Alcohol expectancy moderates attentional bias for alcohol cues in light drinkers

I spy with my little eye: An eye-tracking study examining adolescents' attention to alcoholic and non-alcoholic beverages in Instagram stories

Social media users are frequently exposed to alcohol images on Instagram, which in turn influences their own alcohol behaviors. Yet, it is unclear what factors drive attention to alcohol cues. In an eye-tracking study (N = 108; Mage = 16.54), we examined adolescents' attention to Instagram Stories depending on: (a) the type of beverage depicted (beer vs water), (b) the character-product interaction portrayed (CPI: peers in images shown consuming [high CPI] vs holding beverages [low CPI]) and, (c) participant's own susceptibility (high vs low-risk alcohol drinker). Our results illustrated that adolescents allocated an equal amount of attention to beer and water depicted in Instagram images. Furthermore, they devoted more attention to Instagram images wherein peers were shown consuming water and beer (high CPI) compared to those wherein peers were holding these beverages (low CPI). Surprisingly, high-risk alcohol drinkers were more responsive to both beer and water cues than low-risk drinkers. This was particularly the case for Instagram images with high CPI. These findings have implications for how health cues on Instagram are attended to and processed.

Association Between Alcohol Expectancy and Drinking Behaviors in Summer Vacation and Last Year Among College Students

Background

Drinking in summer vacation, as an important part of college students' drinking behavior, has rarely been studied. At present, there is no research to explore the association between alcohol expectancy and college students' drinking behavior during the summer vacation.

Methods

A total of 487 college students were selected from three universities in Chongqing from July 30, 2017, to August 30, 2017, by cluster sampling. The electronic questionnaires were distributed to complete the anonymous survey related to drinking. The questionnaire on drinking mainly included baseline characteristics, influencing factors related to drinking, drinking behavior in the last year and summer vacation, and alcohol expectancy. Independent sample t-test and one-way ANOVA were used for multi-factor analysis. Multi-level logistic regression analysis and ordered logistic regression analysis were used for multivariate analysis.

Results

The past drinking rate in the study group was 86.24%. In the past year, the drinking rate and binge drinking rate of college students were 63.24% and 23.20%. In summer drinking, these two indicators were 29.57% and 8.42%, respectively. About 92.50% of the moderate and heavy drinking groups among college students had drinking behavior during the summer vacation. The average negative expectancy among college students was 3.26 ± 0.87 while the average positive expectancy was 2.63 ± 0.66. In drinking last year, positive expectancy was a risk factor for occasional and light drinking compared with those of non-drinkers (P<0.05). In summer vacation drinking, compared with those of non-drinkers, negative expectancy was a protective factor for occasional drinking (OR: 1.847, 95% CI: 1.293-2.638), negative expectancy and positive expectancy were both influencing factors for light drinking (P<0.05).

Conclusion

The drinking rate in the study group was at a high level in the past. The association between alcohol expectancy and drinking behavior among college students would be different according to the period and amount of drinking.

Does alcohol automatically capture drinkers' attention? Exploration through an eye-tracking saccadic choice task

RATIONALE

Dominant theoretical models postulate the presence of an automatic attentional bias (AB) towards alcohol-related stimuli in alcohol use disorder, such AB constituting a core feature of this disorder. An early alcohol AB has been documented in subclinical populations such as binge drinking (i.e., a drinking pattern prevalent in youth and characterized by repeated alternation between alcohol intoxications and withdrawals, generating cerebral consequences). However, the automatic nature of AB remains to be established.

OBJECTIVES

We investigated the automatic nature of AB in binge drinkers through the saccadic choice task. This eye-tracking paradigm consistently highlights the extremely fast and involuntary saccadic responses elicited by faces in humans, relative to other object categories. Through an alcohol-related adaptation of the saccadic choice task, we tested whether the early and automatic capture of attentional resources elicited by faces can also be found for alcohol-related stimuli in binge drinkers, as predicted by theoretical models.

METHODS

Forty-three binge drinkers and 44 control participants performed two versions of the saccadic choice task. In the original version, two images (a face, a vehicle) were displayed on the left and right side of the screen respectively. Participants had to perform a saccade as fast as possible towards the target stimulus (either face or vehicle). In the alcohol-related version, the task was identical, but the images were an alcoholic beverage and a non-alcoholic stimulus.

RESULTS

We replicated the automatic attraction towards faces in both groups, as faces generated higher saccadic accuracy, speed, and amplitude than vehicles, as well as higher corrective saccade proportion. Concerning the alcohol-related adaptation of the task, groups did not differ for the accuracy, speed, and amplitude of the first saccade towards alcohol. However, binge drinkers differed from controls regarding the proportion of corrective saccade towards non-alcoholic stimuli after an error saccade towards alcohol, suggesting the presence of an alcohol disengagement bias specific to binge drinkers.

CONCLUSIONS

Alcohol-related AB in binge drinkers is not characterized by an early and automatic hijacking of attention towards alcohol. This AB rather relies on later and more controlled processing stages, namely a difficulty to disengage attentional resources from alcohol-related stimuli.

