Alcohol-related and negatively valenced cues increase motor and oculomotor disinhibition in social drinkers

Behavioral Intervention Components Associated With Cost-effectiveness: A Comparison of Six Domains

Background

To help implement behavior change interventions (BCIs) it is important to be able to characterize their key components and determine their effectiveness.

Purpose

This study assessed and compared the components of BCIs in terms of intervention functions identified using the Behaviour Change Wheel Framework (BCW) and in terms of their specific behavior change techniques (BCTs) identified using the BCT TaxonomyV1, across six behavioral domains and the association of these with cost-effectiveness.

Methods

BCIs in 251 studies targeting smoking, diet, exercise, sexual health, alcohol and multiple health behaviors, were specified in terms of their intervention functions and their BCTs, grouped into 16 categories. Associations with cost-effectiveness measured in terms of incremental cost-effectiveness ratio (ICER) upper and lower estimates were determined using regression analysis.

Results

The most prevalent functions were increasing knowledge through education (72.1%) and imparting skills through training (74.9%). The most prevalent BCT groupings were shaping knowledge (86.5%), changing behavioral antecedents (53.0%), supporting self-regulation (47.7%), and providing social support (44.6%). Intervention functions associated with better cost-effectiveness were those based on training (β_low = −15044.3; p = .002), persuasion (β_low = −19384.9; p = .001; β_upp = −25947.6; p < .001) and restriction (β_upp = −32286.1; p = .019), and with lower cost-effectiveness were those based on environmental restructuring (β = 15023.9_low; p = .033). BCT groupings associated with better cost-effectiveness were goals and planning (β_low = −8537.3; p = .019 and β_upp = −12416.9; p = .037) and comparison of behavior (β_low = −13561.9, p = .047 and β_upp = −30650.2; p = .006). Those associated with lower cost-effectiveness were natural consequences (β_low = 7729.4; p = .033) and reward and threat (β_low = 20106.7; p = .004).

Conclusions

BCIs that focused on training, persuasion and restriction may be more cost-effective, as may those that encourage goal setting and comparison of behaviors with others.

Where's the wine? Heavy social drinkers show attentional bias towards alcohol in a visual conjunction search task

BACKGROUND AND AIMS

Research indicates that high consumers of alcohol exhibit attentional bias (AB) towards alcohol-related cues, suggestive of a cognitive mechanism that might drive substance seeking. Many tasks that measure AB (e.g. visual probe, addiction Stroop), however, are limited by their reliance on non-appetitive control cues, the serial presentation of stimuli and their poor internal reliability. The current study employed a visual conjunction search (VCS) task capable of presenting multiple alcoholic and non-alcoholic appetitive cues simultaneously to assess whether social drinkers attend selectively to alcoholic stimuli. To assess the construct validity of this task, we examined whether alcohol consumption and related problems, subjective craving and drinking motives predict alcohol-specific AB.

DESIGN AND SETTING

A VCS task was performed in a laboratory setting, which required participants to detect the presence of appetitive alcoholic (wine, beer) and non-alcoholic (cola, lemonade) targets within arrays of matching and non-matching distractors.

PARTICIPANTS

Data from 99 participants were assessed [mean_age  = 20.77, standard deviation (SD) = 2.98; 64 (65%) females], with 81.8% meeting the threshold for harmful alcohol consumption (mean_AUDIT  = 12.89, SD = 5.79).

MEASUREMENTS

Self-reports of alcohol consumption and related problems [Alcohol Use Disorders Identification Test (AUDIT)], subjective craving (Alcohol Craving Questionnaire Short Form) and drinking motives (Drinking Motives Questionnaire Short Form) were obtained, and the VCS task measured response times for the correct detection of alcoholic and non-alcoholic targets.

FINDINGS

Participants were significantly quicker to detect alcoholic relative to non-alcoholic appetitive targets (P < 0.001, d_z  = 0.41), which was predicted positively by AUDIT scores (P = 0.013, R²  = 0.06%). The VCS task achieved excellent reliability (α > 0.79), superior to other paradigms.

CONCLUSIONS

The visual conjunction search task appears to be a highly reliable method for assessing alcohol-related attentional bias, and shows that heavy social drinkers prioritize alcoholic cues in their immediate environment.

