Alcohol expectancies and reactivity to alcohol-related and affective cues

High-mind wandering correlates with high risk for problematic alcohol use in China and Germany

Everyone experiences the natural ebb and flow of task-unrelated thoughts. Given how common the fluctuations in these thoughts are, surprisingly, we know very little about how they shape individuals' responses to alcohol use. Here, we investigated if mind wandering is associated with a risk of developing problematic alcohol use. We undertook an online survey among the general population in China (N = 1123) and Germany (N = 1018) from December 2021 to February 2022 and examined the subjective experience of mind wandering and problematic alcohol use through the Mind Wandering Questionnaire (MWQ) and the Alcohol Use Disorders Identification Test (AUDIT). We compared mind wandering and problematic alcohol use between two countries and investigated the association between MWQ scores with AUDIT scores. We found higher scores on the MWQ and a high percentage of problematic alcohol use (i.e., AUDIT score ≥ 8) in Germany (22.5%) as compared to in China (14.5%). Higher self-reported mind wandering was associated with higher AUDIT scores. AUDIT scores were increased mostly in male, elder, and high-mind wandering people. Our findings highlight that mind wandering and problematic alcohol use enhanced in Germany as compared to in China. Our study sheds light on the relationship between mind wandering and problematic alcohol use that may help to further investigate causal effects of interventions.

An experimental investigation into the effect of negative affect on the behavioral economic demand for alcohol

Influential theoretical models hypothesize that alcohol use is an especially potent reinforcer when used as a strategy to cope with negative affect. Although the evidence for this idea in observational data is weak, some experimental evidence suggests that the behavioral economic demand for alcohol increases immediately following a negative emotional event. Because existing studies testing the effect of negative mood inductions on the demand for alcohol have several methodological limitations and do not take inter- and intraindividual variability into account, we developed an improved experimental design to increase our confidence in any potential within-person effect of negative mood inductions on alcohol demand as well as to test whether this effect exhibits systematic inter- and intraindividual variability. We hypothesize that people will show a higher demand for alcohol following negative compared to neutral mood inductions and that this effect is stronger in heavy compared to light drinkers as well as stronger on days characterized by higher coping motives and negative urgency. Three hundred twenty college students will complete the alcohol purchase task (APT) after being subjected to 100 mood inductions (six negative, six neutral) on 20 separate days. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The effects of age on the severity of problem drinking: Mediating effects of positive alcohol expectancy and neural correlates

Aging is associated with reduction in the severity of alcohol misuse. However, the psychological and neural mechanisms underlying the age-related changes remain unclear. Here, we tested the hypothesis that age-related diminution of positive alcohol expectancy (AE) mediated the effects of age on problem drinking and investigated the neural correlates of the mediating effects. Ninety-six drinkers 21-85 years of age, including social drinkers and those with mild/moderate alcohol use disorder (AUD), were assessed for global positive (GP) AE and problem drinking, each with the Alcohol Expectancy Questionnaire and Alcohol Use Disorders Identification Test (AUDIT), and with brain imaging during alcohol cue exposure. We processed imaging data with published routines; identified the correlates shared between whole-brain regression against age, GP and AUDIT scores; and performed mediation and path analyses to explore the interrelationships between the clinical and neural variables. The results showed that age was negatively correlated with both GP and AUDIT scores, with GP score completely mediating the correlation between age and AUDIT score. Lower age and higher GP correlated with shared cue responses in bilateral parahippocampal gyrus and left middle occipital cortex (PHG/OC). Further, higher GP and AUDIT scores were associated with shared cue responses in bilateral rostral anterior cingulate cortex and caudate head (ACC/caudate). Path analyses demonstrated models with significant statistical fit and PHG/OC and ACC/caudate each interrelating age to GP and GP to AUDIT scores. These findings confirmed change in positive AE as a psychological mechanism mitigating alcohol misuse as individuals age and highlighted the neural processes of cue-reactivity interrelating age and alcohol use severity.