Attentional bias in alcohol drinkers: A systematic review of its link with consumption variables

In severe alcohol use disorder (SAUD), attentional bias refers to the preferential allocation of attentional resources toward alcohol-related cues. Dominant models consider that this bias plays a key role in the emergence and maintenance of SAUD. We evaluate the available experimental support for this assumption through a systematic literature review, providing a critical synthesis of studies exploring the links between alcohol consumption and attentional bias. Using PRISMA guidelines, we explored three databases (PsycINFO, PubMed, Scopus) and extracted 95 papers. We assessed their methodological quality and categorized them based on the population targeted, namely patients with SAUD or subclinical populations with various drinking patterns. We also classified papers according to the measures used (i.e., behavioral or eye-tracking measures). Overall, subclinical populations present an alcohol-related bias, but many studies in SAUD did not find such bias, nor approach/avoidance patterns. Moreover, attentional bias fluctuates alongside motivational states rather than according to alcohol use severity, which questions its stability. We provide recommendations to develop further theoretical knowledge and overcome methodological shortcomings.

How laboratory studies of cigarette craving can inform the experimental alcohol craving literature

Interest in alcohol and other drug craving has flourished over the past two decades, and evidence has accumulated showing that craving can be meaningfully linked to both drug use and relapse. Considerable human experimental alcohol craving research since 2000 has focused on craving as a clinical phenomenon. Self-reported craving to drink typically has served as a catch-all for the craving construct in these studies, whereas few studies have considered craving as a process (or hypothetical construct) that interacts with other phenomena to affect use. In contrast to alcohol, we believe that recently there has been more mechanistic work targeting cigarette craving-related processes. Here, we briefly present a narrative review of studies of acute alcohol craving in humans that have been conducted during the past two decades. We then specify important ways in which alcohol and tobacco differ (e.g., the role of withdrawal), and we note the unique challenges in inducing robust alcohol craving states in the laboratory. Finally, we offer recommendations for how the alcohol field might advance its conceptual understanding of craving by adopting ideas and methods drawn from the smoking research literature. Specifically, we suggest that researchers extend their studies to not only examine the link between alcohol craving and relapse but also to focus on why and, in some instances, how alcohol cravings matter clinically, and the circumstances under which craving especially matters. We propose research to investigate the shifts in alcohol-related cognitive and affective processing that occur during alcohol craving states. Furthermore, we highlight the value of research examining the level of insight that individuals with varying levels of alcohol involvement possess about their own craving-related processing shifts. We believe that laboratory studies can provide rich opportunities to examine conceptual questions about alcohol craving that are central to addiction.

The effect of alcohol on food-related attentional bias, food reward and intake: Two experimental studies

Acute alcohol consumption has been shown to increase food intake, and long-term alcohol consumption may be a risk for weight gain. A potential, but under-studied, mechanism for this effect is alcohol's ability to enhance food reward. In two studies, participants consumed an alcoholic drink (Study 1: 0.3 grams of alcohol per kilogram of bodyweight (g/kg); Study 2: 0.6 g/kg) and a placebo-alcohol drink in a within-subjects design. In both studies, food-related appetitive and motivational states, and attentional bias (AB) towards food-related cues were measured. In Study 1 (N = 44), participants completed a visual probe task with concurrent recording of eye-movements which measured AB towards images of palatable foods, unpalatable foods, and non-food control items. Participants also completed measures of appetite and snack urge ratings, salivary response towards palatable foods and an ad libitum food taste test. In Study 2 (N = 84), participants completed a similar procedure, but completed a modified Stroop task which measured differences in food-related and alcohol-related AB across the two drink conditions. In Study 1, there was no difference in food-related AB between drink conditions, and no differences in snack urge, appetite ratings, salivary response, or food intake. In contrast, Study 2 showed an alcohol-induced increase in AB towards food, but not alcohol. Snack urge, alcohol urge ratings and ad libitum food intake were also higher after alcohol consumption, relative to the placebo. Collectively, these findings suggest that alcohol can increase food reward and food intake, but these effects may only occur at a higher dose.

Understanding Attentional Biases in Severe Alcohol Use Disorder: A Combined Behavioral and Eye-Tracking Perspective

RATIONALE

Severe alcohol use disorder (SAUD) is a psychiatric condition linked to cerebral and cognitive consequences. SAUD is notably characterized by an overactivation of the reflexive/reward system when confronted with alcohol-related cues. Such overreactivity generates a preferential allocation of attentional resources toward these cues, labeled as attentional biases (AB). Theoretical assumptions have been made regarding the characteristics of AB and their underlying processes. While often considered as granted, these assumptions remain to be experimentally validated.

AIMS

We first identify the theoretical assumptions made by previous studies exploring the nature and role of AB. We then discuss the current evidence available to establish their validity. We finally propose research avenues to experimentally test them.

