Alcohol and Behavioral Control: Cognitive and Neural Mechanisms

Reassessing Fitness-to-Drive in Drinker Drivers: The Role of Cognition and Personality

Drunken driving is among the main challenges for road safety by causing worldwide motor-vehicle crashes with severe injuries and deaths. The reassessment of fitness-to-drive in drivers stopped for drunken driving includes mainly psychological examinations. The present study aimed to investigate the effectiveness and the consistency of selected variables of different psychological driving-related dimensions (i.e., cognitive skills and personality) in discriminating 90 male drinker drivers (DD) from matched non-drinkers controls. The Montreal Cognitive Assessment (MoCA), the Mental Rotation Test (MRT), and the Perspective-Taking Test (PT) were administered to assess overall cognitive functioning, and object- and self-based spatial transformation abilities, respectively. Participants completed a computerized test measuring resilience of attention (DT), reaction times (RT), and perceptual speed (ATAVT). The Personality Psychopathology Five scales (i.e., PSY-5: Aggressiveness-AGGR, Psychoticism-PSYC, Disconstraint-DISC, Negative-Emotionality-NEGE, and Introversion-INTR) the validity scale (L) and the dissimulation index (F-K) were scored from the Minnesota Multiphasic Personality Inventory (MMPI-2). A logistic binomial regression analysis (backward subtraction method) was used to identify discriminant predictors. A prediction analysis (ROC curve method) was performed on the final model. Results showed that the scores obtained in MRT, DT, and the personality measures of PSYC, DISC, NEGE, and INTR significantly discriminated DD from their matched controls with moderate-to-good values of accuracy (0.79), sensitivity (0.80), and specificity (0.79), as well as a good AUC value (0.89). In some cases, the personality dimensions provided—reliable—unexpected results. Low scores of PSYC, NEGE, and INTR were found to predict the membership to the DD group; results are discussed with reference to response management. Personality measures should be assessed with particular attention in a forensic context because they are more prone to be feigned than cognitive ones. Overall, the present study confirmed the relevance of integrating different driving-related psychological dimensions in the evaluation of fitness-to-drive showing the usefulness of standardized tools for the reassessment of drinker drivers.

Persistence of Neuronal Alterations in Alcohol-Dependent Patients at Conclusion of the Gold Standard Withdrawal Treatment: Evidence From ERPs

Background: One of the main challenges for clinicians is to ensure that alcohol withdrawal treatment is the most effective possible after discharge. To address this issue, we designed a pilot study to investigate the efficacy of the rehabilitation treatment on the main stages of information processing, using an electroencephalographic method. This topic is of main importance as relapse rates after alcohol withdrawal treatment remain very high, indicating that established treatment methods are not fully effective in all patients in the long run. Method: We examined in alcohol-dependent patients (ADP) the effects of the benzodiazepine-based standard detoxification program on event-related potential components at incoming (D0) and completion (D15) of the treatment, using tasks of increasing difficulty (with and without workload) during an auditory oddball target paradigm. Untreated non-alcohol-dependent-volunteers were used as matching controls. Results: At D0, ADP displayed significantly lower amplitude for all ERP components in both tasks, as compared to controls. At D15, this difference disappeared for the amplitude of the N1 component during the workload-free task, as well as the amplitude of the P3b for both tasks. Meanwhile, the amplitude of the N2 remained lower in both tasks for ADP. At D0, latencies of N2 and P3b in both task conditions were longer in ADP, as compared to controls, whilst the latency of N1 was unchanged. At D15, the N2 latency remained longer for the workload condition only, whereas the P3b latency remained longer for the workload-free task only. Conclusion: The present pilot results provide evidence for a persistence of impaired parameters of ERP components, especially the N2 component. This suggests that neural networks related to attention processing remain dysfunctional. Longitudinal long-term follow-up of these patients is mandatory for further assessment of a link between ERP alterations and a later risk of relapse.

No effect of moderate alcohol intake on the detection of concealed identity information in the laboratory

The Concealed Information Test (CIT) enables the detection of certain (e.g., crime-relevant or personal) information, even if participants aim to conceal their knowledge. The current preregistered study investigated whether previously observed impairing effects of alcohol intoxication on participants’ performance in a reaction time CIT (RT CIT) field study also translate to a laboratory environment. In contrast to the previous study of Suchotzki and Gamer (Sci Rep 8:7825, 2018) in which alcohol consumption was voluntary and self-administered, the current study used a randomized assignment of participants to either an alcohol group (n = 88; receiving a drink with 3 cl alcohol) or a sober control group (n = 89; receiving a drink with just some alcohol drops to hide group assignment). After drink administration, participants completed an RT CIT, in which they were instructed to hide knowledge of their own identity. Blood alcohol concentration (BAC) was estimated via breath alcohol ratio. In contrast to the previous field study, results revealed no differences in CIT-performance between intoxicated and sober participants. Aside from questioning the robustness of the result of the previous field study, our results also point to a number of interesting theoretical explanations for the discrepancy between both results, which are elaborated in the discussion.

Do preparatory behaviours predict alcohol consumption among UK university students?

OBJECTIVE

This study explored whether the frequency and habitual nature of engagement in three behaviours that may serve as preparation for alcohol consumption on a night out with friends - that is, contacting friends to arrange a night out, buying alcohol, drinking alone at home before going out - predicted consumption on such nights.

DESIGN

Prospective correlational design.

METHODS

One hundred and twenty UK university students (68 female, 50 male, two non-binary, mean age = 20.78 years, SD = 1.52) completed a survey comprising intentions, habits, and frequency and habit for the three preparatory behaviours. One week later, a second survey measured the number of nights out with friends on which alcohol was drunk (i.e., drinking frequency) and the number on which four or more alcoholic drinks were consumed (i.e, excessive drinking). Regression models were run to predict drinking frequency and excessive drinking.

RESULTS

Drinking frequency was predicted only by frequency of contacting friends (B = .28, SE = .12, p = .02), and habitually drinking alone before going out (B = .20, SE = .09, p = .03). Excessive drinking was only predicted by alcohol consumption habit (B = .67, SE = .23, p = .003).

