An experimental test of affect, subjective craving, and alcohol outcome expectancies as motivators of young adult drinking

Evidence for incentive salience sensitization as a pathway to alcohol use disorder

The incentive salience sensitization (ISS) theory of addiction holds that addictive behavior stems from the ability of drugs to progressively sensitize the brain circuitry that mediates attribution of incentive salience (IS) to reward-predictive cues and its behavioral manifestations. In this article, we establish the plausibility of ISS as an etiological pathway to alcohol use disorder (AUD). We provide a comprehensive and critical review of evidence for: (1) the ability of alcohol to sensitize the brain circuitry of IS attribution and expression; and (2) attribution of IS to alcohol-predictive cues and its sensitization in humans and non-human animals. We point out gaps in the literature and how these might be addressed. We also highlight how individuals with different alcohol subjective response phenotypes may differ in susceptibility to ISS as a pathway to AUD. Finally, we discuss important implications of this neuropsychological mechanism in AUD for psychological and pharmacological interventions attempting to attenuate alcohol craving and cue reactivity.

Morphological and functional evidence of increased excitatory signaling in the prelimbic cortex during ethanol withdrawal

Excessive alcohol consumption in humans induces deficits in decision making and emotional processing, which indicates a dysfunction of the prefrontal cortex (PFC). The present study aimed to determine the impact of chronic intermittent ethanol (CIE) inhalation on mouse medial PFC pyramidal neurons. Data were collected 6-8 days into withdrawal from 7 weeks of CIE exposure, a time point when mice exhibit behavioral symptoms of withdrawal. We found that spine maturity in prelimbic (PL) layer 2/3 neurons was increased, while dendritic spines in PL layer 5 neurons or infralimbic (IL) neurons were not affected. Corroborating these morphological observations, CIE enhanced glutamatergic transmission in PL layer 2/3 pyramidal neurons, but not IL layer 2/3 neurons. Contrary to our predictions, these cellular alterations were associated with improved, rather than impaired, performance in reversal learning and strategy switching tasks in the Barnes maze at an earlier stage of chronic ethanol exposure (5-7 days withdrawal from 3 to 4 weeks of CIE), which could result from the anxiety-like behavior associated with ethanol withdrawal. Altogether, this study adds to a growing body of literature indicating that glutamatergic activity in the PFC is upregulated following chronic ethanol exposure, and identifies PL layer 2/3 pyramidal neurons as a sensitive target of synaptic remodeling. It also indicates that the Barnes maze is not suitable to detect deficits in cognitive flexibility in CIE-withdrawn mice.

Motivational factors and negative affectivity as predictors of alcohol craving

Craving is thought to play an important role in alcohol use disorders. The recent inclusion of "craving" as a formal diagnostic symptom calls for further investigation of this subjective phenomenon with multiple dimensions. Considering that alcohol-dependent patients compensate negative physical/emotional states with alcohol, the aim of this study is to investigate alcohol craving and its correlation with drinking measures and affective personality dimensions. A sample of 135 alcohol-dependent patients (104 males and 31 females) was collected from a clinical setting. Subjects self-rated their cravings (Penn Alcohol Craving Scale) and the stage of change. Several personality scales were also administered. Craving was related to drinking status, abstinence time, age, and taking steps. After controlling for these conditions, psychological characteristics related to low self-concept, neuroticism, cyclothymic affective temperament, depression, and hostility were found to be predictors of craving in sober alcohol-dependent patients. Our results support craving as a component of the phenomenology of alcohol dependence and highlight the presence of unpleasant feelings as predictors of craving in sober alcohol-dependent patients without co-occurring psychiatric conditions. The predisposition to experience negative emotions may induce a stronger craving response and increase the likelihood of a first drink and a subsequent loss of control.

How important are positive and negative outcome expectancies in the treatment of addiction: a narrative review of the literature

Purpose

– The purpose of this paper is to review the substance misuse literature on how outcome expectancies are measured, how they are related with the level of use and other factors as well as their role into treatment and recovery.

Design/methodology/approach

– A narrative review of the literature for all major substances of abuse was undertaken.