METHODS

Capitalizing on a narrative review of studies exploring AB in SAUD, the current limits of the behavioral measures used for their evaluation are highlighted as well as the benefits derived from the use of eye-tracking measures to obtain a deeper understanding of their underlying processes. We describe the issues related to the theoretical proposals on AB and propose research avenues to test them. Four experimental axes are proposed, respectively, related to the determination of (a) the genuine nature of the mechanisms underlying AB; (b) their stability over the disease course; (c) their specificity to alcohol-related stimuli and (d) their reflexive or controlled nature.

CONCLUSIONS

This in-depth exploration of the available knowledge related to AB in SAUD, and of its key limitations, highlights the theoretical and clinical interest of our innovative experimental perspectives capitalizing on eye-tracking measures.

A review of studies exploring fetal alcohol spectrum disorders through eye tracking measures

The widespread cognitive and cerebral consequences of prenatal alcohol exposure have been established during the last decades, through the exploration of fetal alcohol spectrum disorders (FASD) using neuropsychological and neuroscience tools. This research field has recently benefited from the emergence of innovative measures, among which eye tracking, allowing a precise measure of the eye movements indexing a large range of cognitive functions. We propose a comprehensive review, based on PRISMA guidelines, of the eye tracking studies performed in populations with FASD. Studies were selected from the PsycINFO, PubMed and Scopus databases, and were evaluated through a standardized methodological quality assessment. Studies were classified according to the eye tracking indexes recorded (saccade characteristics, initial fixation, number of fixations, dwell time, gaze pattern) and the process measured (perception, memory, executive functions). Eye tracking data showed that FASD are mostly associated with impaired ocular perceptive/motor abilities (i.e., altered eye movements, centrally for saccade initiation), lower accuracy as well as increased error rates in saccadic eye movements involving working memory abilities, and reduced inhibitory control on saccades. After identifying the main limitations presented by the reviewed studies, we propose guidelines for future research, underlining the need to increase the standardization of diagnosis and evaluation tools, and to improve the methodological quality of eye tracking measures.

Eye Tracking Studies Exploring Cognitive and Affective Processes among Alcohol Drinkers: a Systematic Review and Perspectives

Acute alcohol intoxication and alcohol use disorders are characterized by a wide range of psychological and cerebral impairments, which have been widely explored using neuropsychological and neuroscientific techniques. Eye tracking has recently emerged as an innovative tool to renew this exploration, as eye movements offer complementary information on the processes underlying perceptive, attentional, memory or executive abilities. Building on this, the present systematic and critical literature review provides a comprehensive overview of eye tracking studies exploring cognitive and affective processes among alcohol drinkers. Using PRISMA guidelines, 36 papers that measured eye movements among alcohol drinkers were extracted from three databases (PsycINFO, PubMed, Scopus). They were assessed for methodological quality using a standardized procedure, and categorized based on the main cognitive function measured, namely perceptive abilities, attentional bias, executive function, emotion and prevention/intervention. Eye tracking indexes showed that alcohol-related disorders are related to: (1) a stable pattern of basic eye movement impairments, particularly during alcohol intoxication; (2) a robust attentional bias, indexed by increased dwell times for alcohol-related stimuli; (3) a reduced inhibitory control on saccadic movements; (4) an increased pupillary reactivity to visual stimuli, regardless of their emotional content; (5) a limited visual attention to prevention messages. Perspectives for future research are proposed, notably encouraging the exploration of eye movements in severe alcohol use disorders and the establishment of methodological gold standards for eye tracking measures in this field.

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.

Craving is everything: An eye-tracking exploration of attentional bias in binge drinking

BACKGROUND

Attentional bias towards alcohol-related stimuli is a core characteristic of severe alcohol use disorders (AUD), directly linked to clinical variables (e.g. alcohol consumption, relapse). Nevertheless, the extent of this bias in subclinical populations remains poorly documented. This is particularly true for binge drinking, an alcohol consumption pattern highly prevalent in youth, characterised by an alternation between excessive intakes and withdrawal periods.

AIMS

We used eye-tracking to: (a) measure attentional bias in binge drinking, (b) determine its time course by dissociating early/late processing stages, (c) clarify its specificity for alcohol-related stimuli compared to other appetitive stimulations and (d) explore its modulation by current craving intensity.

METHODS

Binge drinkers (n=42) and matched controls (n=43) performed a visual probe task, requiring visual targets preceded by pairs of pictures to be processed, with three conditions (i.e. alcohol vs. soft drink, alcohol vs. high-calorie food, high-calorie food vs. low-calorie food).

RESULTS

No group difference was observed for early processing (i.e. first area of interest visited). Dwell times highlighted a bias towards soft drinks and healthy food among controls, without any global bias towards alcohol in binge drinkers. Centrally, a comparison of binge drinkers with low versus high current craving intensity indicated that binge drinking was associated with a bias towards alcohol and high-calorie food only in the presence of a high craving towards these stimuli.

CONCLUSION

Attentional bias towards alcohol reported in severe AUD is only found in binge drinkers in the presence of high craving and is generalised to other appetitive cues.

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.

