotoxicology

Automatic aspects of response selection remain unchanged during high-dose alcohol intoxication

Regular binge-drinking increases the risk of developing alcohol use disorder (AUD) and induces similar acute effects on behavioral control, particularly in case of response selection conflicts. No such effects have been reported for automatic/bottom-up response selection, even though AUD alters automaticity. However, it has never been reliably tested whether this domain is truly unchanged during high-dose alcohol intoxication. To investigate this question with the help of Bayesian analyses, we subjected n=31 young healthy male participants to a within-subject design, where each participant was tested twice in a counter-balanced order (ie, once sober and once intoxicated at 1.1‰). On each appointment, the participants performed the S-R paradigm, which assesses automatic stimulus-response (S-R) binding within the framework of the theory of event coding (TEC). In short, the TEC states that stimulus features and responses become encoded in an event file when they occur simultaneously. These event files will be reactivated by any matching stimulus feature, thus facilitating the encoded response (and hampering different responses). Alcohol led to a general decrease in behavioral performance, as demonstrated by significant main effects of intoxication status on accuracy and response times (all P ≤ .009). We also reproduced typical task effects, but did not find any significant interactions with the intoxication factor (all P ≥ .099). The latter was further substantiated by Bayesian analyses providing positive to strong evidence for the null hypothesis. Taken together, our results demonstrate that even high-dose alcohol intoxication does not impair automatic response selection/S-R associations.

The Effects of Alcohol Hangover on Executive Functions

Recent research has suggested that processes reliant on executive functions are impaired by an alcohol hangover, yet few studies have investigated the effect of hangovers on core executive function processes. Therefore, the current study investigated the effect of hangovers on the three core components of the unity/diversity model of executive functions: the ability to switch attention, update information in working memory, and maintain goals. Thirty-five 18-to-30-year-old non-smoking individuals who reported experiencing a hangover at least once in the previous month participated in this study. They completed tasks measuring switching (number-switching task), updating (n-back task), and goal maintenance (AX Continuous Performance Test, AX-CPT) whilst experiencing a hangover and without a hangover in a 'naturalistic' within-subjects crossover design. Participants made more errors in the switching task (p = 0.019), more errors in both the 1- (p < 0.001) and 2-back (p < 0.001) versions of the n-back, and more errors in the AX-CPT (p = 0.007) tasks when experiencing a hangover, compared to the no-hangover condition. These results suggest that an alcohol hangover impairs core executive function processes that are important for everyday behaviours, such as decision-making, planning, and mental flexibility.

Acute Alcohol Effects on Response Inhibition Depend on Response Automatization, but not on GABA or Glutamate Levels in the ACC and Striatum

Alcohol increases GABAergic signaling and decreases glutamatergic signaling in the brain. Variations in these neurotransmitter levels may modulate/predict executive functioning. Matching this, strong impairments of response inhibition are one of the most consistently reported cognitive/behavioral effects of acute alcohol intoxication. However, it has never been investigated whether baseline differences in these neurotransmitters allow to predict how much alcohol intoxication impairs response inhibition, and whether this is reflected in neurophysiological measures of cognitive control. We used MR spectroscopy to assess baseline (i.e., sober) GABA and glutamate levels in the anterior cingulate cortex (ACC) and striatum in n = 30 healthy young males, who were subsequently tested once sober and once intoxicated (1.01 permille). Inhibition was assessed with the sustained attention to response task (SART). This paradigm also allows to examine the effect of different degrees of response automatization, which is a known modulator for response inhibition, but does not seem to be substantially impaired during acute intoxication. As a neurophysiological correlate of response inhibition and control, we quantified EEG-derived theta band power and located its source using beamforming analyses. We found that alcohol-induced response inhibition deficits only occurred in the case of response automatization. This was reflected by decreased theta band activity in the left supplementary motor area (SMA), which may reflect modulations in the encoding of a surprise signal in response to inhibition cues. However, we did not find that differences in baseline (i.e., sober) GABA or glutamate levels significantly modulated differences in the size of alcohol-induced inhibition deficits.

Detrimental effects of a high-dose alcohol intoxication on sequential cognitive flexibility are attenuated by practice

It is well-known that alcohol impairs behavioral control and motor response inhibition, but it has remained rather unclear whether it also impairs cognitive inhibition. As automatized behavior is less vulnerable towards the detrimental effects of alcohol than cognitive control processes, potential cognitive inhibition deficits might however improve with training. We investigated the effect of an acute, binge-like alcohol intoxication in a balanced within-subjects design, asking n=32 healthy young males to perform a backward inhibition paradigm once sober and once while intoxicated (~1.1 ‰). To identify the underlying neurophysiological mechanisms, we analyzed stimulus- and response selection-related processes in neurophysiological data after Residue Iteration Decomposition (RIDE). Alcohol generally impaired behavioral task performance (accuracy and response times) during task switching. This was associated with impaired attentional processing of the task-relevant cue (reflected by reduced P1 and N1 amplitudes), which likely resulted in a larger need for reactive control at the later stage of response selection and control (reflected by increased fronto-central theta power). Without prior practice (~30 minutes), the intoxicated participants further struggled to overcome the cognitive inhibition of a previously relevant task set (reflected by a larger backward inhibition effect). This was linked to reduced posterior theta power, which reflects alcohol-induced impairments in working memory capacity and task set-relevant memory retrieval. As individuals with ~30 min task practice did not show the same alcohol-related deficit, it may be deduced that (partial) task set automatization via stimulus-response associations may help to reduce the detrimental effects of alcohol on cognitive inhibition during task switching.