Findings

– Existing measurement tools are substance specific. Most research has been in the field of alcohol, and involved students or light and moderate drinkers. Positive expectancies have been found to be related to initiation and level of alcohol, nicotine and cannabis use and also to be modifiable with repeated cue exposure. Negative expectancies have been found to be associated with prevention of smoking, positive changes in drinking and positive effect on treatment outcome for alcohol.

Research limitations/implications

– Both positive and negative outcome expectancies have been found to predict development of substance misuse and recovery from it respectively, but cross-substance comparisons are hindered by lack of appropriate measures.

Originality/value

– The concept of outcome expectancies is present in several theories of addiction. To date there has been no comprehensive review of the extent to which different types of expectancy play a role in different substances and their treatment.

Mediated substance cues: motivational reactivity and use influence responses to pictures of alcohol

This study examined how emotional and physiological responses to pictures of alcoholic or nonalcoholic beverages vary as a function of motivational type and alcohol use. The authors used the limited capacity model of motivated mediated message processing to guide predictions and the motivational activation measure to measure the reactivity of participants' appetitive and aversive motivational systems. Participants viewed and rated 9 pictures of alcoholic beverages and 9 pictures of nonalcoholic beverages. Facial electromyography data were collected during viewing. Overall results show that heavy users respond both more positively and more negatively to pictures of alcoholic beverages than to pictures of nonalcoholic beverages, whereas light users respond more positively overall and more positively to pictures of alcoholic beverages than to pictures of nonalcohol beverages. In addition, heavy use predictably reverses the response predicted by motivational type.

Alcohol expectancy responses from teenagers: the early forewarning signals

BACKGROUND

The Indian population is overwhelmed by the rapid developmental activities in the new millennium. This has brought in urbanization and several banes of the faster life. Alcoholism is one among the menaces which have to be tackled at an early stage.

OBJECTIVE

To assess the subjective expectancies from alcohol intake in young college students.

METHODS

We carried out a survey on the expectancy from youth of the alcohol effects, which in fact is known as the principal motivator of alcohol intake. We chose the pre-university students (n= 200; 100 males and 100 females) of one of the oldest and prestigious colleges of Mangalore (south India). The survey used the Comprehensive Effect of Alcohol (CEOA) where the students had to respond to two sets of 38 questions, in which they would mention whether they agreed or disagreed to the statement regarding the effects of alcohol intake.

RESULTS

From the results, we found that these young students were in agreement of the view that alcohol could cause a positive reinforcement. They also strongly agreed that alcohol consumption could cause negative effects. This was significantly more pronounced among the girls. Strikingly, only 25% of the boys and 14.5% of girls had consumed alcohol before, who indicated a stronger positive reinforce response as compared to those who had not tasted alcohol.

CONCLUSIONS

The results reveal that the first exposure to alcohol consumption is the key factor which leads to alcoholism. If the experience of alcohol intake and the effects of alcohol are liked with the subjects, that becomes a motivating factor for future attempts. This needs a closer look by the clinicians, counselors and the parents, who need to actively interfere in educating the youth and in guiding them in the right direction during their formative ages.

Mediation-moderation analysis of problematic alcohol use: the roles of urgency, drinking motives, and risk/benefit perception

OBJECTIVE

The goal of the current study is to examine how urgency, drinking motives, and risk/benefit perception concurrently influence problematic alcohol consumption in young adults.

METHOD

Participants were 281 young adults enrolled in large, public US mid-western university. The mean age of the sample was 19.81 (SD=1.82) and 79.7% of the sample was female and 84.7% of the sample was Caucasian.

RESULTS

A series of moderated-mediation analyses indicated the following: The relationship between negative urgency and alcohol use was mediated through coping motives, and this relationship between coping motives and alcohol use was moderated by benefit perception. The relationship between positive urgency and alcohol use was mediated through enhancement motives, and this relationship between enhancement motives and alcohol use was moderated by benefit perception.

CONCLUSIONS

This study suggests that modifying perceptions about the benefits of alcohol and drinking motives could be viable prevention and/or treatment strategy in this population, especially among those who exhibit urgent behaviors.

