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1.  Interactions between Self-Reported Alcohol Outcome Expectancies and Cognitive Functioning in the Prediction of Alcohol Use and Associated Problems: A Further Examination 
A recent debate regarding the theoretical distinction between explicit and implicit cognitive processes relevant to alcohol-related behaviors was strongly shaped by empirical findings from dual-process models (Moss & Albery, 2009; Wiers & Stacy, 2010; Moss & Albery, 2010). Specifically, as part of a broader discussion, Wiers & Stacy (2010) contended that alcohol-related behaviors are better predicted by self-reported alcohol expectancies for individuals with good executive control and with good verbal abilities relative to those without such abilities. The purpose of the current paper is to further test whether self-reported alcohol outcome expectancies are moderated by measures of cognitive functioning. Using multiple indices of alcohol use, alcohol-related consequences, self-reported alcohol outcome expectancies, and cognitive functioning, both cross-sectional and longitudinal analyses were conducted in a prospective sample of 489 individuals at varying risk for alcohol use disorders. Results from a series of regression analyses testing interactions between self-reported alcohol expectancies and cognitive functioning showed minimal support for the hypothesized pattern discussed by Wiers et al. (2010) regarding self-reported alcohol outcome expectancies. The overall rates of significance were consistent with Type I error rates and a substantial proportion of the significant interactions were inconsistent with previous findings. Thus, the conclusion that cognitive measures consistently moderate the relation between self-reported alcohol expectancies and alcohol use and outcomes should be tempered.
PMCID: PMC3135773  PMID: 21443299
alcohol outcome expectancies; dual-process models; cognitive functioning; alcohol use
2.  Alcohol Sales and Risk of Serious Assault 
PLoS Medicine  2008;5(5):e104.
Alcohol is a contributing cause of unintentional injuries, such as motor vehicle crashes. Prior research on the association between alcohol use and violent injury was limited to survey-based data, and the inclusion of cases from a single trauma centre, without adequate controls. Beyond these limitations was the inability of prior researchers to comprehensively capture most alcohol sales. In Ontario, most alcohol is sold through retail outlets run by the provincial government, and hospitals are financed under a provincial health care system. We assessed the risk of being hospitalized due to assault in association with retail alcohol sales across Ontario.
Methods and Findings
We performed a population-based case-crossover analysis of all persons aged 13 years and older hospitalized for assault in Ontario from 1 April 2002 to 1 December 2004. On the day prior to each assault case's hospitalization, the volume of alcohol sold at the store in closest proximity to the victim's home was compared to the volume of alcohol sold at the same store 7 d earlier. Conditional logistic regression analysis was used to determine the associated relative risk (RR) of assault per 1,000 l higher daily sales of alcohol. Of the 3,212 persons admitted to hospital for assault, nearly 25% were between the ages of 13 and 20 y, and 83% were male. A total of 1,150 assaults (36%) involved the use of a sharp or blunt weapon, and 1,532 (48%) arose during an unarmed brawl or fight. For every 1,000 l more of alcohol sold per store per day, the relative risk of being hospitalized for assault was 1.13 (95% confidence interval [CI] 1.02–1.26). The risk was accentuated for males (1.18, 95% CI 1.05–1.33), youth aged 13 to 20 y (1.21, 95% CI 0.99–1.46), and those in urban areas (1.19, 95% CI 1.06–1.35).
The risk of being a victim of serious assault increases with alcohol sales, especially among young urban men. Akin to reducing the risk of driving while impaired, consideration should be given to novel methods of preventing alcohol-related violence.
In a population-based case-crossover analysis, Joel Ray and colleagues find that the risk of being a victim of serious assault increases with retail alcohol sales, especially among young urban men.
Editors' Summary
Alcohol has been produced and consumed around the world since prehistoric times. In the Western world it is now the most commonly consumed psychoactive drug (a substance that changes mood, behavior, and thought processes). The World Health Organization reports that there are 76.3 million persons with alcohol use disorders worldwide. Alcohol consumption is an important factor in unintentional injuries, such as motor vehicle crashes, and in violent criminal behavior. In the United Kingdom, for example, a higher proportion of heavy drinkers than light drinkers cause violent criminal offenses. Other figures suggest that people (in particular, young men) have an increased risk of committing a criminally violent offense within 24 h of drinking alcohol. There is also some evidence that suggests that the victims as well as the perpetrators of assaults have often been drinking recently, possibly because alcohol impairs the victim's ability to judge potentially explosive situations.
Why Was This Study Done?
The researchers wanted to know more about the relationship between alcohol and intentional violence. The recognition of a clear link between driving when impaired by alcohol and motor vehicle crashes has led many countries to introduce public awareness programs that stigmatize drunk driving. If a clear link between alcohol consumption by the people involved in violent crime could also be established, similar programs might reduce alcohol-related assaults. The researchers tested the hypothesis that the risk of being hospitalized due to a violent assault increases when there are increased alcohol sales in the immediate vicinity of the victim's place of residence.
What Did the Researchers Do and Find?
The researchers did their study in Ontario, Canada for three reasons. First, Ontario is Canada's largest province. Second, the province keeps detailed computerized medical records, including records of people hospitalized from being violently assaulted. Third, most alcohol is sold in government-run shops, and the district has the infrastructure to allow daily alcohol sales to be tracked. The researchers identified more than 3,000 people over the age of 13 y who were hospitalized in the province because of a serious assault during a 32-mo period. They compared the volume of alcohol sold at the liquor store nearest to the victim's home the day before the assault with the volume sold at the same store a week earlier (this type of study is called a “case-crossover” study). For every extra 1,000 l of alcohol sold per store per day (a doubling of alcohol sales), the overall risk of being hospitalized for assault increased by 13%. The risk was highest in three subgroups of people: men (18% increased risk), youths aged 13 to 20 y (21% increased risk), and those living in urban areas (19% increased risk). At peak times of alcohol sales, the risk of assault was 41% higher than at times when alcohol sales were lowest.