CONCLUSIONS

Preceding actions may influence the frequency of alcohol consumption on nights out, independently of intentions and habits relating to alcohol consumption. While interventions to reduce consumption quantity in a single session might focus on disrupting the habits that sustain drinking episodes, efforts to reduce alcohol consumption frequency on nights out might focus on disrupting behaviours that precede alcohol consumption.

Working memory reflects vulnerability to early life adversity as a risk factor for substance use disorder in the FKBP5 cortisol cochaperone polymorphism, rs9296158

Early life adversity (ELA) negatively affects health behaviors in adulthood, but pathways from ELA exposure to behavioral outcomes are poorly understood. ELA in childhood and adolescence may translate into adult outcomes by way of modified glucocorticoid signaling. The cortisol cotransporter, FKBP5 has a G-to-A substitution (rs9296158) that hinders cortisol trafficking within target cells, and this impaired glucocorticoid signaling may shape the long-term response to ELA. We used performance on the Stroop test to assess working memory in 546 healthy young adults who had experienced 0, 1, or > 1 forms of ELA in childhood and adolescence and were genotyped for the FKBP5 rs9296158 G-to-A polymorphism. We observed a robust Gene x Environment interaction (F = 9.49, p < .0001) in which increased ELA exposure led to progressively greater Stroop interference in persons carrying AG and AA genotypes of FKBP5 with no such effect in GG carriers. Further work is needed to explore the modification of cognitive function resulting from ELA. Impairments in working memory illustrate how ELA may use glucocorticoid pathways to influence working memory with potential implications for decision-making and risky behavior including substance use disorders.

Motivation, Working Memory, and Decision Making: A Cognitive-Motivational Theory of Personality Vulnerability to Alcoholism

This article presents a cognitive-motivational theory (CMT) of the mechanisms associated with three basic dimensions of personality vulnerability to alcoholism, impulsivity/novelty seeking, harm avoidance, and excitement seeking. CMT describes the interrelationships between activity in basic motivational systems and attentional, decision-making, and working memory processes as the mechanisms associated with variation in each personality trait. Impulsivity/novelty seeking reflects activity in both appetitive and inhibitory motivational systems, greater attention to reward cues, and increased emotional reactivity to reward and frustration. Harm avoidance reflects individual differences in fearfulness and activity in specific inhibitory systems. Excitement seeking reflects the need to engage in appetitive behaviors in less predictable environments to experience positive affect. CMT also describes the impact of working memory and the specific motivational processes underlying each trait dimension on the dynamics ofdecision making from the perspective of decision field theory.

Moderating effect of working memory capacity on acute alcohol effects on BOLD response during inhibition and error monitoring in male heavy drinkers

RATIONALE

While alcohol intoxication is known to increase disinhibited behavior, the degree to which disinhibition occurs appears to depend on a number of factors including executive functioning ability. However, the neural mechanisms by which individual differences in executive functioning lead to variable degrees of disinhibition remain unclear.

OBJECTIVES

The aim of the current study was to examine the neural mechanisms by which individual differences in working memory (WM) capacity moderate alcohol-induced disinhibition.

METHODS

Seventeen heavy-drinking males participated in a within-subjects design in which two sessions were completed: an alcohol session (.82 g/kg) and a control session. Participants completed a go/no-go task while undergoing functional magnetic resonance imaging (fMRI) after ingestion of the control or alcohol beverage. WM capacity was measured using an operation span task.

RESULTS

Significant interactions of session and WM capacity emerged in contrasts examining successful response inhibition within superior temporal gyrus and unsuccessful inhibition in regions within the default mode network. In all cases, individuals with low WM capacity demonstrated a relative decrease in blood oxygen level-dependent (BOLD) response during the alcohol compared to control session, whereas the high-WM-capacity group demonstrated relative increases in BOLD response in the alcohol compared to control session.

CONCLUSIONS

Low WM capacity appears to be associated with decreased neural response to signals indicating a need for behavioral control, an effect that may lead to increased difficulty with inhibiting responses and increased negative consequences from alcohol intoxication.

Alcohol effects on the P2 component of auditory evoked potentials

This is a second part of a research aimed to study the effects of alcohol on the electrophysiological processes in student volunteers. The first part showed that alcohol slowed the Omitted Stimulus Potential (OSP). This work studied the ethanol effects on the parameters (i.e. rate of rise, amplitude and peak latency) of the P2 component of the evoked potentials (EPs) yielded by trains of auditory stimuli. It is hypothesized here that if P2 and OSP waves share some common neural processes then alcohol should also affect these specific parameters. A dose of 0.8 g/kg of alcohol or a placebo (0 g/kg) was administered to two groups of 15 young men who were tested before and again after treatment. The pre-post treatment change in each of the measurements was used to assess the treatment effects. The results showed that compared to placebo, alcohol slowed the P2 rise rate and reduced its amplitude, with no effects on peak latency. The rise rate is more sensitive to alcohol but more resistant to the adaptation process. Alcohol resembles the response inhibition model acting against the adaptation. The rise rate of the P2 and the OSP waves are affected by alcohol in a similar fashion, suggesting similar neural generative mechanisms.

Acute alcohol consumption impairs controlled but not automatic processes in a psychophysical pointing paradigm

Numerous studies have investigated the effects of alcohol consumption on controlled and automatic cognitive processes. Such studies have shown that alcohol impairs performance on tasks requiring conscious, intentional control, while leaving automatic performance relatively intact. Here, we sought to extend these findings to aspects of visuomotor control by investigating the effects of alcohol in a visuomotor pointing paradigm that allowed us to separate the influence of controlled and automatic processes. Six male participants were assigned to an experimental "correction" condition in which they were instructed to point at a visual target as quickly and accurately as possible. On a small percentage of trials, the target "jumped" to a new location. On these trials, the participants' task was to amend their movement such that they pointed to the new target location. A second group of 6 participants were assigned to a "countermanding" condition, in which they were instructed to terminate their movements upon detection of target "jumps". In both the correction and countermanding conditions, participants served as their own controls, taking part in alcohol and no-alcohol conditions on separate days. Alcohol had no effect on participants' ability to correct movements "in flight", but impaired the ability to withhold such automatic corrections. Our data support the notion that alcohol selectively impairs controlled processes in the visuomotor domain.