A Patient-Tailored Evidence-Based Approach for Developing Early Neuropsychological Training Programs in Addiction Settings

Substance use disorders (SUDs) are associated with impairments of cognitive functions, and cognitive training programs are thus rapidly developing in SUD treatment. However, neuropsychological impairments observed early after withdrawal (i.e., early impairments), that is, approximately in the first six months, may be widespread. Consequently, it might not be possible to train all the identified early impairments. In these situations, we propose that the priority of cognitive training should be given to the early impairments found to be associated with early dropout or relapse (i.e., relapse-related impairments). However, substance-specific relapse-related impairments have not been singled out among all early impairments so far. Using a systematic literature search, we identified the types of established early impairments for all SUDs, and we assessed the extent to which these early impairments were found to be associated with relapse-related impairments. All cognitive functions were investigated according to a classification based on current neuropsychological models, distinguishing classical cognitive, substance-bias, and social cognition systems. According to the current evidence, demonstrated relapse-related impairments in alcohol use disorder comprised impulsivity, long-term memory, and higher-order executive functions. For cannabis use disorder, the identified relapse-related impairments were impulsivity and working memory. For stimulant use disorder, the identified relapse-related impairments were attentional abilities and higher-order executive functions. For opioid use disorder, the only identified relapse-related impairments were higher executive functions. However, many early impairments were not explored with respect to dropout/relapse, particularly for stimulant and opioid use disorders. The current literature reveals substance-specific relapse-related impairments, which supports a pragmatic patient-tailored approach for defining which early impairments should be prioritized in terms of training among patients with SUDs.

Substance usage intention does not affect attentional bias: implications from Ecstasy/MDMA users and alcohol drinkers

BACKGROUND

An attentional bias towards substance-related stimuli has been demonstrated with alcohol drinkers and many other types of substance user. There is evidence to suggest that the strength of an attentional bias may vary as a result of context (or use intention), especially within Ecstasy/MDMA users.

OBJECTIVE

Our aim was to empirically investigate attentional biases by observing the affect that use intention plays in recreational MDMA users and compare the findings with that of alcohol users.

METHOD

Regular alcohol drinkers were compared with MDMA users. Performance was assessed for each group separately using two versions of an eye-tracking attentional bias task with pairs of matched neutral, and alcohol or MDMA-related visual stimuli. Dwell time was recorded for alcohol or MDMA. Participants were tested twice, when intending and not intending to use MDMA or alcohol. Note, participants in the alcohol group did not complete any tasks which involved MDMA-related stimuli and vice versa.

RESULTS

Significant attentional biases were found with both MDMA and alcohol users for respective substance-related stimuli, but not control stimuli. Critically, use intention did not affect attentional biases. Attentional biases were demonstrated with both MDMA users and alcohol drinkers when usage was and was not intended.

CONCLUSIONS

These findings demonstrate the robust nature of attentional biases i.e. once an attentional bias has developed, it is not readily affected by intention.

Beer? Over here! Examining attentional bias towards alcoholic and appetitive stimuli in a visual search eye-tracking task

RATIONALE

Experimental tasks that demonstrate alcohol-related attentional bias typically expose participants to single-stimulus targets (e.g. addiction Stroop, visual probe, anti-saccade task), which may not correspond fully with real-world contexts where alcoholic and non-alcoholic cues simultaneously compete for attention. Moreover, alcoholic stimuli are rarely matched to other appetitive non-alcoholic stimuli.

OBJECTIVES

To address these limitations by utilising a conjunction search eye-tracking task and matched stimuli to examine alcohol-related attentional bias.

METHODS

Thirty social drinkers (Mage = 19.87, SD = 1.74) were asked to detect whether alcoholic (beer), non-alcoholic (water) or non-appetitive (detergent) targets were present or absent amongst a visual array of matching and non-matching distractors. Both behavioural response times and eye-movement dwell time were measured.

RESULTS

Social drinkers were significantly quicker to detect alcoholic and non-alcoholic appetitive targets relative to non-appetitive targets in an array of matching and mismatching distractors. Similarly, proportional dwell time was lower for both alcoholic and non-alcoholic appetitive distractors relative to non-appetitive distractors, suggesting that appetitive targets were relatively easier to detect.

CONCLUSIONS

Social drinkers may exhibit generalised attentional bias towards alcoholic and non-alcoholic appetitive cues. This adds to emergent research suggesting that the mechanisms driving these individual's attention towards alcoholic cues might 'spill over' to other appetitive cues, possibly due to associative learning.

The effects of reward and loss anticipation on attentional bias for reward-related stimuli

Attentional biases for reward-related (e.g., food, alcohol) cues are moderated by the expectation of imminent reward availability, but the psychological mechanisms that underlie this effect are unclear. We report two studies in which we investigated if effects of reward gain anticipation are specific to the type of reward that is anticipated, and if anticipation of loss has comparable effects to anticipation of reward gain. We used an eye tracking task to investigate the effects of anticipation of gain (experiment 1) or loss (experiment 2) of alcohol and chocolate on attentional bias for alcohol and chocolate pictures using full crossover designs; the effects of uncertain outcomes were investigated in both experiments. Results indicated robust effects of anticipation of reward gain and uncertainty on attentional bias that were outcome-specific (experiment 1). However attentional bias was not influenced by loss anticipation (experiment 2). Our findings demonstrate that anticipation of reward gain increases attentional bias for the type of reward that is anticipated, but anticipation of loss does not influence attentional bias.