Positive alcohol expectancy and resting-state functional connectivity of the insula in problem drinking

Positive alcohol expectancy (AE), a significant predictor of excessive alcohol consumption, is associated with heightened drinking motivation and reduced control. As the insula interacts with the limbic and prefrontal structures to integrate stimulus saliency, interoception, and cognitive control, the region may play a unique role in modulating AE. Here, we examined resting-state functional connectivity of the right and left insula in relation to AE in 180 adult drinkers. Whole-brain multiple regressions and path analysis were performed to delineate the inter-relationship between AE, insular connectivity, and drinking severity. We found that heightened AE was associated with diminished right insular connectivity with regions involved in negative emotion processing and self-control, including the amygdala, putamen, and ventromedial prefrontal cortex. In contrast, there was a positive relationship between AE and right insular connectivity with regions implicated in motivated responses to alcohol stimuli, including the superior parietal lobule, postcentral and superior frontal gyri. Path analysis showed that the two sets of right insular connectivity exhibited opposing associations with AE and that their net strength (i.e., "control minus motivation") was negatively correlated with AE and drinking severity. Analyses of the left insula seed, in contrast, did not yield regional connectivity in significant correlation with AE. These findings highlight the roles of right insula connectivity in motivational and regulatory processes that may differentially modulate drinking behavior. Recruitment of the motivational circuit and/or disengagement of the affective control circuit would be associated with heightened AE and heavier alcohol consumption.

Changes in interoception after alcohol administration correlate with expectancies and subjective effects

Interoceptive signals give rise to subjective feeling states that can drive motivational and behavioural responses. In the context of alcohol use behaviours, interoceptive signals may shape subjective alcohol experiences and thereby support biobehavioural mechanisms of drinking behaviour change. This study examined the acute effects of alcohol on participants' interoceptive abilities and determined whether pharmacologically induced changes in heart beat detection correlate with subjective alcohol effects, craving and expectancies. Participants completed a two-session, double-blind placebo controlled experiment (n = 27). Participants consumed a beverage containing 0.4 g/kg of alcohol or a placebo. They also completed measurements of alcohol expectancies at baseline, and alcohol-induced changes in mood, craving and light-headedness. Interoceptive ability was measured using the heartbeat discrimination task prior to and following beverage administration, yielding indices of interoceptive accuracy, confidence and meta-cognition. Alcohol administration increased interoceptive accuracy compared with baseline and placebo; and those changes in interoception negatively correlated with negative alcohol expectancies. Further, changes in interoception positively correlated with perceived light-headedness and positive mood after alcohol administration, whereas null effects were found for craving. In the placebo condition, null results were obtained. Alcohol is well established to change bodily states, and here, we find that the extent to which alcohol increases participants' sensitivity to bodily states correlates with their subjective drinking experiences. This was observed in relation to mood, light-headedness and prospective alcohol expectancies. We posit that over successive alcohol experiences, changes in bodily states may feed into the development of alcohol expectancies that could in turn predict future drinking behaviours.

The Galician Beverage Picture Set (GBPS): A standardized database of alcohol and non-alcohol images

BACKGROUND

The available picture sets in alcohol research are scarce and display a number of limitations, including poor picture quality, limited number of stimuli and absence of non-alcohol and/or real-life images. In the present study, we developed the Galician Beverage Picture Set (GBPS), a database of high-quality alcohol and non-alcohol pictures embedded in real-life scenarios.

METHODS

A total of 201 college students (∼59% females) were assessed by the Alcohol Use Disorders Identification Test, ∼54% being characterized as no/low drinkers (N/LDs) and ∼46% as risky drinkers (RDs). The GBPS included six types of beverages: beer, wine, liquor (alcoholic drinks); water, juice, milk (non-alcoholic drinks). Additionally, two subcategories were considered: orientation (landscape, portrait) and number of people (0, 1, ≥2 people). Participants rated the images for valence, arousal and visual complexity. Objective measures of brightness and color and recognition rates were also assessed. Internal consistency was estimated using Cronbach's alpha coefficient.

