BACKGROUND
Alcohol use disorder (AUD) is a major contributor to global disability and mortality. Cross-sectional studies have linked AUD to reduced cognitive control and heightened risky decision-making. However, the temporal direction of these effects remains unknown: are cognitive-behavioral alterations a consequence or a precursor of changes in drinking?
METHODS
We deployed a battery of smartphone-based, gamified tasks in a one-year longitudinal ecological momentary assessment study of N=603 participants diagnosed with mostly mild to moderate AUD. Tasks measured cognitive control (working memory, response inhibition) and decision-making (risk-taking, information sampling). Participants completed tasks monthly and reported alcohol consumption every two days.
RESULTS
We found that monthly fluctuations in aspects of decision-making predicted subsequent consumption. Specifically, participants shifted to higher monthly alcohol consumption when their risk-taking was higher in a mixed gambling context and lower in a loss context in the preceding month. Further, when information sampling biases decreased, participants consumed more alcohol in the subsequent month. This temporal direction-that within-subject fluctuations in task outcomes preceded changes in monthly drinking-was specific, was not observed vice versa and survived correction for autocorrelation in drinking, indicating risky decision-making as a precursor of subsequent drinking. Fluctuations in cognitive control and risk-taking in a win context were not associated with fluctuations in drinking.
DISCUSSION
Our findings offer novel insights into the cognitive-behavioral forces driving changes in alcohol consumption in AUD: specific decision-making alterations precede changes in consumption. These findings suggest that smartphone-based gamified tasks show promise to identify periods of heightened risk paving the way for mechanism-based, real-time interventions in AUD.
Hilmar Zech, Maria Waltmann, D. Reichert et al.· Biological Psychiatry: Cogni...· 0 citations
OBJECTIVE
Adverse childhood experiences (ACEs) play a pivotal role in alcohol use disorder (AUD), and evidence suggests that this role differs by sex. Neural alcohol cue reactivity may represent one pathway linking ACEs to alcohol craving and use. The authors examined whether cue reactivity is differentially associated with the relationship between ACEs and alcohol-related outcomes in males and females with AUD.
METHODS
Functional MRI data were analyzed from 231 non-treatment-seeking individuals (40.7% female; mean age=39.1 years, SD=13.5) with mainly mild to moderate AUD (mean number of DSM-5 criteria, 3.92, SD=1.6) from a 12-month prospective multicenter study. ACEs were assessed via Childhood Trauma Screener score. Participants completed a functional MRI alcohol cue reactivity task, followed by ecological momentary assessment of daily craving and consumption. Linear regression, general linear models, and sex-moderated mediation examined associations among ACEs, brain activation, and alcohol outcomes. Sensitivity analyses controlled for age, AUD severity, baseline consumption, tobacco use, Brief Symptom Inventory score, and progesterone-to-estradiol ratio.
RESULTS
Higher Childhood Trauma Screener scores were associated with significantly greater left superior frontal gyrus/anterior cingulate cortex (SFG/ACC) activation during alcohol-related cues than during neutral cues in females compared with males. This activation significantly predicted prospective daily craving only in females. Sex-moderated mediation showed opposing indirect effects of ACEs on craving via SFG/ACC activation (ab=path a × path b; females: ab=0.008, 95% CI=0.001, 0.022; males: ab=-0.013, 95% CI=-0.034, -0.002). Sensitivity analyses supported robust SFG/ACC activation and directional consistency after adjustment for covariates.
CONCLUSIONS
Sex-specific prefrontal cue reactivity patterns suggest differential neural pathways linking ACEs to craving vulnerability in early AUD, particularly in females. The findings support sex-sensitive, trauma-informed intervention strategies.
L. Rötzer, J. Zaiser, Sabine Hoffmann et al.· American Journal of Psychiat...· 0 citations
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