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

Measuring craving: A systematic review and mapping of assessment instruments. What about sexual craving?

BACKGROUND AND AIMS

Craving is central in the definition of addictive disorders because of its diagnostic and prognostic value. Its measurement is essential in clinical practice. Previous reviews provided a better overview of existing instruments; however, they do not consider emerging substances and behaviors such as sexual addictions. Our objectives were threefold: (1) to provide a systematic review of craving assessment instruments and their psychometric characteristics within a transdiagnostic approach, (2) to highlight and map their conceptual relationships and (3) to identify potential sexual craving assessment instruments.

METHODS

The review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The PubMed, Embase, PsychInfo and Cochrane/Central databases were searched for publications that met the following inclusion criterion: validation studies of craving assessment instruments, regardless of target substance or behavior. The original search identified 4561 references and included 147 articles. Each selected study was a peer-reviewed publication.

RESULTS

This review provides a synthesis of the psychometric properties of 36 original instruments and identified 93 variations of these instruments (e.g. translations). We were able to highlight five transdiagnostic families of instruments, each corresponding to a conceptual model. Only one instrument for assessing craving in the domain of compulsive sexual behavior, focused on pornography use, has been identified: the Pornography Craving Questionnaire.

CONCLUSION

This review mapped all craving assessment instruments from a transdiagnostic perspective, finding 36 original instruments and 93 variations. The evolution of instruments to measure craving mirrors the evolution of the concept of craving which has progressively integrated cognitive, conditioning and sensory dimensions, and attests to the importance of the context of assessment. Development of an instrument to measure 'sexual craving' is needed and could be based on the data from our review.

Enhanced conditioned "liking" of novel visual cues paired with alcohol or non-alcohol beverage container images among individuals at higher risk for alcohol use disorder

RATIONALE/OBJECTIVE

This study used an evaluative conditioning (EC) procedure to assess the affective properties of a CS for ingested drug reward in humans. Specifically, the study tested whether the evaluative response ("liking"/"disliking") to an arbitrary visual stimulus ("CS₂," e.g., a purple hexagon) could be changed through pairings with an alcohol or non-alcohol beverage cue ("CS₁," e.g., a full wine glass, a juice box), which is ostensibly a conditioned visual predictive stimulus for alcohol or non-alcohol liquid reward, respectively.

METHODS

Participants (N = 369, 18-23 years, 66% female, 79% white, 21% reporting no alcohol use ever or in the past year) received 24 CS₁ pairings with each CS₂. CS₂ and CS₁ evaluations were assessed pre- and post-conditioning.

RESULTS

Alcohol and non-alcohol CS₂ "liking" correlated with alcohol use. "Liking" of the alcohol but not non-alcohol CS₁ also correlated with alcohol use. Alcohol CS₁ "liking" also correlated with alcohol and non-alcohol CS₂ 'liking," whereas non-alcohol CS₁ 'liking" correlated with non-alcohol but not alcohol CS₂ "liking."

CONCLUSIONS

Taken together, findings support the idea that drug-related visual stimuli acquire appetitive (hedonic and/or incentive) properties as a function of individual differences in drug use, which entail individual differences in exposure to the conditioning effects of addictive substances like alcohol. Findings also suggest a link between drug use and the propensity to attribute affective/motivational significance to reward-predictive cues in general.

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

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

Wake Forest Alcohol Imagery Set: Development and Validation of a Large Standardized Alcohol Imagery Dataset

BACKGROUND

The study of alcohol use frequency utilizes alcohol-related cue imagery. Although a number of alcohol-image databases currently exist, they have several limitations: Many are not publicly available, some use stock images or clip art rather than real photographs, several eliminate any photographs displaying brand information, and predominantly they contain relatively few images. The aim of this project was to develop a large, open-access database of alcohol-related cue images, containing photographs with and without brand information, taken in real-world environments, with images in a variety of orientations and dimensions.

METHODS

The study collected 1,650 images voluntarily from the larger community, to capture photographs with a wide range of content, environments, and relation to alcohol. All images were then rated on scales of valence, arousal, and relation to alcohol by 1,008 Amazon Mechanical Turk workers, using classical emotion validation methods based on the International Affective Picture System (IAPS). Survey respondents were screened with the Alcohol Use Disorders Identification Test (AUDIT), and Cronbach's alpha scores were calculated to determine the interrater reliability of scores across the whole sample, and within low-risk, moderate-risk, and high-risk drinkers for each rating domain. Univariate ANOVAs were run to determine differences in ratings across drinking groups.

RESULTS

All Cronbach's alpha scores indicated high interrater reliability within the whole sample, and across drinking severity groups. Tukey's HSD post hoc results indicated greater arousal and affect in response to image viewing in moderate- and high-risk drinkers, and higher relation-to-alcohol ratings in low-risk drinkers. All images had categorization tags assigned by members of the study team.

CONCLUSIONS

The established imagery set includes 1,650 alcohol-related images, rated on scales of valence, arousal, and relation to alcohol, and categorized by type of alcohol depicted. The imagery database will be available for open-access download and use through Google Photos.

Interactive Effects of Naturalistic Drinking Context and Alcohol Sensitivity on Neural Alcohol Cue-Reactivity Responses

BACKGROUND

Considerable evidence indicates that a low level of subjective response to alcohol's acute effects (i.e., low sensitivity) is associated with enhanced risk for alcohol use disorder (AUD). Recent work suggests that the highest risk response profile consists of blunted sensitivity to alcohol's sedation-like effects, coupled with enhanced sensitivity to alcohol's stimulation-like effects (i.e., differential sensitivity). A largely separate body of work indicates that enhanced reactivity to alcohol-related cues is associated with increased AUD risk.