RESULTS

There was a high degree of internal consistency within each category (alcoholic and non-alcoholic drinks) for valence, arousal and visual complexity scores. A mixed-model ANOVA revealed that RDs rated alcohol pictures as more pleasant and arousing than N/LDs. Conversely, N/LDs displayed greater valence and arousal ratings than RDs for non-alcohol pictures.

CONCLUSIONS

The GBPS provides normative data on affective (valence/arousal), perceptual (visual complexity) and physical (brightness/color) values for a large number of images that may be useful for alcohol-related research. Differences in subjective assessments between N/LDs and RDs support the picture set's suitability for studies in young drinkers.

When Habits Are Dangerous: Alcohol Expectancies and Habitual Decision Making Predict Relapse in Alcohol Dependence

BACKGROUND

Addiction is supposedly characterized by a shift from goal-directed to habitual decision making, thus facilitating automatic drug intake. The two-step task allows distinguishing between these mechanisms by computationally modeling goal-directed and habitual behavior as model-based and model-free control. In addicted patients, decision making may also strongly depend upon drug-associated expectations. Therefore, we investigated model-based versus model-free decision making and its neural correlates as well as alcohol expectancies in alcohol-dependent patients and healthy controls and assessed treatment outcome in patients.

METHODS

Ninety detoxified, medication-free, alcohol-dependent patients and 96 age- and gender-matched control subjects underwent functional magnetic resonance imaging during the two-step task. Alcohol expectancies were measured with the Alcohol Expectancy Questionnaire. Over a follow-up period of 48 weeks, 37 patients remained abstinent and 53 patients relapsed as indicated by the Alcohol Timeline Followback method.

RESULTS

Patients who relapsed displayed reduced medial prefrontal cortex activation during model-based decision making. Furthermore, high alcohol expectancies were associated with low model-based control in relapsers, while the opposite was observed in abstainers and healthy control subjects. However, reduced model-based control per se was not associated with subsequent relapse.

CONCLUSIONS

These findings suggest that poor treatment outcome in alcohol dependence does not simply result from a shift from model-based to model-free control but is instead dependent on the interaction between high drug expectancies and low model-based decision making. Reduced model-based medial prefrontal cortex signatures in those who relapse point to a neural correlate of relapse risk. These observations suggest that therapeutic interventions should target subjective alcohol expectancies.

The Modulation of the Startle Reflex as Predictor of Alcohol Use Disorders in a Sample of Heavy Drinkers: A 4-Year Follow-Up Study

BACKGROUND

Previous studies demonstrated that patients with alcohol use disorders (AUDs) show altered startle reflex responses to alcohol-related stimuli. However, there is little information about the role of these altered responses in the development of AUDs. This study examined the startle reflex response to different visual stimuli and the role of these patterns in the development of AUDs in a 4-year follow-up.

METHODS

Two hundred and thirty-nine (nondependent) heavy-drinking participants were selected. In the baseline period, the startle reflex responses to alcohol-related, aversive, appetitive, and neutral pictures were assessed. Startle reflex responses to these pictures were used as predictive variables. Status drinking (alcohol dependence and nondependence) assessed at 4-year follow-up was used as outcome measure.

RESULTS

At the 4-year follow-up assessment, 46% of participants fulfilled DSM-IV alcohol abuse or dependence criteria. Alcohol dependence status was predicted by an attenuated startle reflex response to alcohol-related and aversive pictures.

CONCLUSIONS

This study revealed that an attenuated modulation of startle reflex response to alcohol-related and aversive stimuli could be used as a clinical marker to predict the development of AUDs in participants with previous alcohol consumption.

Psychometric evaluation of a standardized set of alcohol cue photographs to assess craving

INTRODUCTION

Research using alcohol-related visual stimuli has been limited due to a lack of published studies examining the psychometric properties of alcohol cues. The primary aim of the current study was to examine the factor structure, validity, and reliability of craving ratings following exposure to alcohol cues (including beer, wine, hard liquor, and mixed drinks) in an alcohol cue-reactivity paradigm.