Effects of high-dose ethanol intoxication and hangover on cognitive flexibility

The effects of high-dose ethanol intoxication on cognitive flexibility processes are not well understood, and processes related to hangover after intoxication have remained even more elusive. Similarly, it is unknown in how far the complexity of cognitive flexibility processes is affected by intoxication and hangover effects. We performed a neurophysiological study applying high density electroencephalography (EEG) recording to analyze event-related potentials (ERPs) and perform source localization in a task switching paradigm which varied the complexity of task switching by means of memory demands. The results show that high-dose ethanol intoxication only affects task switching (i.e. cognitive flexibility processes) when memory processes are required to control task switching mechanisms, suggesting that even high doses of ethanol compromise cognitive processes when they are highly demanding. The EEG and source localization data show that these effects unfold by modulating response selection processes in the anterior cingulate cortex. Perceptual and attentional selection processes as well as working memory processes were only unspecifically modulated. In all subprocesses examined, there were no differences between the sober and hangover states, thus suggesting a fast recovery of cognitive flexibility after high-dose ethanol intoxication. We assume that the gamma-aminobutyric acid (GABAergic) system accounts for the observed effects, while they can hardly be explained by the dopaminergic system.

Low-level alcohol consumption during adolescence and its impact on cognitive control development

Adolescence is a critical period for maturation of cognitive control and most adolescents start experimenting with alcohol around that time. On the one hand, recent studies indicate that low control abilities predict future problematic alcohol use. On the other hand, binge drinking during young adulthood can (further) impair cognitive control. However, so far no study examined the effects of low-level alcohol use during adolescence. In the present longitudinal fMRI study, we therefore investigated the development of cognitive control in a community-based sample of 92 adolescents at ages 14, 16 and 18. Two different cognitive control functions, i.e. inhibition of pre-potent responses (operationalized by incongruence effects) and switching between different task sets, were measured within one task. Alcohol use in our sample was low (mean: 54 g/week at age 18). The study revealed that neither behavioural nor neural measures of cognitive control function at age 14 predicted alcohol use at age 18 but confirmed established predictors such as gender and personality. As expected, from age 14 to 18, cognitive control abilities were improving (decreased reaction times and/or errors), and activation of cognitive control networks (dorsal anterior cingulate cortex and pre-supplementary motor area) during incongruent trials increased. Unexpectedly, higher alcohol consumption during adolescence was associated with a more pronounced increase in cognitive performance and a smaller increase of neural activation when incongruent trials afforded inhibitory control. We conclude that low-level alcohol use during adolescence does not severely impair ongoing maturation of cognitive control abilities and networks.

Effects of binge drinking and hangover on response selection sub-processes-a study using EEG and drift diffusion modeling

Effects of binge drinking on cognitive control and response selection are increasingly recognized in research on alcohol (ethanol) effects. Yet, little is known about how those processes are modulated by hangover effects. Given that acute intoxication and hangover seem to be characterized by partly divergent effects and mechanisms, further research on this topic is needed. In the current study, we hence investigated this with a special focus on potentially differential effects of alcohol intoxication and subsequent hangover on sub-processes involved in the decision to select a response. We do so combining drift diffusion modeling of behavioral data with neurophysiological (EEG) data. Opposed to common sense, the results do not show an impairment of all assessed measures. Instead, they show specific effects of high dose alcohol intoxication and hangover on selective drift diffusion model and EEG parameters (as compared to a sober state). While the acute intoxication induced by binge-drinking decreased the drift rate, it was increased by the subsequent hangover, indicating more efficient information accumulation during hangover. Further, the non-decisional processes of information encoding decreased with intoxication, but not during hangover. These effects were reflected in modulations of the N2, P1 and N1 event-related potentials, which reflect conflict monitoring, perceptual gating and attentional selection processes, respectively. As regards the functional neuroanatomical architecture, the anterior cingulate cortex (ACC) as well as occipital networks seem to be modulated. Even though alcohol is known to have broad neurobiological effects, its effects on cognitive processes are rather specific.

High-dose alcohol intoxication differentially modulates cognitive subprocesses involved in response inhibition

Aside from well-known physiological effects, high-dose alcohol intoxication (a.k.a. binge drinking) can lead to aversive social and legal consequences because response inhibition is usually compromised under the influence of alcohol. Although the behavioral aspects of this phenomenon were reported on extensively, the underlying neurophysiological mechanisms mediating this disinhibition are unclear. To close this gap, we used both behavioral and neurophysiological measures (event-related potentials, ERPs) to investigate which subprocesses of response inhibition are altered under the influence of high-dose alcohol intoxication. Using a within-subject design, we asked young healthy participants (n = 27) to complete a GO/NOGO task once sober and once intoxicated (approximately 1.2‰). During intoxication, high-dose alcohol effects were highest in a condition where the participants could not rely on automated stimulus-response mapping processes during response inhibition. In this context, the NOGO-P3 (ERP), that likely depends on dopaminergic signaling within mesocorticolimbic pathways and is thought to reflect motor inhibition and/or the evaluation of inhibitory processes, was altered in the intoxicated state. In contrast to this, the N2 component, which largely depends on nigrostriatal dopamine pathways and is thought to reflect inhibition on a pre-motor level, was not altered. Based on these results, we demonstrate that alcohol-induced changes of dopaminergic neurotransmission do not exert a global effect on response inhibition. Instead, changes are highly subprocess-specific and seem to mainly target mesocorticolimbic pathways that contribute to motor inhibition and the evaluation of such.