Brain modifications after acute alcohol consumption analyzed by resting state fMRI

Resting-state functional magnetic resonance imaging (fMRI) is a recent breakthrough in neuroimaging research able to describe "in vivo" the spontaneous baseline neuronal activity characterized by blood oxygen level dependent (BOLD) signal fluctuations at slow frequency (0.01-0.1Hz) that, in the absence of any task, forms spatially distributed functional connectivity networks, called resting state networks (RSNs). The aim of this study was to investigate, in the young and healthy population, the changing of the RSNs after acute ingestion of an alcohol dose able to determine a blood concentration (0.5g/L) that barely exceeds the legal limits for driving in the majority of European Countries. Fifteen healthy volunteers underwent two fMRI sessions using a 1.5T MR scanner before and after alcohol oral consumption. The main sequence acquired was EPI 2D BOLD, one per each session. To prevent the excessive alcohol consumption the subjects underwent the estimation of blood rate by breath test and after the stabilization of blood alcohol level (BAL) at 0.5g/L the subjects underwent the second fMRI session. Functional data elaboration was carried out using the probabilistic independent component analysis (PICA). Spatial maps so obtained were further organized, with MELODIC multisession temporal concatenation FSL option, in a cluster representing the group of pre-alcohol sessions and the group of post-alcohol sessions, followed by the dual regression approach in order to evaluate the increase or decrease in terms of connectivity in the RSNs between the two sessions at group level. The results we obtained reveal that acute consumption of alcohol reduces in a significant way the BOLD signal fluctuations in the resting brain selectively in the sub-callosal cortex (SCC), in left temporal fusiform cortex (TFC) and left inferior temporal gyrus (ITG), which are cognitive regions known to be part of the reward brain network and the ventral visual system.

An eight component decision-making model for problem gambling: a systems approach to stimulate integrative research

Problem Gambling (PG) represents a serious problem for affected individuals, their families and society in general. Previous approaches to understanding PG have been confined to only a subset of the psychobiological factors influencing PG. We present a model that attempts to integrate potential causal factors across levels of organization, providing empirical evidence from the vast literature on PG and complimentary literatures in decision-making and addiction. The model posits that components are arranged systematically to bias decisions in favor of either immediately approaching or avoiding targets affording the opportunity for immediate reward. Dopamine, Testosterone and Endogenous Opioids favor immediate approach, while Serotonin and Cortisol favor inhibition. Glutamate is involved in associative learning between stimuli and promotes the approach response through its link to the DA reward system. GABA functions to monitor performance and curb impulsive decision-making. Finally, while very high levels of Norepinephrine can induce arousal to an extent that is detrimental to sound decision-making, the reactivity of the Norepinephrine system and its effects of Cortisol levels can shift the focus towards long-term consequences, thereby inhibiting impulsive decisions. Empirical evidence is provided showing the effects of each component on PG and decision-making across behavioural, neuropsychological, functional neuroimaging and genetic levels. Last, an effect size analysis of the growing pharmacotherapy literature is presented. It is hoped that this model will stimulate multi-level research to solidify our comprehension of biased decision-making in PG and suggest pharmacological and psychological approaches to treatment.

Manipulation of nicotinic acetylcholine receptors differentially affects behavioral inhibition in human subjects with and without disordered baseline impulsivity

RATIONALE

Evidence for a relationship between cigarette smoking and attention-deficit/hyperactivity disorder (ADHD) has prompted investigations into nicotinic treatments for this disorder. Impulsivity is a hallmark of ADHD and is measured in the laboratory as behavioral inhibition (BI) using the stop signal task (SST). Acute nicotine improves SST performance in adolescents and young adults who have both ADHD and impaired baseline SST performance, raising questions about the role of nicotinic acetylcholine receptor function in BI. The specificity of this effect to those with ADHD, the component processes of the SST affected by nicotine, and the effects of nicotinic antagonism are yet unknown.

OBJECTIVES

This study investigated the effects of both a nicotinic receptor agonist and antagonist on the SST and choice reaction time task (CRT) in highly impulsive (HI) and control (CTRL) subjects.

METHODS

This was a within-subjects, double-blind study of: 7 mg transdermal nicotine, 20 mg oral mecamylamine, and placebo. Subjects were recruited into HI (n = 11) and CTRL (n = 14) groups based on both SST and clinical criteria.

RESULTS

BI was significantly improved by nicotine compared with placebo in the HI group and impaired by mecamylamine in the CTRL group. Go signal reaction time on the SST was improved by nicotine compared with placebo in the CTRL group and was unchanged in both groups on the CRT.

CONCLUSIONS

These findings demonstrate nicotinic modulation of BI in subjects with both normal and disordered baseline performance. The effects on BI are consistent with cholinergic enhancement of signal detection processes and/or modulation of noradrenaline by nicotine.

Alcohol affects the emotional modulation of cognitive control: an event-related brain potential study

OBJECTIVE

The present study aimed to determine whether alcohol affects the emotional modulation of cognitive control and its underlying neural mechanisms, which is pivotal to an understanding of the socially maladaptive behaviors frequently seen in alcohol-intoxicated individuals.

METHOD

Event-related potentials (ERPs) were recorded in male participants receiving either a moderate dose of alcohol (0.65 g/kg alcohol; n = 32) or a non-alcoholic placebo beverage (n = 32) while performing an emotional Go/No-Go task that required response execution (Go trials) to pictures of a "target" emotional facial expression (angry, happy, neutral) and response inhibition (No-Go trials) to a different "non-target" expression.

RESULTS

Overall, N200 and P300 amplitudes were more enhanced during No-Go than Go trials. Interestingly, alcohol-intoxicated individuals displayed larger No-Go N200 amplitudes across all emotional conditions than controls, accompanied by decreased task performance (i.e., more errors), particularly in response to angry faces. P300 amplitude in the alcohol group was significantly reduced for both Go and No-Go trials, but only following angry and happy emotional expressions.

CONCLUSIONS

These results suggest that alcohol-intoxicated individuals need to effortfully activate more cognitive resources during the early inhibition process in order to regulate a response than controls. Moreover, alcohol affected the emotional modulation of both response inhibition and execution in the later stages of cognitive control. Alcohol dampened emotional responsiveness, which may restrict the availability of attentional resources for cognitive control. Yet, these findings may underlie the lack of control in alcohol-intoxicated individuals when faced with emotionally or socially challenging situations.