METHODS

U.S. adults ages 21-69 [N = 195; Mage = 32.19, SD = 10.63; 74.4% male; 56.4% Asian/Pacific Islander, 34.9% White (non-Hispanic), 4.6% Other, 2.0% Hispanic/Latino, 1.5% Native American/Alaskan Native, and 0.5% African-American] completed questionnaires and provided craving, arousal, and valence ratings following alcohol, positive, negative and neutral cues in a web-based study.

RESULTS

The alcohol craving ratings following alcohol cues formed one internally consistent factor. Convergent and incremental validity was supported as alcohol cue craving ratings were positively correlated with general craving, past-year hazardous alcohol use, and behavioral activation facets, even while controlling for neutral cue craving ratings and other related variables. Alcohol craving was significantly higher following alcohol cues compared to neutral cues and unrelated to behavioral inhibition, supporting discriminant validity.

CONCLUSIONS

These findings provide support that the alcohol cues we developed are reliable and valid stimuli for the use in alcohol cue reactivity paradigms. Future research assessing alcohol cue reactivity using this validated photographic cue set may facilitate a greater understanding of the affective processes associated with alcohol use and allow for more targeted behavioral change interventions for alcohol-related problems.

Changes on the Modulation of the Startle Reflex in Alcohol-Dependent Patients after 12 Weeks of a Cognitive-Behavioral Intervention

AIMS

Little is known about changes in the modulation of the startle reflex when patients go through an alcohol-dependence treatment in an outpatient facility. In the current study, the affective modulation of the cue-related startle reflex has been used to evaluate changes in the emotional processing of alcohol-related stimuli that occurred after a standard cognitive-behavioral intervention, and to assess the outcome of this intervention. We hypothesized a 'normalization' of the startle inhibition for the alcohol-related cues during the period of treatment. We also assumed that higher startle inhibition at baseline elicited by alcohol cues would predict the relapse on alcohol consumption during treatment.

PARTICIPANTS

A total of 98 alcohol-dependent subjects were included who fulfilled DSM-IV criteria for alcohol dependence. A control group of 72 subjects was selected to match demographic characteristics.

MEASUREMENTS

All patients received a standard cognitive-behavioral therapy once a week throughout the study period.

FINDINGS

Results show that the startle response differed significantly after 12 weeks of treatment for alcohol-related, neutral and aversive stimuli between alcohol-dependent patients and controls. Low startle responses at baseline to alcohol cues predicted relapse.

CONCLUSIONS

These results may indicate that the startle reflex is referred to enduring and permanent processes of cue reactivity, and that the emotional processing of alcohol-associated cues assessed with the affect-modulated startle reflex is less altered by interventions attempting to influence explicit cognitions. Furthermore, lower values of the baseline startle reflex elicited by alcohol-associated stimuli were associated with higher probability of relapse on alcohol use.

Different associations of alcohol cue reactivity with negative alcohol expectancies in mandated and inpatient samples of young adults

Alcohol cue reactivity, operationalized as a classically conditioned response to an alcohol related stimulus, can be assessed by changes in physiological functions such as heart rate variability (HRV), which reflect real time regulation of emotional and cognitive processes. Although ample evidence links drinking histories to cue reactivity, it is unclear whether in-the-moment cue reactivity becomes coupled to a set of consolidated beliefs about the effects of alcohol (i.e., expectancies) and whether treatment helps dissociate the relation of positive versus negative expectancies to cue reactivity. This study examined the relationship between reactivity to alcohol picture cues and alcohol expectancies in two groups of emerging adults: an inpatient sample with alcohol use disorders (n=28) and a college student sample who previously were mandated to a brief intervention for violating university policies about alcohol use in residence halls (n=43). Sequential regression analysis was conducted using several HRV indices and self-report arousal ratings as cue reactivity measures. Results indicated that the relationship between cue reactivity and negative alcohol outcome expectancies differed for the two groups. Greater cue reactivity, assessed using HRV indices, was associated with more negative expectancies in the inpatient sample but with less negative expectancies in the mandated student sample, while an opposite trend was found for subjective arousal. The present findings highlight the importance of characterizing cue reactivity through multi-dimensional assessment modalities that include physiological markers such as HRV.