AIMS

The current research examined the extent to which variability in alcohol response phenotypes is associated with enhanced P3 event-related potential (ERP) responses to alcohol-related pictures (ACR-P3), and whether this reactivity varies according to depicted drinking contexts.

METHODS

Eighty young adults (aged 18 to 33 years) completed a self-report measure of alcohol sensitivity (the Alcohol Sensitivity Questionnaire) and viewed images depicting drinking in naturalistic contexts, alcohol and nonalcohol beverages in isolation (devoid of naturalistic drinking context), and neutral nonbeverage control images while ERPs were recorded.

RESULTS

Results indicated that blunted sensitivity to alcohol's sedative-like effects was differentially associated with enhanced ACR-P3 but reduced P3 reactivity to nonalcohol cues. Variation in sensitivity to alcohol's stimulant-like effects was not associated with differential ACR-P3. Contrary to predictions, these effects were not potentiated by drinking contexts.

CONCLUSIONS

The current results replicate and extend previous work linking low alcohol sensitivity with enhanced incentive salience for alcohol-related cues and suggest that cues depicting drinking contexts are less likely to differentiate high-risk from low-risk drinkers.

Effects of Alcohol Cues on MRS Glutamate Levels in the Anterior Cingulate

Growing evidence suggests that glutamate neurotransmission plays a critical role in alcohol addiction. Cue-induced change of glutamate has been observed in animal studies but never been investigated in humans. This work investigates cue-induced change in forebrain glutamate in individuals with alcohol use disorder (AUD). A total of 35 subjects (17 individuals with AUD and 18 healthy controls) participated in this study. The glutamate concentration was measured with single-voxel 1H-MR spectroscopy at the dorsal anterior cingulate. Two MRS sessions were performed in succession, the first to establish basal glutamate levels and the second to measure the change in response to alcohol cues. The changes in glutamate were quantified for both AUD subjects and controls. A mixed model ANOVA and t-tests were performed for statistical analysis. ANOVA revealed a main effect of cue-induced decrease of glutamate level in the anterior cingulate cortex (ACC). A significant interaction revealed that only AUD subjects showed significant decrease of glutamate in the ACC. There were no significant group differences in the level of basal glutamate. However, a negative correlation was found between the basal glutamate level and the number of drinking days in the past 2 weeks for the AUD subjects. Collectively, our results indicate that glutamate in key areas of the forebrain reward circuit is modulated by alcohol cues in early alcohol dependence.

Non-Alcoholic Beverage Cues as Specific Comparison Images to Alcohol Image Cues

BACKGROUND

Visual alcohol cues are often used to elicit craving (e.g., cue-reactivity), and selection of appropriate comparison cues is important to isolate the specific effect of craving for alcohol.

OBJECTIVES

In the current study, via the development of a new set of non-alcoholic beverage cues, we examine measurement and methodological choices in testing alcohol images for cue-reactivity studies.

METHODS

The current project combined two independent studies of hazardous (Study 1; n = 80) and recent drinkers (Study 2; n = 244) recruited from Amazon Mechanical Turk. Participants viewed either alcohol cues (Lovett, Ham, & Veilleux, 2015 ) or newly developed non-alcoholic beverage cues. We also randomly assigned people to rate the cues regarding motivational (e.g., affect, craving for alcohol, resistance to alcohol) responses or non-motivational features (e.g., artistry).

RESULTS

In Study 1, we included presentation of non-beverage objects, and found that beverages were rated as more positive, less negative and with higher craving than non-beverage objects. In the combined sample, we found that the alcohol beverage cues were associated with greater craving than non-alcoholic beverage cues, and that there were no differences between cue types on either positive or negative affect. We also found an interaction between drinking experience and cue type in predicting resistance to drinking.

CONCLUSIONS

We conclude that the choice of control cues in alcohol cue-reactivity studies is important, and that the currently developed non-alcoholic beverage cue set provides an adequate control for alcohol beverage cues for use in cue-reactivity paradigms.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Vulnerability to alcohol-related problems: a policy brief with implications for the regulation of alcohol marketing

BACKGROUND AND AIMS

The concern that alcohol advertising can have detrimental effects on vulnerable viewers has prompted the development of codes of responsible advertising practices. This paper evaluates critically the concept of vulnerability as it applies to (1) susceptibility to alcohol-related harm and (2) susceptibility to the effects of marketing, and describes its implications for the regulation of alcohol marketing.

METHOD

We describe the findings of key published studies, review papers and expert reports to determine whether these two types of vulnerability apply to population groups defined by (1) age and developmental history; (2) personality characteristics; (3) family history of alcoholism; (4) female sex and pregnancy risk; and (5) history of alcohol dependence and recovery status.

RESULTS

Developmental theory and research suggest that groups defined by younger age, incomplete neurocognitive development and a history of alcohol dependence may be particularly vulnerable because of the disproportionate harm they experience from alcohol and their increased susceptibility to alcohol marketing. Children may be more susceptible to media imagery because they do not have the ability to compensate for biases in advertising portrayals and glamorized media imagery.

CONCLUSION

Young people and people with a history of alcohol dependence appear to be especially vulnerable to alcohol marketing, warranting the development of new content and exposure guidelines focused on protecting those groups to improve current self-regulation codes promoted by the alcohol industry. If adequate protections cannot be implemented through this mechanism, statutory regulations should be considered.