Alcohol attenuates activation in the bilateral anterior insula during an emotional processing task: a pilot study

AIMS

Alcohol acutely reduces agitation and is widely used in social situations, but the neural substrates of emotion processing during its intoxication are not well understood. We examine whether alcohol's social stress dampening effect may be via reduced activity in the cortical systems that subserve awareness of bodily sensations, and are associated with affective distress.

METHODS

Blood oxygen level-dependent activation was measured through 24 functional magnetic resonance imaging sessions in 12 healthy volunteers during an emotional face-processing task following ingestion of a moderate dose of alcohol and a placebo beverage.

RESULTS

Results revealed that bilateral anterior insula response to emotional faces was significantly attenuated following consumption of alcohol, when compared with placebo (clusters >1472 μl; corrected P < 0.05).

CONCLUSION

Attenuated response in the anterior insula after alcohol intake may explain some of the decreased interoceptive awareness described during intoxication.

Differences in "bottom-up" and "top-down" neural activity in current and former cigarette smokers: Evidence for neural substrates which may promote nicotine abstinence through increased cognitive control

Drug-related stimuli, through conditioning, are thought to acquire incentive motivational properties that code possible reward availability and elicit an attentional bias, possibly through increased "bottom-up" neural processing. The processes underlying this attentional bias are considered important in the maintenance of addiction, and crucially, in relapse among substance users attempting to remain abstinent. Equally, impaired "top-down" cognitive control may impair the ability to restrain "bottom-up" pre-potent behaviours, such as drug use, following exposure to drug-related stimuli. Two experiments sought to identify the neural loci of bottom-up/top-down processing during fMRI. Experiment 1 utilised an attentional bias paradigm to examine the behavioural and neural responses to neutral, emotionally evocative and smoking-related cues in control (n=13), ex-smoking (n=10 - abstinent >12months) and smoking (n=13 - mean >6.5years of use) groups. Experiment 2 used a go/no-go paradigm to examine the neural correlates of motor response inhibition and error monitoring in the same sample. The results of Experiment 1 demonstrated that, across conditions, current smokers had significantly less neural activity in cortical but significantly more activity in subcortical areas compared to both controls and ex-smokers. Ex-smokers exhibited more neural activity than both control and smoker groups in prefrontal cortical regions. Similarly, Experiment 2 revealed that smokers had reduced neural activity in prefrontal cortical regions during motor response inhibition compared to controls while ex-smokers demonstrated greater neural activity in prefrontal cortical regions compared to both controls and smokers during error monitoring. The results reveal cortical and subcortical differences between current smokers and controls and a general pattern of increased prefrontal cortical activity in ex-smokers. These findings may suggest that elevated topdown control might be an important characteristic of successful abstinence in individuals formerly dependent on nicotine.

The effects of acute ethanol consumption on sexual response and sexual risk-taking intent

Two theories of sexual risk taking (disinhibition and alcohol myopia) were tested using genital measures of sexual response and computer measures of sexual risk propensity. A total of 44 men and women completed two sessions comparing responses to erotic films while consuming alcohol (breath alcohol doses were .025 g/kg and .08 g/kg) or juice alone. After consuming alcohol, more sexual arousal was reported in response to neutral films and at a breath alcohol level of .08 g/kg as compared to no alcohol. Genital responses for men and women increased during sexual films, but men did not respond as strongly when breath alcohol level was .08 g/kg. Intentions to have intercourse with a new partner at baseline predicted the level of sexual arousal reported. As self-reported sexual arousal increased in response to sexual films and higher alcohol dose, the intent to engage in intercourse with a new partner increased. Alcohol dose was not related to later sexual intercourse intentions. With no direct relationship of alcohol and intercourse intentions, results appear more consistent with a disinhibition model of sexual arousal.

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.

Comparing the Effects of Light Alcohol Consumption on Human Response to Auditory and Visual Stimuli

The purpose of this study is to examine the effects of various levels of alcohol consumption on human response to auditory and visual stimuli in terms of reaction time, movement time, total reaction time, and error rate. Placebo level and three low-level alcohol doses were randomly assigned to 20 male university student volunteers. 30 min. after consuming the alcohol or placebo, participants responded to either auditory or visual stimuli. Total reaction time increased significantly at the mid-low dose of alcohol (0.3 g/kg). For alcohol doses less than .5 g/kg, the change in total reaction time was confined to reaction time, i.e., the processing time between onset of stimulus and onset of movement. Effects of alcohol were significantly more pronounced in the choice-type tests. Notably, the effects of alcohol on total reaction time and error rate were significant for auditory but not visual stimuli.

Effects of alcoholism severity and smoking on executive neurocognitive function

AIMS

Neurocognitive deficits in chronic alcoholic men are well documented. Impairments include memory, visual-spatial processing, problem solving and executive function. The cause of impairment could include direct effects of alcohol toxicity, pre-existing cognitive deficits that predispose towards substance abuse, comorbid psychiatric disorders and abuse of substances other than alcohol. Cigarette smoking occurs at higher rates in alcoholism and has been linked to poor cognitive performance, yet the effects of smoking on cognitive function in alcoholism are often ignored. We examined whether chronic alcoholism and chronic smoking have effects on executive function.

METHODS

Alcoholism and smoking were examined in a community-recruited sample of alcoholic and non-alcoholic men (n = 240) using standard neuropsychological and reaction-time measures of executive function. Alcoholism was measured as the average level of alcoholism diagnoses across the study duration (12 years). Smoking was measured in pack-years.

RESULTS

Both alcoholism and smoking were correlated negatively with a composite executive function score. For component measures, alcoholism was correlated negatively with a broad range of measures, whereas smoking was correlated negatively with measures that emphasize response speed. In regression analyses, both smoking and alcoholism were significant predictors of executive function composite. However, when IQ is included in the regression analyses, alcoholism severity is no longer significant.

CONCLUSIONS

Both smoking and alcoholism were related to executive function. However, the effect of alcoholism was not independent of IQ, suggesting a generalized effect, perhaps affecting a wide range of cognitive abilities of which executive function is a component. On the other hand, the effect of smoking on measures relying on response speed were independent of IQ, suggesting a more specific processing speed deficit associated with chronic smoking.