Light social drinkers are more distracted by irrelevant information from an induced attentional bias than heavy social drinkers

It is well established that alcoholics and heavy social drinkers show a bias of attention towards alcohol-related items. Previous research suggests that there is a shared foundation of attentional bias, which is linked to attentional control settings. Specifically, attentional bias relates to a persistent selection of a Feature Search Mode which prioritises attentional bias-related information for selection and processing. However, no research has yet examined the effect of pre-existing biases on the development of an additional attentional bias. This paper seeks to discover how pre-existing biases affect the formation of a new, additional attentional bias. Twenty-five heavy and 25 light social drinkers, with and without a pre-existing bias to alcohol-related items, respectively, had an attentional bias towards the colour green induced via an information sheet. They then completed a series of one-shot change detection tasks. In the critical task, green items were present but task-irrelevant. Irrelevant green items caused significantly more interference for light than heavy social drinkers. This somewhat counter intuitive result is likely due to heavy drinkers having more experience in exerting cognitive control over attentional biases, something not previously observed in investigations of the effects of holding an attentional bias. Our findings demonstrate for the first time that an established attentional bias significantly modulates future behaviour.

Problem Drinking, Alcohol Expectancy, and Thalamic Resting-State Functional Connectivity in Nondependent Adult Drinkers

Alcohol misuse is associated with thalamic dysfunction. The thalamus comprises subnuclei that relay and integrate information between cortical and subcortical structures. However, it is unclear how the subnuclei contribute to thalamic dysfunctions in problem drinking. We investigated resting-state functional connectivity (rsFC) of thalamic subregions in 107 nondependent drinkers (57 women), using masks delineated by white matter tractography. Thalamus was parceled into motor, somatosensory, visual, premotor, frontal association, parietal association, and temporal association subregions. Whole-brain linear regression, each against Alcohol Use Disorders Identification Test (AUDIT) and positive alcohol expectancy (AE) score with age as a covariate, was performed for each seed, for men and women combined, and separately. Overall, problem drinking was associated with increased thalamic connectivities, whereas AE was associated with a mixed pattern of increased and decreased connectivities. Motor, premotor, somatosensory, and frontal association thalamic connectivity with bilateral caudate head was positively correlated with AUDIT score in men and women combined. Connectivity of the right caudate head with frontal association and premotor thalamus was also positively correlated with AE score in men and women combined. In contrast, motor and premotor thalamic connectivity with a number of cortical and subcortical structures showed sex differences in the correlation each with AUDIT and AE score. In mediation analyses, AE score completely mediated the correlation between thalamic caudate connectivity and AUDIT score, whereas the model where AE contributed to problem drinking and, in turn, altered thalamic caudate connectivity was not supported. To conclude, thalamic subregional rsFCs showed both shared and distinct changes and sex differences in association with problem drinking and AE. Increased thalamic caudate connectivity may contribute to problem drinking via enhanced AE. The findings suggest the importance of examining thalamic subdivisions and sex in investigating the functional roles of thalamus in problem drinking.

The dual-process model in young adults with a consistent binge drinking trajectory into adulthood

BACKGROUND

Binge Drinking (BD) generally declines once students have left university. However, many individuals continue to partake in BD into adulthood, constituting a scarcely investigated high-risk group towards whom interventions should be prioritized. Following the dual-process model, we examined the relationship between BD and both the reflective system (executive functions) and the affective system (alcohol bias) in young adults with a consistent BD trajectory. We considered impulsivity as a moderator in the relationship between BD and alcohol bias.

METHODS

A cohort of 63 (31♀) young adults were followed for eleven years (18-29 years old). In the last assessment, participants, with high and low drinking trajectories underwent neuropsychological assessment of executive functions (working memory [SOPT], cognitive flexibility [TMT -Verbal Fluency], inhibition [Stroop]) and alcohol bias (Addiction Stroop). The Barratt Impulsivity Scale measured impulsivity. Generalized linear mixed models and regression-based moderation models were applied.

RESULTS

BD was associated with weak inhibitory control, poor working memory and greater alcohol bias moderated by non-planning impulsivity. At moderate levels of non-planning impulsivity, BD was associated with greater alcohol bias. This association was not found at high levels of impulsivity. These deficits were related to loss of control over drinking and severity of alcohol use.

CONCLUSIONS

The imbalance between poor cognitive control and greater alcohol bias may contribute to the persistence of BD into adulthood. The findings highlight the complexities of the dual-process model, with intervention implications.