What Do These Findings Mean?
These findings indicate that the risk of being seriously assaulted increases with the amount of alcohol sold locally the day before the assault and show that the individuals most at risk are young men living in urban areas. Because the study considers only serious assaults and alcohol sold in shops (i.e., not including alcohol sold in bars), it probably underestimates the association between alcohol and assault. It also does not indicate whether the victim or perpetrator of the assault (or both) had been drinking, and its findings may not apply to countries with different drinking habits. Nevertheless, these findings support the idea that the consumption of alcohol contributes to the occurrence of medical injuries from intentional violence. Increasing the price of alcohol or making alcohol harder to obtain might help to reduce the occurrence of alcohol-related assaults. The researchers suggest that a particularly effective approach may be to stigmatize alcohol-related brawling, analogous to the way that driving under the influence of alcohol has been made socially unacceptable.
Additional Information.
Please access these Web sites via the online version of this summary at
This study is further discussed in a PLoS Medicine Perspective by Bennetts and Seabrook
The US National Institute on Alcohol Abuse and Alcoholism provides information on all aspects of alcohol abuse, including an article on alcohol use and violence among young adults
Alcohol-related assault is examined in the British Crime Survey
Alcohol Concern, the UK national agency on alcohol misuse, provides fact sheets on the health impacts of alcohol, young people's drinking, and alcohol and crime
The Canadian Centre for Addiction and Mental Health in Toronto provides information about alcohol addiction (in English and French)
PMCID: PMC2375945  PMID: 18479181
3.  The effects of alcohol and cue salience on young men’s acceptance of sexual aggression☆ 
Addictive behaviors  2008;34(4):386-394.
Research suggests that alcohol intoxication may increase a young man’s likelihood of sexual aggression. This laboratory analogue experiment tested a disinhibition versus alcohol myopia explanation of alcohol’s role by investigating effects of acute alcohol administration, expectations and individual differences drawn from Malamuth’s Confluence Model of Sexual Aggression (i.e., Acceptance of Interpersonal Violence: AIV, Need for Sexual Dominance: NSD) on young men’s acceptance of sexual aggression. Young adult heterosexual men (n=334) attended two laboratory sessions each. In the first, they completed screening and individual differences measures. In the second, they were assigned randomly to consume one of four beverages: Control, Placebo, Low Dose Alcohol (0.33 ml alcohol/kg body weight) or Moderate Dose Alcohol (0.75 ml/kg) and view one of two video-delivered scenario conditions: “Anti-Force Cues” (scenario of a couple on a date with embedded explicit cues mitigating against forced sex) or “No Cues” (Identical scenario with no Anti-Force cues). Participants then judged 1) should the man continue to force the woman to have sex? 2) would they force the woman? and 3) who was responsible for the outcome? Results supported a disinhibition versus alcohol myopia model. Consuming alcohol increased acceptance of sexual aggression. Further, higher NSD and AIV scores were associated with acceptance of forced sex, but only after alcohol consumption. Overall, findings showed that key individual difference factors from Malamuth’s Confluence Model enhance precision of predicting sexual aggression risk by young men under the influence of alcohol.
PMCID: PMC3755468  PMID: 19108956
Sexual aggression; Alcohol administration; Need for Sexual Dominance; Acceptance of Interpersonal Violence; Heterosexual males
4.  Genuine episodic memory deficits and executive dysfunctions in alcoholic subjects early in abstinence 
Chronic alcoholism is known to impair episodic memory function, but the specific nature of this impairment is still unclear. Moreover, it has never been established whether episodic memory deficit in alcoholism is an intrinsic memory deficit or whether it has an executive origin. Thus, the objectives are to specify which episodic memory processes are impaired early in abstinence from alcohol and to determine whether they should be regarded as genuine memory deficits or rather as the indirect consequences of executive impairments.
Forty recently detoxified alcoholic inpatients at alcohol entry treatment and fifty five group-matched controls underwent a neuropsychological assessment of episodic memory and executive functions. The episodic memory evaluation consisted of three tasks complementing each other designed to measure the different episodic memory components (learning, storage, encoding and retrieval, contextual memory and autonoetic consciousness) and five executive tasks testing capacities of organization, inhibition, flexibility, up-dating and integration.
Compared with control subjects, alcoholic patients presented impaired learning abilities, encoding processes, retrieval processes, contextual memory and autonoetic consciousness. However, there was no difference between the two groups regarding the storage capacities assessed by the rate of forgetting. Concerning executive functions, alcoholics displayed deficits in each executive task used. Nevertheless, stepwise regression analyses showed that only performances on fluency tasks were significantly predictive of some of the episodic memory disorders (learning abilities for 40%, encoding processes for 20%, temporal memory for 21% and state of consciousness associated with memories for 26%) in the alcoholic group.
At alcohol treatment entry, alcoholic patients present genuine episodic memory deficits which cannot be regarded solely as the consequences of executive dysfunctions. These results are in accordance with neuroimaging findings showing hippocampal atrophy. Moreover, given the involvement of episodic memory and executive functions in alcohol treatment, these data could have clinical implications.
PMCID: PMC2895973  PMID: 17511749
Alcoholism; diagnosis; physiopathology; rehabilitation; Cognition Disorders; diagnosis; physiopathology; Frontal Lobe; physiopathology; Hospitalization; Humans; Male; Memory Disorders; diagnosis; physiopathology; Middle Aged; Neuropsychological Tests; statistics & numerical data; Regression Analysis; Temperance; psychology; alcoholism; episodic memory; executive functions; treatment
5.  The Effectiveness of Community Action in Reducing Risky Alcohol Consumption and Harm: A Cluster Randomised Controlled Trial 
PLoS Medicine  2014;11(3):e1001617.