The role of context in the processing of alcohol-relevant cues

In line with learning theories of drug addiction, drug-related cues may be viewed as important motivators of continued drug use. They may be differentially effective depending on the context and motivational significance. The present study aimed to test the significance of different contexts in modulating alcohol-related cue reactivity. Pictures depicting alcohol intake or its paraphernalia and pictures without any relation to alcohol intake were varied to depict physical and social contexts or different consumptive contexts associated with full/half-full/empty alcohol beverage containers. We obtained ratings of craving, valence and arousal of the cues as well as skin conductance responses (SCRs) and startle reflex modulation measures from 21 abstinent alcohol-dependent patients, recruited from an addiction treatment center, and 21 matched healthy controls. Social scenes and full glasses or bottles were rated as more pleasant and arousing compared with neutral drinking situations and empty glasses or bottles in patients. Furthermore, we found a decreased startle reflex magnitude to social compared with neutral drinking situations, and both higher SCRs and decreased startle reflex magnitude to full compared with empty glasses or bottles in patients versus controls. These results show that both physical and social and consumptive contexts differentially influence cue reactivity in abstinent alcohol-dependent patients with both social and pub-related physical contexts, and the initial consumptive context eliciting the most appetitive and arousing responses. These data have not only important implications for our understanding of the role of learning in drug dependence but also for treatment, which needs to take these factors into account.

The Geneva Smoking Pictures: development and preliminary validation

Cue reactivity is essential to the maintenance of addictive disorders. A useful way to study cue reactivity is by means of normative pictures, but few validated tobacco-related pictures are available. This study describes a database of smoking-related pictures: The Geneva Smoking Pictures (GSP). Sixty smoking-related pictures were presented to 91 participants who assessed them according to the classic emotional pictures validation provided by the International Affective Picture System (NIMH Center for the Study of Emotion and Attention, 2002). The pictures were rated according to three dimensions: (1) valence (from positive to negative), (2) emotional arousal (from high arousing to low arousing), and (3) dominance (from submissive to dominant). Participants were also screened with the Fagerström Test for Nicotine Dependence. Normative ratings for valence, arousal and dominance of the pictures are provided for the whole sample, as well as separately for dependent (n = 46) and nondependent smokers (n = 45). Arousal and dominance were associated with greater nicotine dependence, but valence ratings were not. The GSP is a normative database providing a large number of stimuli for investigators who are conducting nicotine and tobacco research.

Affiliation Goals and Health Behaviors

People are inherently driven by the need to form and maintain relationships, and these affiliation goals can influence health behaviors in two ways: (a) indirectly, by increasing a person's attention to others and subsequently leaving them more likely to emulate the health behaviors of others (social contagion); (b) directly, by leading people to be more likely to engage in health behaviors they perceive as helping them to form and maintain relationships with others (self-initiated behavioral engagement). In this review, we discuss the evidence for the catalyzing role of affiliation goals in these two processes for a variety of positive (e.g., exercising, smoking-cessation) and detrimental health behaviors (e.g., binge drinking and eating, needle sharing). Additionally, we discuss individual difference factors that may temporarily or chronically activate affiliation goals and ultimately impact health behaviors. Affiliation goals hold many implications for future work, and for improving interventions.

Predictive value of obsessive-compulsive drinking scale (OCDS) for outcome in alcohol-dependent inpatients: results of a 24-month follow-up study

BACKGROUND

The present study examined whether craving as measured by the obsessive-compulsive drinking scale (OCDS) predict long-term outcome in alcohol-dependent inpatients.