History of childhood abuse and alcohol use disorder: Relationship with intermittent explosive disorder and intoxicated aggression frequency

Intermittent Explosive Disorder (IED), the only psychiatric diagnosis for which affective aggression is the cardinal symptom, is uniquely associated with both a history of childhood abuse and a diagnosis of an alcohol use disorder (AUD). Moreover, both childhood abuse and AUD are associated with increased general aggression and aggression while intoxicated. Yet, no study to date has examined the relative contributions of childhood abuse and AUD to IED, nor their effects on overall and intoxicated aggression among those with and without IED. The following study aimed to fill these gaps. Participants were 493 individuals (68% female; Age M = 26.65) either with (n = 265) or without (psychiatric control group; n = 228) IED. All participants completed a clinical interview to (a) diagnose AUD, IED, and other comorbid psychiatric disorders; (b) assess childhood abuse history; and (c) determine lifetime frequency of overall and intoxicated aggression. Results indicated that a history of childhood abuse, but not AUD status, was uniquely predictive of IED status. With regard to aggression frequency, IED, AUD and childhood abuse were all independently associated with overall aggression, although only those with IED showed increased intoxicated aggression as a function of AUD severity. Overall, these results suggest that a history of childhood abuse may increase the chances of engaging in overall aggression and developing IED, which in turn may increase the association between AUD severity and intoxicated aggression.

Isolating Proactive Slowing from Reactive Inhibitory Control in Heavy Drinkers

Background: Impaired inhibitory control is thought to contribute to alcohol (mis)use. However, current definitions of inhibitory control are over-simplified by a failure to distinguish reactive inhibitory control from proactive slowing. Objectives: To distinguish "reactive" inhibitory control and proactive slowing in heavy drinkers, and characterize associations between both constructs and individual differences in alcohol consumption. Methods: Sixty heavy drinkers completed self-reported measures of alcohol consumption, followed by two modified Stop-Signal tasks and an AX-continuous performance task in a laboratory setting. Results: Heavy drinkers demonstrated proactive slowing when inhibition was more likely but individual differences in proactive slowing and reactive stopping were unrelated to individual differences in alcohol consumption. Conclusions/Importance: Within a sample of heavy drinkers, individual differences in reactive inhibitory control and proactive slowing are unrelated to individual differences in alcohol consumption.

Impaired subjective self-control in alcohol use: An ecological momentary assessment study

BACKGROUND

While both theory and empirical findings have supported impaired self-control as a crucial factor in understanding problem drinking, little is known about the relationship of self-control and drinking in naturalistic settings. The present study uses Ecological Momentary Assessment (EMA) to examine the predictive relationships between impaired subjective self-control, craving and alcohol use in everyday life.

METHODS

A sample of 172 regular drinkers responded on their smartphone to three random prompts each day for seven days in which amount of perceived self-control and craving were measured with self-report. In the meantime, participants were instructed to initiate an EMA report when they started drinking alcohol.

RESULTS

Findings supported the hypotheses that impaired self-control and higher craving levels were prospectively related to the likelihood that people will drink. That is, on random assessments that preceded drinking (i.e., were within two hours of drinking), perceived self-control was lower and craving was higher compared to random assessments that were not followed by drinking. Additionally, during drink consumption, impaired self-control and craving were associated with a higher amount of expected alcohol consumption. Findings further indicated that subjective self-control acted as a moderator of the relationship between craving and alcohol consumption during drinking occasions.

CONCLUSIONS

By using a smartphone mobile application, this study showed that impaired subjective self-control and craving are prospectively related to alcohol use in the real-world. Furthermore, findings are consistent with theories of addiction that substance use might be associated with the interplay of control processes and increased motivation.

Alcohol-related attentional bias in a gaze contingency task: Comparing appetitive and non-appetitive cues

BACKGROUND

Non-problem drinkers attend automatically to alcohol-related cues compared to non-alcohol related cues on tests of inhibitory control. Moreover, attentional bias for alcohol-related cues varies between problem and non-problem drinkers.

AIM

To examine attentional bias towards alcoholic and non-alcoholic appetitive cues between problem and non-problem drinkers.

METHOD

Forty-one university students (9 male, 32 female; Mage = 21.50) completed an eye-tracking gaze contingency paradigm, measuring the number of times participants looked at peripherally and centrally located stimuli (break frequency) when instructed to maintain focus on a target object. Stimuli consisted of appetitive alcohol-related (e.g., wine), appetitive non-alcohol-related (e.g., cola) and non-appetitive (e.g., fabric softener) stimuli. Participants were split using the Alcohol Use Disorders Identification Test (AUDIT) into non-problem (M AUDIT = 3.86) and problematic drinkers (M AUDIT = 11.59).