Cue-elicited affect and craving: advancement of the conceptualization of craving in co-occurring posttraumatic stress disorder and alcohol dependence

Posttraumatic stress disorder (PTSD) commonly co-occurs with alcohol dependence (AD) and negatively affects treatment outcomes. Trauma-related negative affect enhances substance craving in laboratory cue-reactivity studies of AD individuals, but the role of positive affect has not been established. In this study, 108 AD treatment-seeking adults with current PTSD and AD were presented with four counterbalanced trials consisting of an audio cue (personalized trauma or neutral script) followed by a beverage cue (alcohol or water). Results revealed alcohol cues increased positive and negative affect, and positive affective responses explained significant incremental variance in self-reported craving and salivation, but only when cues were accompanied by neutral not trauma imagery. Ambivalent (high negative and positive) responses were associated with strongest craving. Findings advance the conceptualization of craving in individuals with PTSD-AD and highlight the importance of independently assessing positive and negative affective responses to cues in individuals with co-occurring PTSD-AD.

Family functioning and binge drinking among Italian adolescents

Limited studies have sought to describe binge drinking among adolescents and even fewer studies have attempted to examine whether family functioning, family communication and satisfaction could be associated with alcohol abuse. Our sample was made up of 726 Italian adolescents between the ages of 16 and 18. According to previous research, adolescents were categorized into non-drinkers, social, binge and heavy drinkers. Results showed that social, binge and heavy drinkers differ in terms of some drinking variables, family functioning, family communication and satisfaction.

An examination of college students' willingness to experience consequences as a unique predictor of alcohol problems

The focus of the study was to examine (1) the unique variance between willingness to experience specific consequences (e.g., vomit) and reported experience of the consequence after controlling for drinking, and (2) the relationships between consequence specific constructs (attitudes and norms) and willingness to experience specific consequences in the context of a structural equation model. Freshmen students (n = 167) from a large northeastern university were randomly selected to participate. Results indicated willingness to experience consequences accounted for significant variance across consequence outcomes controlling for drinking. Significant relationships were observed between consequence specific constructs (attitudes and norms) and students' willingness to experience consequences. Findings provide empirical support that alcohol-related consequences have multiple determinants and are not only a function of alcohol consumption. Prevention efforts may benefit from a more comprehensive approach that includes both drinking and consequence-specific constructs as targets of change.

A comparison of craving and emotional states between pathological gamblers and alcoholics

Fifty pathological gamblers and 42 alcohol dependent subjects were compared regarding craving, emotional states and social functioning. Subjects self-rated their cravings using the Weiss Craving Scale (WCS) and the Pennsylvania Craving Scale (PCS). Subjects answered a semi-structured interview, the Positive and Negative Affect Scale Extended Form (PANAS-X), and the Social Adjustment Scale (SAS-SR). Gamblers had higher scores on craving measures. Regression models showed that craving for gambling and alcohol have a significant correlation with emotional states. Craving for gambling was inversely correlated with positive affect and craving for alcohol was directly correlated with negative affect. Gambling craving was more dependent upon external factors and related to an unpleasant dearousing state, while alcohol craving was associated with an unpleasant arousing state. These findings point to the key role of emotional deregulation on gambling and alcohol cravings following early abstinence.

Physiological and subjective responding to alcohol cue exposure in alcoholics and control subjects: evidence for appetitive responding

36 alcoholic patients, recruited from a treatment program, and 20 non-alcohol abusing control subjects were tested for their reactions to alcohol and non-alcohol cues. The cue exposure paradigm included audio-visual (video), tactile, olfactory, and guided imagery cue components related to alcohol and non-alcohol beverages. Response measures were analyzed for significant difference based on alcohol and non-alcohol cue and patient type. Among the subjective ratings, alcohol cue specific increases in alcohol craving, desire to drink, alcohol-like high, positive drinking expectancies and alcohol-like withdrawal were seen in alcoholic subjects. Among the physiological measures, alcohol cue specific increases in salivation were seen in alcoholic subjects. Changes in heart rate, skin conductance and temperature were not specific to alcohol cues, or to alcoholic patients. The smelling of alcohol had the greatest impact on alcohol craving and skin conductance in alcoholic subjects. These findings demonstrate robust subjective effects, and weak physiological effects, in response to a multidimensional alcohol cue exposure paradigm. The response profile indicates cue reactivity in alcoholics as an appetitive based form of alcohol craving.