Effects of alcohol on inhibitory processes

Earlier work has shown that alcohol may have disinhibiting effects on behaviour. Two studies tested the effects of a moderate dose of alcohol (0.6 g/kg) versus placebo on tasks that evaluate inhibitory processes related to alcohol stimuli, in moderate-to-heavy social drinkers (student population). An inhibition of interference task, the Stroop task (ST; study 1), and an inhibition of a prepotent response task, the go/no-go task (GNG; study 2), were used. The effects of alcohol on working memory function were also examined. Participants preloaded with alcohol made more errors on the colour and alcohol ST than those preloaded with placebo. In the GNG task, responding to alcohol-related pictures was slower than responding to neutral pictures. When participants were required to switch responding from neutral to alcohol-related go stimuli, responding became slower; however, responding to alcohol go stimuli became faster as time progressed; no effect of alcohol was found. Alcohol had no effect, compared with placebo, on the working memory tasks. Therefore, a moderate dose of alcohol had restricted effects on inhibitory processes: only interference inhibition measured in the ST was affected. Although the data obtained with the GNG task did not show an effect of alcohol on response inhibition, increased latency of response in the presence of alcohol-related stimuli compared with neutral stimuli indicates that alcohol stimuli are more salient to social drinkers, attracting a greater amount of attention.

Influence of trait anxiety on inhibitory control in alcohol-dependent patients: simultaneous acquisition of ERPs and BOLD responses

Alcohol-dependence is often associated with comorbid psychiatric symptoms. However, the results concerning the influence of these symptoms on cognitive functioning in alcoholism are still inconsistent. The aim of this study was to determine performance monitoring in healthy volunteers and alcohol-dependent patients, and to assess the influence of trait anxiety on these processes. Sixteen healthy volunteers and 16 detoxified alcohol-dependent patients completed an auditory go/nogo paradigm. Functional magnetic resonance imaging, event-related potentials and behavioral data were acquired simultaneously. The patients were classified by median split based on level of self-rated trait anxiety (state-trait anxiety inventory; STAI). The results showed no significant differences regarding inhibition-associated electrophysiological and behavioral responses between alcohol-dependent patients with high-trait anxiety scores and alcohol-addicts with low-STAI scores. However, the functional MRI data revealed elevated activations during the response inhibition task especially in the middle frontal gyrus (BA 6/9), the superior frontal gyrus (BA 6/8/9) and the right inferior frontal gyrus, as well as temporo-parietal brain regions in patients with high-trait anxiety compared to non-anxious alcohol-addicts. Patients and healthy controls showed comparable results with regard to neural and behavioral responses. These results suggest that inhibitory control capacities of alcohol-dependent patients are not consistent: alcohol-addicts with high-trait anxiety ratings showed elevated neural responses compared to patients without any comorbid psychiatric symptoms. This may indicate that comorbid psychiatric symptoms need to be considered when assessing brain responses in alcohol-dependent patients.

Early developmental processes and the continuity of risk for underage drinking and problem drinking

Developmental pathways to underage drinking emerge before the second decade of life. Many scientists, however, as well as the general public, continue to focus on proximal influences surrounding the initiation of drinking in adolescence, such as social, behavioral, and genetic variables related to availability and ease of acquisition of the drug, social reinforcement for its use, and individual differences in drug responses. In the past 20 years, a considerable body of evidence has accumulated on the early (often much earlier than the time of the first drink) predictors and pathways of youthful alcohol use and abuse. These early developmental influences involve numerous risk, vulnerability, promotive, and protective processes. Some of these factors are not related directly to alcohol use, whereas others involve learning and expectancies about later drug use that are shaped by social experience. The salience of these factors (identifiable in early childhood) for understanding the course and development of adult alcohol and other drug use disorders is evident from the large and growing body of findings on their ability to predict adult clinical outcomes. This review summarizes the evidence on early pathways toward and away from underage drinking, with a particular focus on the risk and protective factors and the mediators and moderators of risk for underage drinking that become evident during the preschool and early school years. It is guided by a developmental perspective on the aggregation of risk and protection and examines the contributions of biological, psychological, and social processes within the context of normal development. Implications of this evidence for policy, intervention, and future research are discussed.

Fetal learning about ethanol and later ethanol responsiveness: evidence against "safe" amounts of prenatal exposure

Near-term fetuses of different mammalian species, including humans, exhibit functional sensory and learning capabilities. The neurobiological literature indicates that the unborn organism processes sensory stimuli present in the amniotic fluid, retains this information for considerable amounts of time, and is also capable of associating such stimuli with biologically relevant events. This research has stimulated studies aimed at the analysis of fetal and neonatal learning about ethanol, a topic that constitutes the core of the present review. Ethanol has characteristic sensory (olfactory, taste, and trigeminal) attributes and can exert pharmacologic reinforcing effects. The studies under examination support the hypothesis that low to moderate levels of maternal ethanol intoxication during late pregnancy set the opportunity for fetal learning about ethanol. These levels of prenatal ethanol exposure do not generate evident morphologic or neurobehavioral alterations in the offspring, but they exert a significant impact upon later ethanol-seeking and intake behaviors. Supported by preclinical and clinical findings, this review contributes to strengthening the case for the ability of prenatal ethanol exposure to have effects on the postnatal organism.

Impaired stimulus-outcome but preserved stimulus-response shifting in young substance-dependent individuals

Substance dependency has been related to an impairment in executive functions and to a dysfunction of the frontal cortex. In this study we developed two experimental tasks, which are physically identical, to analyze whether substance-dependent individuals are impaired in shifting response patterns (stimulus response links) or preferences (stimulus outcome links). To increase the specificity of the dependent variable, we also used two control tasks to analyze for unspecific performance deficits. We included 35 young subjects with polysubstance abuse (International Classification of Diseases, F19.2 ICD 10 diagnosis, mean age of 22 years, maximum age < 27 years) and 18 normal controls, but for a first step focused on only 22 patients and 15 age-matched controls, because we excluded all patients with an IQ below 100. The results show that the substance-dependent individuals are selectively impaired in shifting object preference (stimulus-outcome links) and not in shifting response patterns. They moreover show a higher general impulsivity as reflected in their faster responses than controls on all tasks except the stimulus-outcome task. In a second step we replicated these results by analyzing the original groups of 35 patients and 18 controls. We argue that substance-dependent subjects show an impairment only on specific executive tasks, and these tasks concern stimulus-outcome link shifting, which has been associated with the functioning of the orbitofrontal cortex, not of the lateral prefrontal cortex.