Attentional blink to alcohol cues in binge drinkers versus non-binge drinkers

Previous studies have shown alcohol-related attentional biases in social drinkers; however, the temporal dynamics of these biases are not well understood. The current study examined this issue in 94 participants (27 male) categorized as binge drinkers (BD) or non-binge drinkers (NBD). Two versions of an alcohol-related attentional blink (AB) paradigm were used: one with words and one with images. It was predicted that BDs (versus NBDs) would exhibit reduced AB for alcohol cues, which would be enhanced for the pictorial version of the task (versus words). The relationships between AB and alcohol craving, quantity and frequency of alcohol consumption, symptoms of alcohol use disorder, and family history of alcohol use disorder (AUD) were also examined. While an AB was observed for both alcohol and non-alcohol targets in the NBD group, no AB was found for alcohol targets in the BD group. Furthermore, the magnitude of the AB was related to drinking, such that higher self-reported hazardous drinking was associated with smaller ABs to alcohol-related targets. However, AB was not related to craving or family history of AUD. These results suggest that alcohol-related stimuli are processed more efficiently by BDs, especially those with hazardous alcohol consumption patterns. These results may inform treatment and prevention efforts targeting binge drinkers.

Deadly Attraction - Attentional Bias toward Preferred Cigarette Brand in Smokers

Numerous studies have shown that biases in visual attention might be evoked by affective and personally relevant stimuli, for example addiction-related objects. Despite the fact that addiction is often linked to specific products and systematic purchase behaviors, no studies focused directly on the existence of bias evoked by brands. Smokers are characterized by high levels of brand loyalty and everyday contact with cigarette packaging. Using the incentive-salience mechanism as a theoretical framework, we hypothesized that this group might exhibit a bias toward the preferred cigarette brand. In our study, a group of smokers (N = 40) performed a dot probe task while their eye movements were recorded. In every trial a pair of pictures was presented - each of them showed a single cigarette pack. The visual properties of stimuli were carefully controlled, so branding information was the key factor affecting subjects' reactions. For each participant, we compared gaze behavior related to the preferred vs. other brands. The analyses revealed no attentional bias in the early, orienting phase of the stimulus processing and strong differences in maintenance and disengagement. Participants spent more time looking at the preferred cigarettes and saccades starting at the preferred brand location had longer latencies. In sum, our data shows that attentional bias toward brands might be found in situations not involving choice or decision making. These results provide important insights into the mechanisms of formation and maintenance of attentional biases to stimuli of personal relevance and might serve as a first step toward developing new attitude measurement techniques.

Sex differences in the interacting roles of impulsivity and positive alcohol expectancy in problem drinking: A structural brain imaging study

Alcohol expectancy and impulsivity are implicated in alcohol misuse. However, how these two risk factors interact to determine problem drinking and whether men and women differ in these risk processes remain unclear. In 158 social drinkers (86 women) assessed for Alcohol Use Disorder Identification Test (AUDIT), positive alcohol expectancy, and Barratt impulsivity, we examined sex differences in these risk processes. Further, with structural brain imaging, we examined the neural bases underlying the relationship between these risk factors and problem drinking. The results of general linear modeling showed that alcohol expectancy best predicted problem drinking in women, whereas in men as well as in the combined group alcohol expectancy and impulsivity interacted to best predict problem drinking. Alcohol expectancy was associated with decreased gray matter volume (GMV) of the right posterior insula in women and the interaction of alcohol expectancy and impulsivity was associated with decreased GMV of the left thalamus in women and men combined and in men alone, albeit less significantly. These risk factors mediated the correlation between GMV and problem drinking. Conversely, models where GMV resulted from problem drinking were not supported. These new findings reveal distinct psychological factors that dispose men and women to problem drinking. Although mediation analyses did not determine a causal link, GMV reduction in the insula and thalamus may represent neural phenotype of these risk processes rather than the consequence of alcohol consumption in non-dependent social drinkers. The results add to the alcohol imaging literature which has largely focused on dependent individuals and help elucidate alterations in brain structures that may contribute to the transition from social to habitual drinking.

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Alcohol expectancy (AE) and impulsivity are risk factors for problem drinking.

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AE mediates the correlation between right insula GMV and problem drinking in women.

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AE and impulsivity interacts to mediate left thalamus GMV and problem drinking in all.

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Models where changes in GMV as a result of problem drinking are not supported.

Meta-analysis of the relationship between impulsivity and substance-related cognitive biases

BACKGROUND

Evidence indicates that substance-related cognitive biases (attentional, memory, and approach bias) contribute to the maintenance and development of substance misuse. Impulsivity has been suggested to influence how cognitive biases contribute to substance misuse, possibly by biasing incentive salience attribution processes. However, the strength and moderators of the relationship between impulsivity and substance-related cognitive biases has yet to be empirically examined.

METHODS

A meta-analysis using random-effects models was completed assessing 19 studies that reported a quantitative relationship between an impulsivity measure and a substance-related cognitive bias. Two-component conceptualisation of impulsivity, impulsivity measurement type, gender, and age were assessed as moderators.

RESULTS

A small, significant positive relationship (r=0.10) was observed between impulsivity and substance-related attentional, memory, and approach biases. No moderators examined had a significant influence on this relationship.