RESULTS

Problematic drinkers had higher break frequencies towards peripheral appetitive stimuli than towards non-appetitive stimuli, while break frequency was equivalent between appetitive cues presented centrally (alcohol and non-alcohol-related). In contrast, there were no differences in break frequency across stimuli type or cue presentation location (central or peripheral) for non-problem drinkers.

CONCLUSION

In contrast to non-problem drinkers, people displaying more problematic consumption practices may find it more difficult to inhibit eye movements towards appetitive stimuli, particularly when in peripheral vision. This may suggest that attentional biases, as measured in terms of overt eye movements, in problem drinkers may be most powerful when the alcoholic and appetitive stimuli are not directly in field of view. An uncertainty reduction process in the allocation of attention to appetitive cues may help explain the patterns of results observed.

A randomized controlled trial of inhibitory control training for the reduction of alcohol consumption in problem drinkers

OBJECTIVE

We conducted a randomized controlled trial to compare the effects of three types of Internet-delivered Inhibitory Control Training (ICT) with each other and with an active control intervention on alcohol consumption in a community sample of problem drinkers.

METHOD

Two hundred and 46 heavy drinkers, who were motivated to reduce their alcohol consumption (mean age 41.32, 130 female) self-monitored their alcohol consumption for 1 week before being randomized to receive 1 of 3 variants of ICT (Associative No-Go, Associative Stop Signal, General Inhibition) or an active control. Participants then completed up to 14 ICT/control sessions on the Internet over a 4-week period, while regularly recording their alcohol consumption.

RESULTS

There were significant reductions in alcohol consumption across all groups over the 4-week training period (main effect of time, F(2, 402) = 77.12, p < .01, ηp2 = .28, BF10 > 99), however there were no differences between ICT groups, or between ICT groups and the active control group (Group × Time interaction, F(6, 402) = 1.10, p = .36, ηp2 = .02, BF10 = 0.03). Contrary to hypotheses, there were no changes in general inhibitory control, the disinhibiting effects of alcohol cues, or alcohol affective associations after ICT.

CONCLUSIONS

In this study, which attempted to translate findings from proof-of-concept laboratory studies into a viable behavior change intervention, we found that multiple sessions of ICT delivered over the Internet did not help heavy drinkers to reduce their alcohol consumption beyond nonspecific effects associated with taking part in a trial. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

From neuroscience to evidence based psychological treatments - The promise and the challenge, ECNP March 2016, Nice, France

This ECNP meeting was designed to build bridges between different constituencies of mental illness treatment researchers from a range of backgrounds with a specific focus on enhancing the development of novel, evidence based, psychological treatments. In particular we wished to explore the potential for basic neuroscience to support the development of more effective psychological treatments, just as this approach is starting to illuminate the actions of drugs. To fulfil this aim, a selection of clinical psychologists, psychiatrists and neuroscientists were invited to sit at the same table. The starting point of the meeting was the proposition that we know certain psychological treatments work, but we have only an approximate understanding of why they work. The first task in developing a coherent mental health science would therefore be to uncover the mechanisms (at all levels of analysis) of effective psychological treatments. Delineating these mechanisms, a task that will require input from both the clinic and the laboratory, will provide a key foundation for the rational optimisation of psychological treatments. As reviewed in this paper, the speakers at the meeting reviewed recent advances in the understanding of clinical and cognitive psychology, neuroscience, experimental psychopathology, and treatment delivery technology focussed primarily on anxiety disorders and depression. We started by asking three rhetorical questions: What has psychology done for treatment? What has technology done for psychology? What has neuroscience done for psychology? We then addressed how research in five broad research areas could inform the future development of better treatments: Attention, Conditioning, Compulsions and addiction, Emotional Memory, and Reward and emotional bias. Research in all these areas (and more) can be harnessed to neuroscience since psychological therapies are a learning process with a biological basis in the brain. Because current treatment approaches are not fully satisfactory, there is an imperative to understand why not. And when psychological therapies do work we need to understand why this is the case, and how we can improve them. We may be able to improve accessibility to treatment without understanding mechanisms. But for treatment innovation and improvement, mechanistic insights may actually help. Applying neuroscience in this way will become an additional mission for ECNP.

Do daily fluctuations in inhibitory control predict alcohol consumption? An ecological momentary assessment study

RATIONALE

Deficient inhibitory control is predictive of increased alcohol consumption in the laboratory; however, little is known about this relationship in naturalistic, real-world settings.