In a cluster randomized controlled trial, Anthony Shakeshaft and colleagues measure the effectiveness of a multi-component community-based intervention for reducing alcohol-related harm.
The World Health Organization, governments, and communities agree that community action is likely to reduce risky alcohol consumption and harm. Despite this agreement, there is little rigorous evidence that community action is effective: of the six randomised trials of community action published to date, all were US-based and focused on young people (rather than the whole community), and their outcomes were limited to self-report or alcohol purchase attempts. The objective of this study was to conduct the first non-US randomised controlled trial (RCT) of community action to quantify the effectiveness of this approach in reducing risky alcohol consumption and harms measured using both self-report and routinely collected data.
Methods and Findings
We conducted a cluster RCT comprising 20 communities in Australia that had populations of 5,000–20,000, were at least 100 km from an urban centre (population ≥ 100,000), and were not involved in another community alcohol project. Communities were pair-matched, and one member of each pair was randomly allocated to the experimental group. Thirteen interventions were implemented in the experimental communities from 2005 to 2009: community engagement; general practitioner training in alcohol screening and brief intervention (SBI); feedback to key stakeholders; media campaign; workplace policies/practices training; school-based intervention; general practitioner feedback on their prescribing of alcohol medications; community pharmacy-based SBI; web-based SBI; Aboriginal Community Controlled Health Services support for SBI; Good Sports program for sports clubs; identifying and targeting high-risk weekends; and hospital emergency department–based SBI. Primary outcomes based on routinely collected data were alcohol-related crime, traffic crashes, and hospital inpatient admissions. Routinely collected data for the entire study period (2001–2009) were obtained in 2010. Secondary outcomes based on pre- and post-intervention surveys (n = 2,977 and 2,255, respectively) were the following: long-term risky drinking, short-term high-risk drinking, short-term risky drinking, weekly consumption, hazardous/harmful alcohol use, and experience of alcohol harm. At the 5% level of statistical significance, there was insufficient evidence to conclude that the interventions were effective in the experimental, relative to control, communities for alcohol-related crime, traffic crashes, and hospital inpatient admissions, and for rates of risky alcohol consumption and hazardous/harmful alcohol use. Although respondents in the experimental communities reported statistically significantly lower average weekly consumption (1.90 fewer standard drinks per week, 95% CI = −3.37 to −0.43, p = 0.01) and less alcohol-related verbal abuse (odds ratio = 0.58, 95% CI = 0.35 to 0.96, p = 0.04) post-intervention, the low survey response rates (40% and 24% for the pre- and post-intervention surveys, respectively) require conservative interpretation. The main limitations of this study are as follows: (1) that the study may have been under-powered to detect differences in routinely collected data outcomes as statistically significant, and (2) the low survey response rates.
This RCT provides little evidence that community action significantly reduces risky alcohol consumption and alcohol-related harms, other than potential reductions in self-reported average weekly consumption and experience of alcohol-related verbal abuse. Complementary legislative action may be required to more effectively reduce alcohol harms.
Trial registration
Australian New Zealand Clinical Trials Registry ACTRN12607000123448
Please see later in the article for the Editors' Summary
Editors' Summary
People have consumed alcoholic beverages throughout history, but alcohol use is now an increasing global public health problem. According to the World Health Organization's 2010 Global Burden of Disease Study, alcohol use is the fifth leading risk factor (after high blood pressure and smoking) for disease and is responsible for 3.9% of the global disease burden. Alcohol use contributes to heart disease, liver disease, depression, some cancers, and many other health conditions. Alcohol also affects the well-being and health of people around those who drink, through alcohol-related crimes and road traffic crashes. The impact of alcohol use on disease and injury depends on the amount of alcohol consumed and the pattern of drinking. Most guidelines define long-term risky drinking as more than four drinks per day on average for men or more than two drinks per day for women (a “drink” is, roughly speaking, a can of beer or a small glass of wine), and short-term risky drinking (also called binge drinking) as seven or more drinks on a single occasion for men or five or more drinks on a single occasion for women. However, recent changes to the Australian guidelines acknowledge that a lower level of alcohol consumption is considered risky (with lifetime risky drinking defined as more than two drinks a day and binge drinking defined as more than four drinks on one occasion).
Why Was This Study Done?
In 2010, the World Health Assembly endorsed a global strategy to reduce the harmful use of alcohol. This strategy emphasizes the importance of community action–a process in which a community defines its own needs and determines the actions that are required to meet these needs. Although community action is highly acceptable to community members, few studies have looked at the effectiveness of community action in reducing risky alcohol consumption and alcohol-related harm. Here, the researchers undertake a cluster randomized controlled trial (the Alcohol Action in Rural Communities [AARC] project) to quantify the effectiveness of community action in reducing risky alcohol consumption and harms in rural communities in Australia. A cluster randomized trial compares outcomes in clusters of people (here, communities) who receive alternative interventions assigned through the play of chance.
What Did the Researchers Do and Find?