CONCLUSIONS

Results are consistent with incentive sensitisation theories of addiction and suggests a weak synergistic relationship between impulsivity and substance-related cognitive biases. This relationship holds across different measures and components of impulsivity. Results provide some support for the viability of impulsivity and cognitive bias interaction models which may warrant further investigation of these factors in relation to predicting addiction treatment outcomes.

Effects of transcranial direct current stimulation on craving, heart-rate variability and prefrontal hemodynamics during smoking cue exposure

OBJECTIVE

Drug-related cue exposure elicits craving and risk for relapse during recovery. Transcranial direct current stimulation is a promising research tool and possible treatment for relapse prevention. Enhanced functional neuroconnectivity is discussed as a treatment target. The goal of this research was to examine whether transcranial direct current stimulation affected cortical hemodynamic indicators of functional connectivity, craving, and heart rate variability during smoking-related cue exposure in non-treatment-seeking smokers.

METHOD

In vivo smoking cue exposure supported by a 2mA transcranial direct current stimulation (anode: dorsolateral prefrontal cortex, cathode: orbitofrontal cortex; placebo-controlled, randomized, double-blind) in 29 (age: M=25, SD=5) German university students (smoking at least once a week). Cue reactivity was assessed on an autonomous (heart rate variability) and a subjective level (craving ratings). Functional near-infrared spectroscopy measured changes in the concentration of deoxygenated hemoglobin, and seed-based correlation analysis was used to quantify prefrontal connectivity of brain regions involved in cue reactivity.

RESULTS

Cue exposure elicited increased subjective craving and heart rate variability changes in smokers. Connectivity between the orbitofrontal and dorsolateral prefrontal cortex was increased in subjects receiving verum compared to placebo stimulation (d=0.66). Hemodynamics in the left dorsolateral prefrontal cortex, however, increased in the group receiving sham stimulation (η²=0.140). Transcranial direct current stimulation did not significantly alter craving or heart rate variability during cue exposure.

CONCLUSION

Prefrontal connectivity - between regions involved in the processing of reinforcement value and cognitive control - was increased by anodal transcranial direct current stimulation during smoking cue exposure. Possible clinical implications should be considered in future studies.

Internal reliability of the alcohol-related visual probe task is increased by utilising personalised stimuli and eye-tracking

BACKGROUND

In the current study, we investigated whether the internal reliability of the visual probe task measure of attentional bias for substance-related cues could be improved by incorporating eye-tracking methods and personalised stimuli.

METHOD

Sixty social drinkers completed two visual probe tasks: one with a broad range of different alcohol pictures, the other containing only images of the participants' preferred drink. Attentional bias was inferred from manual reaction times to probes replacing the pictures, and from the duration of eye movement fixations towards the pictures (gaze dwell time).

RESULTS

Internal reliability was highest for personalised (versus general) alcohol stimuli, and for eye-tracking (versus manual reaction time) measures of attentional bias. The internal reliability of both reaction time (α=.73) and gaze dwell time measures (α=.76) of attentional bias for personalised alcohol stimuli was acceptable. Internal reliability of indices of attentional bias for general alcohol stimuli was inferior, although better for the gaze dwell time (α=.51) compared to the reaction time measure (α=.19). Attentional bias towards personalised stimuli was larger than bias to general stimuli, but only for the reaction time measure. There were no statistically significant associations between measures of attentional bias and alcohol consumption or craving.

CONCLUSIONS

Adopting personalised stimuli and eye movement monitoring significantly improves the internal reliability of the alcohol-related visual probe task.

Gray matter volume correlates of global positive alcohol expectancy in non-dependent adult drinkers

Alcohol use and misuse is known to involve structural brain changes. Numerous imaging studies have examined changes in gray matter (GM) volumes in dependent drinkers, but there is little information on whether non-dependent drinking is associated with structural changes and whether these changes are related to psychological factors-such as alcohol expectancy-that influence drinking behavior. We used voxel-based morphometry (VBM) to examine whether the global positive scale of alcohol expectancy, as measured by the Alcohol Expectancy Questionnaire-3, is associated with specific structural markers and whether such markers are associated with drinking behavior in 113 adult non-dependent drinkers (66 women). Alcohol expectancy is positively correlated with GM volume of left precentral gyrus (PCG) in men and women combined and bilateral superior frontal gyri (SFG) in women, and negatively correlated with GM volume of the right ventral putamen in men. Furthermore, mediation analyses showed that the GM volume of PCG mediate the correlation of alcohol expectancy and the average number of drinks consumed per occasion and monthly total number of drinks in the past year. When recent drinking was directly accounted for in multiple regressions, GM volume of bilateral dorsolateral prefrontal cortices correlated positively with alcohol expectancy in the combined sample. To our knowledge, these results are the first to identify the structural brain correlates of alcohol expectancy and its mediation of drinking behaviors. These findings suggest that more studies are needed to investigate increased GM volume in the frontal cortices as a neural correlate of alcohol expectancy.