OBJECTIVES

In the present study, we implemented ecological momentary assessment methods to investigate the relationship between inhibitory control and alcohol consumption in the real world.

METHODS

Heavy drinkers who were motivated to reduce their alcohol consumption (N = 100) were loaned a smartphone which administered a stop signal task twice per day at random intervals between 10 a.m. and 6 p.m. for 2 weeks. Each day, participants also recorded their planned and actual alcohol consumption and their subjective craving and mood. We hypothesised that day-to-day fluctuations in inhibitory control (stop signal reaction time) would predict alcohol consumption, over and above planned consumption and craving.

RESULTS

Multilevel modelling demonstrated that daily alcohol consumption was predicted by planned consumption (β = .816; 95% CI .762-.870) and craving (β = .022; 95% CI .013-.031), but inhibitory control did not predict any additional variance in alcohol consumption. However, secondary analyses demonstrated that the magnitude of deterioration in inhibitory control across the day was a significant predictor of increased alcohol consumption on that day (β = .007; 95% CI .004-.011), after controlling for planned consumption and craving.

CONCLUSIONS

These findings demonstrate that short-term fluctuations in inhibitory control predict alcohol consumption, which suggests that transient fluctuations in inhibition may be a risk factor for heavy drinking episodes.

Generalised inhibitory impairment to appetitive cues: From alcoholic to non-alcoholic visual stimuli

BACKGROUND

Prior research demonstrates that individuals who consume alcohol show diminished inhibitory control towards alcohol-related cues. However, such research contrasts predominantly alcoholic appetitive cues with non-alcoholic, non-appetitive cues (e.g., stationary items). As such, it is not clear whether it is specifically the alcoholic nature of the cues that influences impairments in inhibitory control or whether more general appetitive processes are at play.

AIMS

The current study examined the hitherto untested assertion that the disinhibiting effects of alcohol-related stimuli might generalise to other appetitive liquid stimuli, but not to non-appetitive liquid stimuli.

METHOD

Fifty-nine participants (Mage=21.63, SD=5.85) completed a modified version of the Stop Signal Task, which exposed them to visual stimuli of three types of liquids: Alcoholic appetitive (e.g., wine), non-alcoholic appetitive (e.g., water) and non-appetitive (e.g., washing-up liquid).

RESULTS

Consistent with predictions, Stop-signal reaction time was significantly longer for appetitive (alcoholic, non-alcoholic) compared to non-appetitive stimuli. Participants were also faster and less error-prone when responding to appetitive relative to non-appetitive stimuli on go-trials. There were no apparent differences in stop signal reaction times between alcoholic and non-alcoholic appetitive products.

CONCLUSIONS

These findings suggest that decreases in inhibitory control in response to alcohol-related cues might generalise to other appetitive liquids, possibly due to evaluative conditioning. Implications for existing research methodologies include the use of appetitive control conditions and the diversification of cues within tests of alcohol-related inhibitory control.

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.

Elevated alcohol consumption following alcohol cue exposure is partially mediated by reduced inhibitory control and increased craving

RATIONALE

Exposure to alcohol-related cues leads to increased alcohol consumption, and this may be partially attributable to momentarily impaired impulse control.

OBJECTIVES

We investigated if exposure to alcohol cues would impair inhibitory control and if the extent of this impairment would partially mediate the effect of alcohol cues on subsequent voluntary alcohol consumption.

METHODS

We recruited 81 heavy drinkers (50 female) who completed baseline measures of inhibitory control (stop-signal task) and subjective craving before random allocation to an alcohol cue exposure or control group. The alcohol cue exposure group then completed a second stop-signal task (with embedded alcohol cues) with concurrent exposure to olfactory alcohol cues, in an alcohol context. The control group completed a second stop-signal task (with embedded water cues), accompanied by exposure to water cues, in a neutral context. Then, subjective craving and ad libitum alcohol consumption were measured in all participants.

RESULTS

Inhibitory control worsened (compared to baseline) to a greater extent in the alcohol cue exposure group compared to the control group. Craving and ad libitum alcohol consumption were elevated in the alcohol cue exposure group compared to the control group, although the group difference in alcohol consumption fell short of statistical significance. In support of our hypotheses, multiple mediation analyses demonstrated that elevated ad libitum alcohol consumption following alcohol cue exposure was partially mediated by both impaired inhibitory control and increased craving.