The researchers pair-matched 20 rural Australian communities according to the proportion of their population that was Aboriginal (rates of alcohol-related harm are disproportionately higher among Aboriginal individuals than among non-Aboriginal individuals in Australia; they are also higher among young people and males, but the proportions of these two groups across communities was comparable). They randomly assigned one member of each pair to the experimental group and implemented 13 interventions in these communities by negotiating with key individuals in each community to define and implement each intervention. Examples of interventions included general practitioner training in screening for alcohol use disorders and in implementing a brief intervention, and a school-based interactive session designed to reduce alcohol harm among young people. The researchers quantified the effectiveness of the interventions using routinely collected data on alcohol-related crime and road traffic crashes, and on hospital inpatient admissions for alcohol dependence or abuse (which were expected to increase in the experimental group if the intervention was effective because of more people seeking or being referred for treatment). They also examined drinking habits and experiences of alcohol-related harm, such as verbal abuse, among community members using pre- and post-intervention surveys. After implementation of the interventions, the rates of alcohol-related crime, road traffic crashes, and hospital admissions, and of risky and hazardous/harmful alcohol consumption (measured using a validated tool called the Alcohol Use Disorders Identification Test) were not statistically significantly different in the experimental and control communities (a difference in outcomes that is not statistically significantly different can occur by chance). However, the reported average weekly consumption of alcohol was 20% lower in the experimental communities after the intervention than in the control communities (equivalent to 1.9 fewer standard drinks per week per respondent) and there was less alcohol-related verbal abuse post-intervention in the experimental communities than in the control communities.
What Do These Findings Mean?
These findings provide little evidence that community action reduced risky alcohol consumption and alcohol-related harms in rural Australian communities. Although there was some evidence of significant reductions in self-reported weekly alcohol consumption and in experiences of alcohol-related verbal abuse, these findings must be interpreted cautiously because they are based on surveys with very low response rates. A larger or differently designed study might provide statistically significant evidence for the effectiveness of community action in reducing risky alcohol consumption. However, given their findings, the researchers suggest that legislative approaches that are beyond the control of individual communities, such as alcohol taxation and restrictions on alcohol availability, may be required to effectively reduce alcohol harms. In other words, community action alone may not be the most effective way to reduce alcohol-related harm.
Additional Information
Please access these websites via the online version of this summary at
The World Health Organization provides detailed information about alcohol; its fact sheet on alcohol includes information about the global strategy to reduce the harmful use of alcohol; the Global Information System on Alcohol and Health provides further information about alcohol, including information on control policies around the world
The US National Institute on Alcohol Abuse and Alcoholism has information about alcohol and its effects on health
The US Centers for Disease Control and Prevention has a website on alcohol and public health that includes information on the health risks of excessive drinking
The UK National Health Service Choices website provides detailed information about drinking and alcohol, including information on the risks of drinking too much, tools for calculating alcohol consumption, and personal stories about alcohol use problems
MedlinePlus provides links to many other resources on alcohol
More information about the Alcohol Action in Rural Communities project is available
PMCID: PMC3949675  PMID: 24618831
6.  Paradoxical Effects of Alcohol Information on Alcohol Outcome Expectancies 
Cognitive associations with alcohol predict both current and future use in youth and young adults. Much cognitive and social cognitive research suggests that exposure to information may have unconscious influences on thinking and behavior. The present study assessed the impact of information statements on the accessibility of alcohol outcome expectancies.
The 2 studies reported here investigated the effects of exposure to alcohol statements typical of informational approaches to prevention on the accessibility of alcohol outcome expectancies. High school and university students were presented with information statements about the effects of alcohol and other commercial products. The alcohol statements were taken from expectancy questionnaires. Some of these statements were presented as facts and others as myths. The retention of detailed information about these statements was manipulated by (i) divided attention versus focused attention or (ii) immediate versus delayed testing. Accessibility of personal alcohol outcome expectancies was subsequently measured using an open-ended question about the expected effects of alcohol.
Participants reported more alcohol outcomes seen during the information task as personal expectations about the effects of alcohol use than similar unseen items. Paradoxically, myth statements were also more likely to be reported as expectancies than unseen items in all conditions. Additionally, myth statements were generated less often than fact statements only under the condition of immediate testing with strong content processing instructions.
These observations are consistent with findings from cognitive research where familiarity in the absence of explicit memory can have an unconscious influence on performance. In particular, the exposure to these items in an informational format increases accessibility of the seen items even when the participants were told that they were myths. The findings have implications for the development of effective prevention materials.
PMCID: PMC4164266  PMID: 20477773
Alcohol Outcome Expectancies; Priming; Unconscious Influences; Associations; Memory
7.  Impulsive and Reflective Processes Related to Alcohol Use in Young Adolescents 
Background: Dual process models suggest that the development of addictive behaviors is the result of interplay between impulsive and reflective processes, modulated by boundary conditions such as individual or situational factors. Empirical support for this model has been repeatedly demonstrated in adult samples [for a meta-analysis, see Ref. (1)]. The purpose of this study was to test these processes as they relate to emerging alcohol use in adolescents. Specifically, the interactive effects of several measures of impulsive and reflective processes and working memory capacity (WMC) are examined as predictors of changes in alcohol use among adolescents. It was expected that measures of reflective processes would better predict changes in alcohol use than measures of impulsive processes. Moreover, it was anticipated that WMC would moderate the relation between alcohol-specific impulsive and reflective processes and changes in adolescent alcohol use.
Methods: The sample consisted of 427 adolescents (47.7% male) between 12 and 16 years of age (M = 13.96, SD = 0.78) who reported drinking alcohol at least once. Four measures of impulsive processes were included. Attentional bias for alcohol was assessed with a Visual Probe Test; approach bias toward alcohol was assessed with a Stimulus Response Compatibility (SRC) Test; and memory associations with alcohol were assessed with an Implicit Association Test (IAT) and a Word Association Test. Two measures of reflective measures were included: positive and negative expectancies. WMC was measured using a Self-Ordered Pointing Task.
Results: Results showed that positive expectancies predicted changes in alcohol use, but this effect was qualified by an interaction with IAT scores. Moreover, SRC scores predicted changes in alcohol use only when negative expectancies were low. Attentional bias and word association scores did not predict changes in alcohol use. The relations between alcohol-specific processes or reflective processes and alcohol use were not moderated by WMC.
Conclusion: Although there is empirical evidence for the validity of the model in predicting heavier alcohol use in adolescents, or alcohol abuse and dependence in adults, these observations do not generalize to a sample of normative, early adolescents. More specifically, results indicated that reflective processes are more important predictors of changes in alcohol use than impulsive process during adolescence.