Gender, alcohol consumption, and differing alcohol expectancy dimensions in college drinkers

Examinations of gender differences in alcohol expectancies among college drinkers typically have used self-report measures to assess single expectancy dimensions and often have been confounded by drinking level. This study examined gender differences in alcohol expectancies using 2 assessment methods. College students (N = 88) completed self-report questionnaires, including expectancy likelihood and subjective evaluation endorsements of expectancies, and a computerized expectancy accessibility task. Expectancy accessibility and endorsement were modestly correlated, with higher alcohol consumption and female gender linked to greater accessibility and endorsement of social enhancement expectancies. Gender moderated the relation between consumption and sociability expectancy accessibility; among men, heavier drinking was associated with more rapid activation of expectancies. Findings suggest complexity in associations among these variables and underscore the need to capture the multidimensionality of the expectancy construct and its relationship to alcohol use.

Reactivity to Alcohol-Related Cues: Relationship Among Cue Type, Motivational Processes, and Personality

This study examined the relationship between personality traits implicated in the drinking literature (i.e., sensation seeking and anxiety) and reactivity to 2 different alcohol cues. The opportunity to consume alcohol was manipulated, and differences in urge and affective reactivity were assessed. Gray's (1987) model of impulsive sensation seeking and anxiety was adopted to investigate relationships between personality and responses to the appetitive (consumption) and aversive (no consumption, nonrewarding) alcohol cues in 40 regular social drinkers. The consumption cue produced increases in appetitive motivation and positive correlations with sensation-seeking traits. The no-consumption cue produced increases in aversive motivation and positive correlations with anxiety-related traits. It was concluded that Gray's model of impulsive sensation seeking and anxiety may provide a useful framework for examining the personality correlates of cue reactivity to different cues.

Beyond invulnerability: the importance of benefits in adolescents' decision to drink alcohol

Some investigators propose that adolescents engage in risky behaviors mainly because they perceive themselves to be invulnerable to risk. However, studies have typically not included perceived benefits. In the current study, 5th, 7th, and 9th graders were surveyed about their perceptions of and experience with alcohol and tobacco. Results indicated that perceptions of the benefits were significantly related to drinking and smoking 6 months later, over and above perceptions of the risks, age of the respondent, and experience level. Further, the importance of benefits was replicated across 3 separate analyses. Experience with alcohol alone, especially positive experience, was also related to perception and behavior. These findings are discussed in terms of how to improve messages and influence adolescents' decisions regarding risk-taking behaviors.

Negative emotional expectancies and readiness to change among college student binge drinkers

While expectancies are considered to be an important cognitive variable in the etiology and maintenance of substance use, less is known about their role in attitudes toward addictive behavior change. It has recently been suggested that negative alcohol expectancies, in particular, might play a fundamental role in motivation to change. Among a population of college student binge drinkers, the differential ability of positive and negative expectancies to predict total readiness to change (RTC) scores was examined. Hierarchical regression analyses revealed that controlling for level of consumption and number of drinking-related problems, negative and not positive expectancies significantly predicted RTC. In an examination of expectancy subtypes, negative emotional expectancies emerged as the only significant predictor of change motivation. Possible explanations for the findings and implications for interventions with undergraduate heavy drinkers are discussed.

Psychometric evaluation of the marijuana and stimulant effect expectancy questionnaires for adolescents

Alcohol expectancies are important in the mediation and prediction of alcohol use. Expectancies for the effects of other drugs, although less well delineated, appear equally important. Therefore, development and validation of expectancy measures for drugs other than alcohol is necessary for evaluating the importance of these constructs. We examined the factor structure, reliability, and validity of the Marijuana Effect Expectancy Questionnaire (MEEQ) and the Stimulant Effect Expectancy Questionnaire (SEEQ) in clinical and community samples of adolescents as they moved into young adulthood (N=279). Confirmatory factor analyses (CFAs) supported the a priori factors, and we found good reliability for most individual scales. Temporal stability and convergent and discriminant validity of drug effect expectancies were supported in this sample of adolescents and young adults. Drug effect expectancies were associated with drug preference and drug use patterns over 2 years. Use of these measures may aid our understanding of the etiology and course of marijuana and stimulant involvement during adolescence and young adulthood.