Alcohol's effects on video lottery terminal (VLT) play among probable pathological and non-pathological gamblers

This study tested whether alcohol increases behaviors associated with video lottery terminal (VLT) play, particularly among probable pathological gamblers. Forty-four regular VLT players were designated either probable pathological gamblers or non-pathological gamblers on the basis of scores on the South Oaks Gambling Screen (SOGS); [Lesieur & Blume (1997). American Journal of Psychiatry, 144, 1184-1188] Gamblers from each SOGS category were randomly assigned to either a moderately intoxicating alcohol dose or a control beverage condition (n = 11 per cell in the 2 x 2 between-subjects design). Following beverage consumption and absorption, participants played a video poker VLT game for up to 30 minutes. Four behaviors were measured: "power-bets" (doubling bet after viewing only two cards of the five-card poker hand); total money spent; mean bet magnitude; and number of minutes played. Alcohol increased time spent playing and rate of power-bets, particular among the probable pathological gamblers. Post hoc analyses revealed that alcohol also influenced the proportion of losing hands played--increasing them among the probable pathological gamblers while decreasing them among the non-pathological gamblers. Clinical and policy implications of the findings are discussed.

Conditional Responding is Impaired in Chronic Alcoholics

Bechara (2003) describes a model for disturbances in executive functions related to addiction. This model involves deficits in decision-making and in suppressing pre-potent representations or response patterns. We tested this model in 29 individuals with long-term heavy alcohol dependency and compared their performance with that of 20 control subjects. Only individuals without memory impairment, with normal intelligence and normal visual response times were included. We examined word fluency, object alternation, spatial stimulus-response incompatibility, extra-dimensional shift learning and decision-making using the Gambling task. We subtracted the performance in a control condition from that of the executive condition, in order to focus specifically on the executive component of each task. Only the object alternation and incompatibility tasks revealed significant differences between the group of alcoholics and the control group. Moreover, response times in the object alternation task correlated with duration of alcohol dependency. The results do not argue in favor of a specific deficit in decision-making or in shifting between relevant representations. We conclude that long-term alcohol abuse leads to an impairment in conditional responding, provided the response depends on former reactions or the inhibition of pre-potent response patterns.

Alcohol attenuates load-related activation during a working memory task: relation to level of response to alcohol

BACKGROUND

A low level of response to alcohol is a major risk factor for the development of alcohol dependence, but neural correlates of this marker are unclear.

METHOD

Ten healthy volunteers were classified by median split on level of response to alcohol and underwent 2 sessions of functional magnetic resonance imaging following ingestion of a moderate dose of alcohol and a placebo. The blood oxygen level-dependent activation to an event-related visual working memory test was examined.

RESULTS

The subjects exhibited longer response latencies and more errors as a function of increasing working memory load and showed a load-dependent increase in activation in dorsolateral prefrontal cortex, posterior parietal cortex, and visual cortex. Alcohol did not affect performance (errors or response latency), but attenuated the working memory load-dependent activation in the dorsolateral prefrontal cortex. During the placebo condition, individuals with a low level of response to alcohol showed greater activation in dorsolateral prefrontal cortex and posterior parietal cortex than those with a high level of response to alcohol. During the alcohol condition, groups showed similar attenuation of load-dependent brain activation in these regions.

CONCLUSION

Low-level responders relative to high-level responders exhibited an increased working memory load-dependent activation in dorsolateral prefrontal cortex and posterior parietal cortex when not exposed to alcohol. This increase in brain response was attenuated in low-level responders after ingesting a moderate dose of alcohol.

Alcohol-induced suppression of BOLD activity during goal-directed visuomotor performance

The neurophysiological influence of alcohol produces deficits of many cognitive functions, including executive and motor control processes. This study examined the acute effects of alcohol in the context of goal-directed visuomotor performance during functional magnetic resonance imaging (fMRI). Subjects consumed alcohol-laced gelatin during one scan session and non-alcoholic placebo gelatin in another. During each session, subjects performed a visuomotor target capture where they received continuous or terminal positional feedback information. Blood-oxygen level-dependent (BOLD) activity in the cerebellum was suppressed in the presence of alcohol, consistent with the known ethanol sensitivity of the cerebellum. A fronto-parietal network was identified as most affected by alcohol consumption, with differential patterns of BOLD contingent on visual feedback. Results indicate that alcohol selectively suppresses cognitive activity in frontal and posterior parietal brain regions that, in conjunction with cerebellar nuclei, are believed to contribute to the formation of internal cognitive models of motor representation and action.

Neuropsychological profile of acute alcohol intoxication during ascending and descending blood alcohol concentrations

Numerous studies have investigated the effects of alcohol on motor processes during rising and declining blood alcohol concentrations (BAC), however, relatively little research has examined the alcohol-induced impairment of cognitive performance on the two limbs of the BAC curve. This experiment administered a neuropsychological test battery to assess the degree to which rising and declining BACs during an acute dose of alcohol impair nine cognitive processes within an individual. In all, 20 healthy male social drinkers (university students) were assigned to one of two groups (n = 10) who received a beverage containing either 0.0 g/kg (placebo) or 0.65 g/kg alcohol and performed the test battery when BAC was increasing and was decreasing. Comparisons of alcohol and placebo groups revealed impairment (slower response and/or increased errors) in seven of the cognitive processes: long-term verbal memory; information processing; declarative memory; inhibitory control; short-term visual memory; long-term visual memory, and visual-spatial working memory. However, some processes were impaired only during rising BACs whereas the impairment of others during declining BACs was evident only by an increase in errors. These results show cognitive tasks performed by an individual are not similarly affected by rising and declining BACs, and call attention to the importance of assessing both speed and accuracy on both limbs of the BAC curve. The particular cognitive processes differentially affected by rising vs declining BACs raised the possibility that acute alcohol intoxication may impair one cerebral hemisphere to a greater degree than the other, and this could be explored by neuroimaging techniques.