PMCID: PMC4033066  PMID: 24904439
implicit cognition; explicit cognition; adolescents; alcohol use; working memory capacity; dual process model
8.  Interactions between implicit and explicit cognition and working memory capacity in the prediction of alcohol use in at-risk adolescents 
Drug and alcohol dependence  2007;94(1-3):116-124.
Dual process models of addiction suggest that the influence of alcohol-related cognition might be dependent on the level of executive functioning. This study investigated if the interaction between implicit and explicit alcohol-related cognitions and working memory capacity predicted alcohol use after one month in at-risk youth. Implicit and explicit alcohol-related cognitions were assessed in 88 Dutch at-risk adolescents ranging in age from 14 to 20 (51 males) with an adapted version of the Implicit Association Test (IAT) and an expectancy questionnaire. Working memory capacity was assessed using the computer-based version of the Self-Ordered Pointing Task (SOPT). Alcohol use and alcohol-related problems were measured at baseline and after one month with self-report questionnaires. The hierarchical regression analysis showed that both the interaction between implicit positive-arousal cognitions and working memory capacity and the interaction between explicit positive-arousal cognitions and working memory capacity predicted unique variance in alcohol use after one month. Implicit positive-arousal cognitions predicted alcohol use after one month more strongly in students with lower levels of working memory capacity, whereas explicit positive-arousal cognitions predicted one-month follow-up alcohol use more strongly in students with higher levels of working memory capacity. This could imply that different intervention methods could be effective for different subgroups of at-risk youth.
PMCID: PMC3413632  PMID: 18155856
implicit cognition; explicit cognition; executive functioning; IAT; adolescence; alcohol use
9.  Reinforcement Sensitivity Theory and Alcohol Outcome Expectancies in Early Adolescence 
Little research has examined the development of alcohol expectancies in childhood, a notable omission as expectancies are viable targets for prevention programs. Moreover, limited alcohol expectancies research has been conducted from the perspective of psychobiological models of motivation despite the strong conceptual links between such models and cognitive models of alcohol use.
To examine if the associations between individual differences from the revised reinforcement sensitivity theory and alcohol use is mediated by alcohol expectancies in a large community sample of early adolescents using a prospective design.
378 families (1 caregiver; 1 child) were recruited via random digit phone call using a prospective design.
Our findings suggest that both a strong behavioral approach system and fight-flight or freeze system were associated with high levels of positive outcome expectancies, which subsequently predicted an increase in likelihood of alcohol use. There was also some evidence that drive (an aspect of behavioral approach system) was also positively associated with negative expectancies, which subsequently predicted a low probability of alcohol use.
Conclusions and Scientific Significance
Individual differences in reinforcement sensitivity may influence the acquisition of positive and negative outcome expectancies, thereby potentially influencing the likelihood of alcohol use in early adolescence. Thus, reinforcement sensitivity theory is a promising theory to account for the link between neural models of addiction and early acquisition of alcohol use in humans.
PMCID: PMC4033694  PMID: 22220630
BAS; BIS; FFFS; substance use initiation; expectancies; adolescence
10.  Acute Alcohol Effects on Inhibitory Control and Implicit Cognition: Implications for Loss of Control Over Drinking 
Alcohol impairs inhibitory control, and it alters implicit alcohol cognitions including attentional bias and implicit associations. These effects are seen after doses of alcohol which do not lead to global impairments in cognitive performance. We review studies which demonstrate that the effects of alcohol on inhibitory control are associated with the ability of alcohol to prime alcohol-seeking behavior. We also hypothesize that alcohol-induced changes in implicit alcohol cognitions may partially mediate alcohol-induced priming of the motivation to drink. Based on contemporary theoretical models and conceptualizations of executive function, impulsivity, and the motivational salience of alcohol-related cues, we speculate on other aspects of cognition that may underlie alcohol’s effects on alcohol seeking. Inconsistencies in existing research and priorities for future research are highlighted, including dose effects and the potential interactions between chronic heavy drinking and the acute effects of alcohol on these cognitive processes.
PMCID: PMC2999764  PMID: 20491732
Inhibitory Control; Attentional Bias; Automatic Alcohol Associations; Priming
11.  Olfactory Impairment Is Correlated with Confabulation in Alcoholism: Towards a Multimodal Testing of Orbitofrontal Cortex 
PLoS ONE  2011;6(8):e23190.
Olfactory abilities are now a flourishing field in psychiatry research. As the orbitofrontal cortex appears to be simultaneously implicated in odour processing and executive impairments, it has been proposed that olfaction could constitute a cognitive marker of psychiatric states. While this assumption appears promising, very few studies have been conducted on this topic among psychopathological populations. The present study thus aimed at exploring the links between olfaction and executive functions. These links were evaluated using two tasks of comparable difficulty, one known to rely on orbitofrontal cortex processing (i.e., a confabulation task), and one not associated with this area (i.e., Stop-Signal task).
Methodology/Principal Findings
Twenty recently detoxified alcoholic individuals and twenty paired controls took part in an experiment evaluating olfactory abilities and executive functioning (i.e., Stop-Signal task and confabulation task). Comorbidities and potential biasing variables were also controlled for. Alcoholic individuals exhibited impaired performance for high-level olfactory processing and significant confabulation problems as compared to controls (but no deficit in Stop-Signal task), even when the influence of comorbidities was taken into account. Most importantly, olfactory abilities and confabulation rates were significantly correlated in both groups.
Alcoholism jointly leads to olfactory and memory source impairments, and these two categories of deficits are associated. These results strongly support the proposition that olfactory and confabulation measures both index orbitofrontal functioning, and suggest that olfaction could become a reliable cognitive marker in psychiatric disorders. Moreover, it underlines the need to take into account these olfactory and source memory impairments in a clinical context.