The clinical relevance of attentional bias in substance use disorders

Individuals with substance use disorders typically show an "attentional bias" for substance-related cues: Those cues are able to grab and hold the attention, in preference to other cues in the environment. We discuss the theoretical context for this work before reviewing the measurement of attentional bias, and its relationship to motivational state and relapse to substance use after a period of abstinence. Finally, we discuss the implications of this research for the treatment of substance use disorders. We conclude that attentional bias is associated with subjective craving, and that moment-by-moment fluctuations in attentional bias may precede relapse to substance use. The evidence regarding the predictive relationship between attentional bias assessed in treatment contexts and subsequent relapse is inconsistent. Furthermore, there is currently insufficient evidence to endorse attentional bias modification as a treatment for substance use disorders. Clinical implications and suggestions for future research are highlighted.

Reward expectancy promotes generalized increases in attentional bias for rewarding stimuli

Expectations of drug availability increase the magnitude of attentional biases for drug-related cues. However, it is unknown whether these effects are outcome specific, or whether expectation of a specific reinforcer produces a general enhancement of attentional bias for other types of rewarding cues. In the present study, 31 social drinkers completed an eye-tracking task in which attentional bias for alcohol- and chocolate-related cues was assessed while the expectation of receiving alcohol and chocolate was manipulated on a trial-by-trial basis. Participants showed attentional bias for alcohol and chocolate cues (relative to neutral cues) overall. Importantly, these attentional biases for reward cues were magnified when participants expected to receive alcohol and chocolate, but effects were not outcome specific: The expectation of receiving either alcohol or chocolate increased attentional bias for both alcohol and chocolate cues. Results suggest that anticipation of reward produces a general rather than an outcome-specific enhancement of attentional bias for reward-related stimuli.

Pornographic picture processing interferes with working memory performance

Some individuals report problems during and after Internet sex engagement, such as missing sleep and forgetting appointments, which are associated with negative life consequences. One mechanism potentially leading to these kinds of problems is that sexual arousal during Internet sex might interfere with working memory (WM) capacity, resulting in a neglect of relevant environmental information and therefore disadvantageous decision making. In this study, 28 healthy individuals performed 4 experimental manipulations of a pictorial 4-back WM task with neutral, negative, positive, or pornographic stimuli. Participants also rated 100 pornographic pictures with respect to sexual arousal and indicated masturbation urges previous to and following pornographic picture presentation. Results revealed worse WM performance in the pornographic picture condition of the 4-back task compared with the three remaining picture conditions. Furthermore, hierarchical regression analysis indicated an explanation of variance of the sensitivity in the pornographic picture condition by the subjective rating of the pornographic pictures as well as by a moderation effect of masturbation urges. Results contribute to the view that indicators of sexual arousal due to pornographic picture processing interfere with WM performance. Findings are discussed with respect to Internet sex addiction because WM interference by addiction-related cues is well known from substance dependencies.

Problematic alcohol use and mild intellectual disability: standardization of pictorial stimuli for an alcohol cue reactivity task

The present study focused on the first step in developing a cue reactivity task for studying cognitive biases in individuals with mild to borderline intellectual disability (ID) and alcohol use-related problems: the standardization of pictorial stimuli. Participants (N=40), both with and without a history of alcohol use-related problems and varying in IQ, were admitted to a forensic setting and were all abstinent. They were asked to rate familiarity, complexity, valence and attractiveness of pictures portraying both alcoholic and non-alcoholic beverages. There was a tendency to rate non-alcoholic beverages as more pleasant and attractive than alcoholic beverages. In participants with mild to borderline ID, this difference reached statistical significance, even when controlling for alcohol use-related problems in the past. The overall result of the study is a large database of 255 pictures portraying both alcoholic and non-alcoholic beverages that will be used to validate an implicit measure of cognitive biases for alcohol in individuals with mild to borderline ID.

Effects of 0.4 g/kg alcohol on attentional bias and alcohol-seeking behaviour in heavy and moderate social drinkers

Alcohol intoxication is known to influence attentional biases for alcohol-related cues and alcohol-seeking behaviour. It is unknown if heavier drinkers are more or less sensitive to these effects of alcohol, or whether the effects of alcohol on attentional bias are associated with subsequent alcohol-seeking behaviour. In the present study, 55 social drinkers were administered either 0.4 g/kg alcohol or placebo in a repeated measures, double-blind experimental design. Participants completed a visual probe task with eye movement monitoring (to measure attentional bias) and a bogus taste test (to measure alcohol-seeking) in both alcohol and placebo sessions. Heavy drinkers showed an attentional bias for alcohol cues that was unaffected by alcohol, whereas in moderate drinkers attentional bias was present after alcohol administration, but was absent after placebo. All participants voluntarily consumed more beer during the taste test after administration of alcohol compared with placebo. The effects of alcohol on attentional bias were unrelated to the effects of alcohol on beer consumption. Results are consistent with the development of tolerance, rather than sensitization, to the acute effects of alcohol on attentional biases in heavy drinkers. However, alcohol-induced increases in attentional bias were not related to the effects of alcohol on the motivation to drink.