Possible association between response inhibition and a variant in the brain-expressed tryptophan hydroxylase-2 gene

The ability to inhibit a response is an important component of normal behavioral control and is an aspect of psychopathology when diminished. Converging evidence implicates the serotonergic neurotransmitter system in response inhibition circuitry.

OBJECTIVES

The present study examined potential associations between serotonergic genetic markers and response inhibition as indexed by Stop Task performance.

METHODS

College-age participants (N=199) completed self-report questionnaires, the computerized Stop Task, and donated buccal cells for genetic analyses. Statistics were analyzed by ANOVA.

RESULTS

Stop Signal reaction time was not associated with allelic variation at a monoamine oxidase A promoter length polymorphism or a serotonin 1B terminal autoreceptor polymorphism (G861C). An intronic genetic marker of the neuronal tryptophan hydroxylase-2 (the rate-limiting enzyme for serotonin biosynthesis) gene, however, was associated with the Stop Signal reaction time. Individuals homozygous for the T variant at an intron-8 polymorphism had the longest Stop Signal reaction time (i.e. greater impulsivity, P=0.01), and this effect was stronger in males (P=0.01) than in females (P=0.10).

CONCLUSIONS

A genotype at an intron-8 tryptophan hydroxylase-2 polymorphism was associated with response inhibition as indexed by the Stop Task. These results, if replicated, would implicate dorsal raphe serotonin neurons in response inhibition. It may be that individuals with the T/T genotype may have reduced tryptophan hydroxylase-2 function and correspondingly lower central serotonin levels; however, further investigation of the reported association is required.

Alcohol attentional bias: drinking salience or cognitive impairment?

OBJECTIVE

This study evaluated whether alcohol attentional bias is an artifact of excessive drinkers' impaired cognitive functioning, which adversely affects their performance on the classic Stroop test (a measure of inhibitory control) and the Shipley Institute of Living Scale (SILS; a measure of verbal and abstraction ability). Both tests measure aspects of executive cognitive functioning (ECF).

METHODS

Social drinkers (N=87) and alcohol-dependent drinkers (N=47) completed a measure of alcohol consumption, classic and alcohol-related Stroop tests, and the SILS.

RESULTS

A multivariate analysis of variance (MANOVA) showed that the dependent drinkers were poorer on the cognitive measures (SILS scores and classic Stroop interference) and had greater alcohol attentional bias than the social drinkers. An analysis of covariance (ANCOVA) in which the cognitive measures were controlled showed that the dependent drinkers' greater alcohol attentional bias was not an artifact of their poorer cognitive performance.

CONCLUSION

The results are discussed in terms of cognitive-motivational models, which suggest that excessive drinking sensitizes alcohol abusers' attentional responsiveness to alcohol-related stimuli to a degree that exceeds the adverse effects of alcohol on their general cognitive functioning.

Alcohol consumption impairs stimulus- and error-related processing during a Go/No-Go Task

Alcohol consumption has been shown to increase the number of errors in tasks that require a high degree of cognitive control, such as a go/no-go task. The alcohol-related decline in performance may be related to difficulties in maintaining attention on the task at hand and/or deficits in inhibiting a prepotent response. To test these two accounts, we investigated the effects of alcohol on stimulus- and response-locked evoked potentials recorded during a go/no-go task that involved the withholding of key presses to rare targets. All participants performed the task prior to drinking and were then assigned randomly to either a control, low-dose, or moderate-dose treatment. Both doses of alcohol increased the number of errors relative to alcohol-free performance. Success in withholding a prepotent response was associated with an early-enhanced stimulus-locked negativity at inferior parietal sites, which was delayed when participants failed to inhibit the motor command. Moreover, low and moderate doses of alcohol reduced N170 and P3 amplitudes during go, no-go, and error trials. In comparison with the correct responses, errors generated large response-locked negative (Ne) and positive (Pe) waves at central sites. Both doses of alcohol reduced the Ne amplitude whereas the Pe amplitude decreased only after moderate doses of alcohol. These results are consistent with the interpretation that behavioral disinhibition following alcohol consumption involved alcohol-induced deficits in maintaining and allocating attention thereby affecting the processing of incoming stimuli and the recognition that an errant response has been made.

Alcohol-induced impairment of behavioral control: differential effects on engaging vs. disengaging responses

RATIONALE

Model-based assessments of behavioral control have been used to study the acute effects of alcohol on the ability to execute and inhibit behavioral responses. Response inhibition appears more vulnerable to the impairing effects of alcohol than response execution. Current information processing models have yet to account for this observation.

OBJECTIVES

The present study used a reductionist approach to determine if the particular vulnerability of response inhibition to the effects of alcohol occurs at the level of the action (motor program). The study examined the effects of alcohol on the ability to execute and inhibit behavior in a context in which preliminary information signaled the likelihood that a response should be executed or suppressed. The engagement and disengagement of responses were directly compared under alcohol.

METHODS

Adults (N = 24) performed a cued go/no-go task that required quick responses to go targets and suppression of responses to no-go targets. Response requirements were manipulated by varying the nature of the action required whereby half of the participants made key press responses (response engagement) and the other half released ongoing key presses (response disengagement). Performance was tested under three doses of alcohol: 0.00, 0.45, and 0.65 g/kg.

RESULTS

Dose-dependent increases in commission errors were only observed with response engagement and not with response disengagement. Reaction times were faster for response engagement than response disengagement.

CONCLUSIONS

Response disengagement affords some protection against alcohol-induced impairment of inhibition, indicating that not all aspects of motor processing requiring inhibition are equally impaired by alcohol.

Psychological Processes Underlying Risky Decisions in Drug Abusers

Decision-making deficits are considered to be a significant contributing factor for drug abuse. Drug abusers performed poorly on a simulated gambling task (A. Bechara, H. Damasio, D. Tranel, & S. Anderson, 1994); however, the psychological processes that contribute to these deficits are unknown. The authors used cognitive decision models with a simulated gambling task (SGT) to examine underlying processes of decision making in 66 drug abusers and 58 control participants. As expected, male drug abusers performed more poorly than male controls, and model results showed that male drug abusers placed greater emphasis on wins. The findings for women were less clear because control women performed at chance level on the SGT. Additional studies of gender differences on the SGT are needed to clarify these findings of discrepant performance in the control women.