PMCID: PMC3155545  PMID: 21858026
12.  The Effects of Alcohol and Expectancies on Risk Perception and Behavioral Skills Relevant to Safer Sex Among Heterosexual Young Adult Women 
Journal of studies on alcohol  2002;63(4):476-485.
This study was undertaken to test the hypotheses that acute alcohol intoxication and alcohol-rated sex expectancies are negatively related both to risk perception (a motivational factor) and ability to negotiate safer sex (a behavioral skills factor) with a partner. Motivation and behavioral skills are determinants of safer sex according to the Information-Motivation-Behavioral Skills (IMB) model.
A total of 102 heterosexual females aged 21–30 years participated in two sessions. The first session involved the administration of various measures to confirm eligibility status, and random assignment to one of three beverage conditions: water control, alcohol (.65gm alcohol/kg. body weight), or placebo. The second session involved administration of the beverage and then completion of a risk perception measure and an audio-visual role-play measure of behavioral skills.
Regression analyses showed that alcohol expectancies and the perception of intoxication contributed independent variance to both risk perception and behavioral skills. Actual alcohol intoxication had little influence on these dependent variables.
Alcohol expectancies and related factors can be related to variables that theoretically precede the occurrence of risky sex. Research is needed on the processes through which expectancies might be related to the occurrence of safer sex, as well as on person and situation variables that moderate the effects of alcohol and alcohol expectancies on safer sex.
PMCID: PMC2423734  PMID: 12160107
13.  Examining Personality and Alcohol Expectancies Using Functional Magnetic Resonance Imaging (fMRI) with Adolescents* 
Journal of studies on alcohol  2005;66(3):323-331.
Personality and alcohol expectancies have been examined as risk factors for the initiation and maintenance of alcohol use in adolescents and young adults. Differences in processing appetitive stimuli are seen as a mechanism for personality's influence on behavior, and that mechanism predisposes individuals to form more positive expectancies for alcohol. The go/no-go task has been used to show how personality differences influence responding to appetitive stimuli in adolescents and adults, and functional magnetic resonance imaging (fMRI) has been used to examine the relation of go/no-go responding to personality in adult males. However, no study to date has examined the relation between fMRI responding, personality and alcohol expectancies in adolescents.
Forty-six adolescents (ages 12−14 years; 61% male) with minimal substance use histories completed measures of neuroticism, extraversion, and alcohol expectancies, and performed a go/no-go task during fMRI acquisition.
Greater blood oxygen level-dependent (BOLD) response to inhibition predicted fewer expectancies of cognitive and motor improvements but more expectancies of cognitive and motor impairment from alcohol. In addition, extraverted youths reported more positive alcohol expectancies. However, BOLD response did not predict neuroticism or extraversion.
These preliminary results suggest that decreased inhibitory neural processing may contribute to more positive and less negative expectancies, which can eventually lead to problem drinking. Further, extraversion may also yield more positive expectancies and could underlie a vulnerability to disordered alcohol use.
PMCID: PMC2270701  PMID: 16047521
14.  Neurotrophin levels at admission did not change significantly upon alcohol deprivation and were positively correlated with the BMI and LDL levels 
The neurotrophins brain-derived neurotrophic factor (BDNF) and neurotrophic factor 3 (NT3) could play a role in addictive behavior. Interactions between BDNF and dopamine transmission influence the alcohol intake. It has been hypothesized that extensive alcohol consumption leads to diminished circulating BDNF levels and impaired BDNF-mediated protective mechanisms. What is more, alcohol dependency causes changes in lipid metabolism which in turn may influence the neurotrophin system.
In this study, we tested the hypothesis that alcohol withdrawal increases the serum levels of BDNF in alcoholic patients and investigated correlations between serum BDNF and NT3 and alcohol in breath as well as with the body-mass-index (BMI), lipoprotein profiles and lifestyle factors in 110 male in-patients diagnosed with alcohol addiction on the first day after admission and at discharge.
The intoxication level (alcohol in breath at admission) was significantly correlated with liver enzymes and BDNF concentrations (R = .28; p = .004). Patients with positive breath-alcohol test at admission had about 9 times higher NT3 levels and higher liver enzyme concentration levels than nonintoxicated subjects. Alcohol intoxicated patients with pathological aspartate aminase (ASAT) levels had even higher NT3 level (F = 5.41; p = .022). The concentration of NT3 was positively associated with the (BMI) (admission R = .36; p = .004; discharge R = .33; p = .001), and the obese patients had 3 to 5 times higher NT3 concentration than the others. Low-density lipoprotein (LDL) concentration levels were found to positively correlate with NT3 concentration levels (admission R = .025; p = .015 discharge R = .24; p = .23).
Other than expected, the levels of NT3 and to a lesser extent BDNF levels, were found to be significantly increased in acute alcohol abuse. Alcohol deprivation did not significantly change the serum neurotrophin levels at admission. NT3 levels were positively correlated with the BMI and LDL levels. Because of expected difference between genders, we recommend investigating these correlations further in patients of both genders.
PMCID: PMC4223886  PMID: 25408911
Alcoholism; Brain-derived neurotrophic factor; Neurotrophin-derived factor 3; Detoxification; Lipoproteins
15.  Comparative Analysis of Alcohol Control Policies in 30 Countries 
PLoS Medicine  2007;4(4):e151.
Alcohol consumption causes an estimated 4% of the global disease burden, prompting goverments to impose regulations to mitigate the adverse effects of alcohol. To assist public health leaders and policymakers, the authors developed a composite indicator—the Alcohol Policy Index—to gauge the strength of a country's alcohol control policies.