METHODS

This was a 24-month prospective, observational study in 198 alcohol-dependent inpatients treated under standardized conditions. The primary outcome criterion was abstinence, defined as no subjective report or objective indication of alcohol consumption since discharge from treatment. The patients self-rated their craving for alcohol at the 6- and 12-month follow-ups by using the German version of the OCDS, which measures obsessive and compulsive aspects of craving. Univariate and logistic regression analyses with covariates were performed.

RESULTS

Of the 104 patients interviewed at the 24-month follow-up, 60% (n = 62) were abstinent. We found significant associations between total OCDS scores at 6 months and outcome at 12 months and between total OCDS scores at 12 months and outcome at 24 months: the higher the OCDS total score at one follow-up evaluation, the less likely patients were to be abstinent at the subsequent one. The same association was found for each of the two OCDS subscales, control and consequences and drinking obsessions.

CONCLUSIONS

These results support earlier findings that OCDS scores can predict outcome in alcohol-dependent patients. This information can be used for the timely development of protective resources. Hence, decisions over the use of resources can be made on the basis of objectified parameters to develop a personalized treatment concept. Consequently, economic considerations can induce a reduction of high medical costs.

Appetitive and regulatory processes in young adolescent drinkers

Dual-process models of addiction propose that alcohol (mis)use develops because of an imbalance between a fast automatic appetitive system, in which stimuli are valued in terms of their emotional and motivational significance and a slower controlled regulatory system, which acts on deliberate considerations. This study focused on the automatic and regulatory processes that are involved in the early stages of young adolescent alcohol use. Participants were 43 young adolescent drinkers, who completed an explicit alcohol valence measure, two versions of an Affective Simon Task (AST), a working memory task and an alcohol use questionnaire. Alcohol use was associated with relatively positive self-reported valence of alcohol pictures, especially for adolescents with lower inhibition capacity. The Affective Simon Tasks did not show stronger automatic approach tendencies in heavier drinkers. This study suggests that in early stages of alcohol use appetitive valence is a more important stimulator for the initiation of alcohol use than automatic approach tendencies, and supports the view that young adolescents with low inhibition capacity are especially at risk for developing alcohol misuse. Prevention therefore should be focused on reducing the attractive valence of alcoholic drinks and strengthening the cognitive control of at-risk children.

The Geneva Appetitive Alcohol Pictures (GAAP): development and preliminary validation

This study describes a new database of alcohol-related pictures: The Geneva Appetitive Alcohol Pictures (GAAP). 60 alcohol-related pictures (beverages, drinking-related behaviors, alcohol-related cues) were presented to 101 participants (ranging from social drinkers to problem drinkers), who assessed them according to the classic emotional pictures validation provided by the International Affective Picture System (Center for the Study of Emotion and Attention (CSEA[-]NIMH), 2002). Participants were also screened with the Alcohol Use Disorders Identification Test. Normative ratings for valence, arousal and dominance of the pictures are provided separately for problem/risky users (n = 49) and non-risky drinkers (n = 52). The GAAP is a normative database that provides a large number of stimuli for investigators who conduct research on alcohol.

Binge drinking in undergraduates: relationships with sex, drinking behaviors, impulsivity, and the perceived effects of alcohol

Binge drinking on university campuses is associated with social and health-related problems. To determine the factors that may predict this behavior, we collected information on alcohol use, alcohol expectations, and impulsivity from 428 undergraduate students attending a Canadian university. The subjective effects of a binge drinking dose of alcohol were assessed in a subset of participants. In the larger sample, 72% of students reported drinking at or above binge drinking thresholds on a regular basis. Men reported alcohol consumption per drinking occasion, which was consistent with other studies, but the frequency of drinking occasions among women was higher than in earlier studies, suggesting that consumption in women may be increasing. Compared with men, women reported different expectations of alcohol, specifically related to sociability and sexuality. Self-reported impulsivity scores were related, albeit weakly, to drinking behaviors and to expectations in both the sexes. Finally, intoxicated binge drinkers reported feeling less intoxicated, liking the effects more, and wanting more alcohol than did non-binge drinkers receiving an equivalent dose of alcohol. These results have implications for sex-specific prevention strategies for binge drinking on university campuses.