Response shifting and inhibition, but not working memory, are impaired after long-term heavy alcohol consumption

Chronic alcohol abuse leads to cognitive deficits. The authors investigated whether a systematic increase of interference in a 2-back working memory paradigm would lead to cognitive deficits in alcoholic participants and compared their performance in such a task with that in an alternate-response task. Twenty-four nonamnesic and nondemented alcohol abuse (AA) patients and 12 patients with Korsakoff's syndrome (KS) were compared with a control group. AA patients were impaired in the alternate-response task but not in working memory interference resolution. KS patients performed worse than the AA patients and the controls in both tasks. The neurotoxic side effects of alcohol therefore lead to a specific deficit in alternating between response rules but not in working memory, independently of whether the working memory task involves interference resolution or not.

Multiple binge alcohol consumption during rat adolescence increases anxiety but does not impair retention in the passive avoidance task

We investigated the effect of binge alcohol consumption on anxiety-related behavior and memory in adolescent male Wistar rats. Three consecutive daily sessions of ethanol administration (5 g/kg) were repeated weekly for 4 weeks. The retention of passive avoidance was measured weekly, 48 h following the treatment. Three days after the last memory test a novel object exploration test was done. There was no significant difference in step-through latency between the groups, but the ethanol-treated group displayed a significantly higher incidence of defecation, and an increased number of boluses during the passive avoidance test. The latency to explore a novel object was also higher, while the duration of exploration was significantly lower. Together, these data suggest that binge alcohol consumption in adolescent rats does not impair their memory in passive avoidance tasks, but may significantly increase their anxiety.

The role of brain oscillations as functional correlates of cognitive systems: a study of frontal inhibitory control in alcoholism

Event-related oscillations play a key role in understanding the brain dynamics and human information processing. In the present study, the Go/No-Go paradigm has been used to examine whether alcoholics have poor inhibitory control as compared to control subjects in terms of different oscillatory brain responses. The matching pursuit algorithm was used to decompose the event-related electroencephalogram into oscillations of different frequencies. It was found that alcoholics (n=58) showed significant reduction in delta (1.0-3.0 Hz) and theta (3.5-7.0 Hz) power during No-Go trials as compared to controls (n=29). This reduction was prominent at the frontal region. The decreased delta and theta power associated with No-Go processing perhaps suggests a deficient inhibitory control and information-processing mechanism. A neuro-cognitive model has been provided to explain the findings. It is suggested that the oscillatory correlates during cognitive processing can be an endophenotypic marker in alcoholism.

Advances in nonhuman primate alcohol abuse and alcoholism research

Advances in our understanding of the biological basis of alcohol abuse and alcoholism and the development of prevention and therapeutic intervention require appropriate animal models. Nonhuman primates are important to the study of complex biomedical disease processes. Genetic, anatomical, physiological, and behavioral similarities to humans offer unique opportunities for translational research along with the advantage of a degree of experimental control that is not possible in human studies. The purpose of this review is to outline the approaches taken with nonhuman primates as subjects in alcohol research and to highlight our current understanding of data on organismal variables that can be uniquely studied in these complex organisms. We review literature on alcohol self-administration to provide an integrative framework for discussion of progress in 2 important areas of research. Designs that incorporate self-administration provide a context for studying excessive alcohol consumption, including the organismal and environmental factors that influence risk for heavy drinking. We then review the use of monkeys to identify aspects of adverse biomedical consequences that follow excessive alcohol consumption. One of the primary conclusions to be drawn from this review is that nonhuman primates are a central part of the translational bridge in alcohol research, providing powerful and unique opportunities for experimental work that can address the biomedical complexities of alcohol abuse and alcoholism.

Effects of alcohol consumption and alcohol susceptibility on cognition: a psychophysiological examination

The present study sought to examine acute effects of alcohol on cognitive processing and performance within the context of two prominent theories of alcohol's effects; namely, that alcohol restricts the focus of attention (e.g. Steele and Josephs, 1990. Journal of Abnormal Psychology, 97, 196-205) and that alcohol impairs response inhibition (e.g. Fillmore and Vogel-Sprott, 1999. Experimental and Clinical Psychopharmacology, 7, 49-55; Fillmore and Vogel-Sprott, 2000. Journal of Studies on Alcohol, 61, 239-246). Forty-five participants were randomly assigned to receive either a placebo level of alcohol (0.04 g/kg), a moderate dose (0.40 g/kg), or a higher dose (0.80 g/kg). Brain electrical activity (ERPs) and behavioral responses (reaction time and accuracy) were measured while participants performed a modified flanker task, in which a target letter was flanked by response-compatible or response-incompatible letters. Analyses of behavioral data showed that alcohol increased response competition in accuracy but not response times, suggesting that alcohol influences response selection more than attentional processes per se. This finding is in-line with predictions derived from the response inhibition model. ERP latency data provided mixed support for both models. ERP amplitude data showed that the high dose of alcohol primarily influenced a mostly frontal negativity in the ERP, present on both correct and incorrect response trials. Differences in self-reported susceptibility to alcohol were most evident in the amplitude of the P3 component. Findings are discussed in terms of the differential effects of acute dose and susceptibility on information processing.

Ethanol effects on volitional versus reflexive saccades

The effects of a moderate alcohol dose on reflexive and volitional saccades were compared. Healthy male subjects (n = 17) made horizontal reflexive saccades, antisaccades and self-paced saccades before and after the ingestion of a body-weight-related dose of alcohol. At a mean blood alcohol concentration of 0.044%, reflexive saccade latency significantly increased although accuracy remained unimpaired at each target amplitude. No significant ethanol effects were noted for antisaccade accuracy and latency. Antisaccade error rates decreased significantly, likely demonstrating a learning effect. The mean rate of self-paced saccades did not significantly change post-ethanol and their accuracy was also unimpaired. All saccades share a final common pathway for their execution. It thus seems reasonable to propose that ethanol modulated connections between the posterior parietal cortex and superior colliculus to increase reflexive saccade latency. Higher-order paradigms, which require inhibition and are mediated by frontal areas, might be impaired at greater blood alcohol concentrations.