Methods and Findings
The Index generates a score based on policies from five regulatory domains—physical availability of alcohol, drinking context, alcohol prices, alcohol advertising, and operation of motor vehicles. The Index was applied to the 30 countries that compose the Organization for Economic Cooperation and Development and regression analysis was used to examine the relationship between policy score and per capita alcohol consumption. Countries attained a median score of 42.4 of a possible 100 points, ranging from 14.5 (Luxembourg) to 67.3 (Norway). The analysis revealed a strong negative correlation between score and consumption (r = −0.57; p = 0.001): a 10-point increase in the score was associated with a one-liter decrease in absolute alcohol consumption per person per year (95% confidence interval, 0.4–1.5 l). A sensitivity analysis demonstrated the robustness of the Index by showing that countries' scores and ranks remained relatively stable in response to variations in methodological assumptions.
The strength of alcohol control policies, as estimated by the Alcohol Policy Index, varied widely among 30 countries located in Europe, Asia, North America, and Australia. The study revealed a clear inverse relationship between policy strength and alcohol consumption. The Index provides a straightforward tool for facilitating international comparisons. In addition, it can help policymakers review and strengthen existing regulations aimed at minimizing alcohol-related harm and estimate the likely impact of policy changes.
Using an index that gauges the strength of national alcohol policies, a clear inverse relationship was found between policy strength and alcohol consumption.
Editors' Summary
Alcohol drinking is now recognized as one of the most important risks to human health. Previous research studies (see the research article by Rodgers et al., linked below) have predicted that around 4% of the burden of disease worldwide comes about as a result of drinking alcohol, which can be a factor in a wide range of health problems. These include chronic diseases such as cirrhosis of the liver and certain cancers, as well as poor health resulting from trauma, violence, and accidental injuries. For these reasons, most governments try to control the consumption of alcohol through laws, although very few countries ban alcohol entirely.
Why Was This Study Done?
Although bodies such as the World Health Assembly have recommended that its member countries develop national control policies to prevent excessive alcohol use, there is a huge variation between national policies. It is also very unclear whether there is any link between the strictness of legislation regarding alcohol control in any given country and how much people in that country actually drink.
What Did the Researchers Do and Find?
The researchers carrying out this study had two broad goals. First, they wanted to develop an index (or scoring system) that would allow them and others to rate the strength of any given country's alcohol control policy. Second, they wanted to see whether there is any link between the strength of control policies on this index and the amount of alcohol that is drunk by people on average in each country. In order to develop the alcohol control index, the researchers chose five main areas relating to alcohol control. These five areas related to the availability of alcohol, the “drinking context,” pricing, advertising, and vehicles. Within each policy area, specific policy topics relating to prevention of alcohol consumption and harm were identified. Then, each of 30 countries within the OECD (Organization for Economic Cooperation and Development) were rated on this index using recent data from public reports and databases. The researchers also collected data on alcohol consumption within each country from the World Health Organization and used this to estimate the average amount drunk per person in a year. When the researchers plotted scores on their index against the average amount drunk per person per year, they saw a negative correlation. That is, the stronger the alcohol control policy in any given country, the less people seemed to drink. This worked out at around roughly a 10-point increase on the index equating to a one-liter drop in alcohol consumption per person per year. However, some countries did not seem to fit these predictions very well.
What Do These Findings Mean?
The finding that there is a link between the strength of alcohol control policies and amount of alcohol drinking does not necessarily mean that greater government control causes lower drinking rates. The relationship might just mean that some other variable (e.g., some cultural factor) plays a role in determining the amount that people drink as well as affecting national policies for alcohol control. However, the index developed here is a useful method for researchers and policy makers to measure changes in alcohol controls and therefore understand more clearly the factors that affect drinking rates. This study looked only at the connection between control measures and extent of alcohol consumption, and did not examine alcohol-related harm. Future research might focus on the links between controls and the harms caused by alcohol.
Additional Information.
Please access these Web sites via the online version of this summary at
A Perspective in PLoS Medicine by Alison Ritter accompanies this article: “Comparing alcohol policies between countries: Science or silliness?”
Facts and figures on alcohol are available from the World Health Organization, including information about the burden of disease worldwide as a result of alcohol
Information from the US Centers for Disease Control and Prevention is available about alcohol and public health
A 2004 PLoS Medicine research article includes discussion of the health burdens of alcohol: Rodgers A, Ezzati M, Vander Hoorn S, Lopez AD, Lin RB, et al. (2004) Distribution of major health risks: Findings from the global burden of disease study. PLoS Medicine 1(1): e27. doi:10.1371/journal.pmed.0010027
Current information about research on alcohol and alcoholism is available from the National Institute on Alcohol Abuse and Alcoholism
PMCID: PMC1876414  PMID: 17455992
16.  Mood and Implicit Alcohol Expectancy Processes: Predicting Alcohol Consumption in the Laboratory 
Implicit positive alcohol expectancy (PAEs) processes are thought to respond phasically to external and internal stimuli – including mood states – and so they may exert powerful proximal influences over drinking behavior. Although social learning theory contends that mood states activate mood-congruent implicit PAEs, which in turn lead to alcohol use, there is a dearth of experimental research examining this mediation model relative to observable drinking. Moreover, an expectancy theory perspective might suggest that, rather than influencing PAEs directly, mood may moderate the association between PAEs and drinking. To test these models, the present study examined the role of mood in the association between implicitly measured PAE processes (i.e., latency to endorse PAEs) and immediate alcohol consumption in the laboratory. Gender differences in these processes also were examined.
College students (N=146) were exposed to either a positive, negative, or neutral mood induction procedure, completed a computerized PAE reaction time (RT) task, and subsequently consumed alcohol ad libitum.
