Resisting temptation: Decreasing alcohol-related affect and drinking behavior by training response inhibition

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Abstract

According to dual-process models, excessive alcohol use emerges when response inhibition ability is insufficient to inhibit automatic impulses to drink alcohol. This study examined whether strengthening response inhibition for alcohol-related cues decreases alcohol intake. Fifty-two heavy drinking students were randomly assigned to one of two conditions: In the beer/no-go condition, participants performed a go/no-go task that consistently paired alcohol-related stimuli with a stopping response, to increase response inhibition for alcohol-related stimuli. In the beer/go condition, in contrast, participants were always required to respond to alcohol-related stimuli during the go/no-go task. Before and after the go/no-go manipulation, we measured weekly alcohol intake and implicit attitudes toward alcohol. In addition, we measured alcohol consumption during a taste test immediately after the go/no-go manipulation. Following the manipulation, participants in the beer/no-go condition demonstrated significantly increased negative implicit attitudes toward alcohol, and a significant reduction in weekly alcohol intake, while participants in the beer/go condition showed a non-significant increase in implicit positive attitudes toward alcohol and a significant increase in weekly alcohol intake. This study demonstrates that repeatedly stopping prepotent responses toward alcohol-related stimuli can be an effective strategy to reduce excessive alcohol use.

Introduction

Contemporary dual-process theories propose that drinking behavior is guided by two distinct cognitive systems: One system is associative and operates through fast automatic processes, while the other system is propositional and operates through slower controlled processes (Bechara et al., 2006, Deutsch and Strack, 2006, Wiers et al., 2007). According to these theories, drinking behavior is instigated by automatic processes, which generate an automatic impulse to drink alcohol, unless one is able to engage in effortful controlled processing to regulate automatic impulses. In line with these models, stronger automatic associations between alcohol and positive affect predict increased levels of alcohol consumption (Houben and Wiers, 2007a, Houben and Wiers, 2007b, Houben and Wiers, 2008, Jajodia and Earleywine, 2003, McCarthy and Thompsen, 2006), especially when cognitive control abilities, such as response inhibition and working memory, are low (Houben and Wiers, 2009, Thush et al., 2008).

The clinical implication of these insights is that interventions might benefit from procedures that decrease automatic processes which lead to excessive alcohol use. Recent research indeed suggests that automatic alcohol-related affective processes are amenable to change and that decreasing these automatic impulses reduces alcohol intake (Houben et al., 2010). Alternatively, interventions might also aim to strengthen cognitive control abilities such as response inhibition and working memory, which are important moderators of the predictive relationship between automatic impulses and drinking behavior. If cognitive control can be enhanced, automatic impulses could be regulated more easily and control over drinking behavior could be increased. Consistent with this perspective, Jones et al. (2011) demonstrated decreased alcohol intake following a manipulation that primed inhibitory control compared to a manipulation that primed impulsive behavior. Hence, these findings indicate that increasing inhibitory control may indeed be a valuable technique to decrease alcohol use. However, Jones et al. (2011) did not include a control condition or pretest measures in their study, which makes it impossible to determine whether both the impulsivity and the inhibition manipulation effectively influenced alcohol consumption relative to baseline. Moreover, Jones et al. (2011) merely induced a temporary state of impulsivity or inhibition. While priming such a mental state is interesting to show causality, it is highly unlikely that temporarily priming an inhibitory mental state induces long-term effects on both inhibitory control and drinking behavior.

The current study further explores this issue by examining whether increasing or decreasing inhibitory control respectively decreases or increases alcohol consumption relative to baseline. Moreover, the present study tested a behavioral training of inhibition that consistently paired certain stimuli with a stopping response in an adapted version of a go/no-go task. Recent research confirms that response inhibition can be trained by consistently mapping stimuli onto a stopping response (no-go) as this effectively strengthens the ability to inhibit responses to those stimuli (Verbruggen and Logan, 2008). Moreover, the effect of such a behavioral training should be even more potent when rewarding stimuli, such as alcohol cues, are mapped onto a stopping response. Because positive stimuli automatically elicit approach tendencies due to their reward value, pairing such stimuli with situational cues signaling that approach is unwanted (no-go signal) should result in response conflict (Veling and Aarts, in press, Veling et al., 2008). As a result, pairing such rewarding stimuli with stopping responses causes a devaluation of those stimuli (Veling et al., 2008) and increases motor inhibition for those stimuli (Veling and Aarts, in press) in an effort to resolve the response conflict. Importantly, the consistent mapping of stimuli onto stopping is not limited to short-term effects on behavior and may even cause automatic inhibition to develop (Verbruggen and Logan, 2008).

Hence, recent research shows that training response inhibition changes both evaluations of stimuli that were associated with a stopping response, and increases inhibitory control over these stimuli. In this study, we used a similar go/no-go task that consistently paired alcohol-related cues with a stopping response to strengthen the ability to inhibit responses to alcohol-related stimuli in heavy drinking college students. Especially for heavy drinkers, alcohol-related stimuli automatically elicit positive affect (Houben and Wiers, 2007a, Houben and Wiers, 2007b, Houben and Wiers, 2008, Jajodia and Earleywine, 2003, McCarthy and Thompsen, 2006), and approach tendencies (Field et al., 2008, Palfai and Ostafin, 2003, Wiers et al., 2009). Therefore, it was expected that repeatedly pairing alcohol-related stimuli with a stopping response would decrease automatic affect that is elicited by alcohol-related stimuli as well as decrease alcohol intake.

Section snippets

Participants

Participants were 52 heavy drinking students of Maastricht University (33 female students; mean age = 22.37, SD = 4.92), who regularly consumed beer. Participants were recruited via advertisements and flyers. The advertisements stated that participants were needed for research on attitudes and preferences for beer. Participants were screened for alcohol use and were only included if they consumed an average of 12 (males) or 10 (females) alcoholic consumptions or more per week and if beer was their

Results

None of the participants guessed the goal of the study or the purpose of the go/no-go manipulation. At baseline, there was no significant difference between conditions in age (F = 2.80) or AUDIT scores (F < 1). With respect to the go/no-go manipulation, results showed relatively low error percentages on both beer and water trials, in the beer/go condition (M = .07, SD = .19, and M = .01, SD = .02, respectively) and in the beer/no-go condition (M = .01, SD = .02, and M = .03, SD = .03, respectively).

Discussion

In this study, we examined whether training response inhibition by consistently pairing alcohol-related stimuli with a stopping response would decrease alcohol intake. Further, it was tested whether this pairing of alcohol with a stopping response would decrease the positive affect that is automatically associated with alcohol-related stimuli. As expected, participants who repeatedly inhibited responding to alcohol cues showed both increased negative automatic associations with alcohol-related

Role of funding source

Funding for this study was provided by a grant from ERAB: The European Foundation for Alcohol Research awarded to the first author and a grant from the Technology Foundation STW to the third author; the sponsors had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Contributors

Katrijn Houben designed the study, performed the statistical analysis, and wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

Conflict of interest

All other authors declare that they have no conflicts of interest.

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