CONCLUSIONS

These findings suggest that state fluctuations in inhibitory control are a potential mechanism through which alcohol cues increase drinking behaviour.

Introspective responses to cues and motivation to reduce cigarette smoking influence state and behavioral responses to cue exposure

In the current study, we aimed to extend smoking cue-reactivity research by evaluating delay discounting as an outcome of cigarette cue exposure. We also separated introspection in response to cues (e.g., self-reporting craving and affect) from cue exposure alone, to determine if introspection changes behavioral responses to cigarette cues. Finally, we included measures of quit motivation and resistance to smoking to assess motivational influences on cue exposure. Smokers were invited to participate in an online cue-reactivity study. Participants were randomly assigned to view smoking images or neutral images, and were randomized to respond to cues with either craving and affect questions (e.g., introspection) or filler questions. Following cue exposure, participants completed a delay discounting task and then reported state affect, craving, and resistance to smoking, as well as an assessment of quit motivation. We found that after controlling for trait impulsivity, participants who introspected on craving and affect showed higher delay discounting, irrespective of cue type, but we found no effect of response condition on subsequent craving (e.g., craving reactivity). We also found that motivation to quit interacted with experimental conditions to predict state craving and state resistance to smoking. Although asking about craving during cue exposure did not increase later craving, it resulted in greater delaying of discounted rewards. Overall, our findings suggest the need to further assess the implications of introspection and motivation on behavioral outcomes of cue exposure.

Acute stress increases ad-libitum alcohol consumption in heavy drinkers, but not through impaired inhibitory control

RATIONALE

Stress increases alcohol consumption and the risk of relapse, but little is known about the psychological mechanisms that underlie these effects. One candidate mechanism is inhibitory control, which may be impaired by acute stress and is believed to exert a causal influence on alcohol consumption.

OBJECTIVES

We investigated if acute stress would impair inhibitory control and if impaired inhibitory control would be associated with subsequent ad-libitum alcohol consumption in a naturalistic laboratory setting.

MATERIALS AND METHODS

One hundred heavy drinkers took part in an experimental study in a naturalistic 'bar laboratory'. Participants were randomly assigned to an acute stress (n = 50) or control (n = 50) group. In the stress group, participants were exposed to the social evaluative threat of giving a self-critical presentation, whereas the control group completed simple anagrams. Prior to and following the manipulation, participants completed the stop signal task as a measure of inhibitory control. Finally, participants completed a bogus taste test, as a measure of ad-libitum alcohol consumption.

RESULTS

The stress manipulation had no effect on performance on the stop signal task. However, there was a small but significant increase in ad-libitum alcohol consumption in the acute stress group compared to that in the control group.

CONCLUSIONS

Acute stress increased alcohol consumption in heavy drinkers, in a semi-naturalistic setting. However, this was not through the hypothesised mechanism of a transient impairment in inhibitory control.

Inhibitory control training for appetitive behaviour change: A meta-analytic investigation of mechanisms of action and moderators of effectiveness

Inhibitory control training (ICT) is a novel intervention in which participants learn to associate appetitive cues with inhibition of behaviour. We present a meta-analytic investigation of laboratory studies of ICT for appetitive behaviour change in which we investigate candidate mechanisms of action, individual differences that may moderate its effectiveness, and compare it to other psychological interventions. We conducted random-effects generic inverse variance meta-analysis on data from 14 articles (18 effect sizes in total). Participants who received ICT chose or consumed significantly less food or alcohol compared to control groups (SMD = 0.36, 95% CIs [0.24, 0.47]; Z = 6.18, p < .001; I(2) = 71%). Effect sizes were larger for motor (Go/No-Go and Stop Signal) compared to oculomotor (Antisaccade) ICT. The effects of ICT on behaviour were comparable to those produced by other psychological interventions, and effects of ICT on food intake were greater in participants who were attempting to restrict their food intake. The magnitude of the effect of ICT on behaviour was predicted by the proportion of successful inhibitions but was unrelated to the absolute number of trials in which appetitive cues were paired with the requirement to inhibit, or the contingency between appetitive cues and the requirement to inhibit. The effect of ICT on cue devaluation (primarily assessed with implicit association tests) was not statistically significant. Our analysis confirms the efficacy of ICT for short-term behaviour change in the laboratory, and we have demonstrated that its effectiveness may depend on pairings between appetitive cues and successful inhibition. We highlight the need for further research to translate these findings outside of the laboratory.