The mood manipulation had no direct effects on drinking in the lab, making the mediation hypothesis irrelevant. Instead, gender and mood condition moderated the association between RT to endorse PAEs and drinking in the lab. For males, RT to tension reduction PAEs was a stronger predictor of volume of beer consumed and peak BAC in the context of general arousal (i.e., positive and negative mood) relative to neutral mood. RT to PAEs did not predict drinking in the lab for females.
The results show that PAE processes are important determinants of immediate drinking behavior in men, suggesting that biased attention to mood-relevant PAEs – as indicated by longer RTs – predicts greater alcohol consumption in the appropriate mood context. The findings also highlight the need to consider gender differences in PAE processes. This study underscores the need for interventions that target automatic cognitive processes related to alcohol use.
PMCID: PMC3208123  PMID: 21797887
alcohol expectancies; implicit cognition; mood; gender
17.  The predictive validity of the Drinking-Related Cognitions Scale in alcohol-dependent patients under abstinence-oriented treatment 
Cognitive factors associated with drinking behavior such as positive alcohol expectancies, self-efficacy, perception of impaired control over drinking and perception of drinking problems are considered to have a significant influence on treatment effects and outcome in alcohol-dependent patients. However, the development of a rating scale on lack of perception or denial of drinking problems and impaired control over drinking has not been substantial, even though these are important factors in patients under abstinence-oriented treatment as well as participants in self-help groups such as Alcoholics Anonymous (AA). The Drinking-Related Cognitions Scale (DRCS) is a new self-reported rating scale developed to briefly measure cognitive factors associated with drinking behavior in alcohol-dependent patients under abstinence-oriented treatment, including positive alcohol expectancies, abstinence self-efficacy, perception of impaired control over drinking, and perception of drinking problems. Here, we conducted a prospective cohort study to explore the predictive validity of DRCS.
Participants in this study were 175 middle-aged and elderly Japanese male patients who met the DSM-IV Diagnostic Criteria for Alcohol Dependence. DRCS scores were recorded before and after the inpatient abstinence-oriented treatment program, and treatment outcome was evaluated one year after discharge.
Of the 175 participants, 30 were not available for follow-up; thus the number of subjects for analysis in this study was 145. When the total DRCS score and subscale scores were compared before and after inpatient treatment, a significant increase was seen for both scores. Both the total DRCS score and each subscale score were significantly related to total abstinence, percentage of abstinent days, and the first drinking occasion during the one-year post-treatment period. Therefore, good treatment outcome was significantly predicted by low positive alcohol expectancies, high abstinence self-efficacy, high perception level of impaired control over drinking, and high perception level of drinking problems measured by DRCS.
The DRCS was considered to have satisfactory predictive validity, which further supports our previous findings. It was suggested that DRCS is a promising rating scale for evaluating multidimensional cognitive factors associated with drinking behavior in alcohol-dependent patients under abstinence-oriented treatment.
PMCID: PMC3487873  PMID: 22559788
Alcohol-dependent; Treatment outcome; Predictive validity; Drinking-related cognitions scale; Abstinence-oriented treatment; Positive alcohol expectancies; Abstinence self-efficacy; Perception of impaired control; Perception of drinking problems; Denial
18.  The Role of Issue Familiarity And Social Norms: Findings on New College Students’ Alcohol Use Intentions 
Scholars in a variety of disciplines are interested in understanding the conditions under which social norms affect human behavior. Following the distinction made between descriptive and injunctive norms by the focus theory of normative conduct, the theory of normative social behavior predicts that the influence of descriptive norms on behavior is moderated by injunctive norms, outcome expectations, and group identity. We extended the theory by testing the proposition that the influence of descriptive norms on behavior would be greater under conditions of greater issue familiarity, defined as the ease with which one can cognitively access the behavior or behavioral issue.
Design and Methods
The model was tested in the domain of alcohol consumption intentions by conducting a survey among incoming students (n=719) to a large university in the United States. Data indicated that students in the sample were well representative of the university population.
The influence of descriptive norms on behavioral intentions was moderated by issue familiarity, as predicted. Familiarity was a facilitator of behavior: the influence of descriptive norms on behavioral intentions was greater under conditions of high, rather than low, familiarity. The overall model explained 53% of the variance in alcohol consumption intentions.
Public health interventions promoting health behaviors need to take into account the extent to which the behaviors are familiar to the target audience. The influence of norms appears to be weaker when the behavior is unfamiliar or novel. Implications for theory and interventions for reducing alcohol consumption are discussed.
PMCID: PMC4140328  PMID: 25170478
descriptive norms; alcohol; theory of normative social behavior; familiarity
19.  ALDH2, ADH1B and Alcohol Expectancies: Integrating Genetic and Learning Perspectives 
Genetic factors are presumed to contribute to individual differences in alcohol expectancies, but few studies have examined this possibility directly. Genes with functional implications for alcohol metabolism and sensitivity are good candidates for studies of genetic effects on expectancy processes. The present study evaluated influences of ALDH2 and ADH1B genotypes on alcohol expectancies and drinking behavior in a sample of Asian-American young adults. In addition to assessing global alcohol expectancies, a measure of physiological expectancies was developed to evaluate an expectancy phenotype specific to the mechanism by which ALDH2 and ADH1B variations presumably influence drinking behavior. Compared to individuals with the ALDH2*1/*1 genotype, those with the ALDH2*2 allele reported greater negative alcohol expectancies, greater expectancies for physiological effects of alcohol and lower rates of alcohol use. ADH1B was not associated with alcohol expectancies or drinking behavior. Hierarchical models showed that demographic factors, ALDH2 genotype and expectancy variables explained unique variance in drinking outcomes. Mediation tests showed significant indirect effects of ALDH2 on drinking frequency and peak lifetime consumption via expectancies. These results provide support for influences of genetic factors and alcohol sensitivity on alcohol-related learning and suggest the importance of developing biopsychosocial models of drinking behavior in Asian Americans.
PMCID: PMC2761721  PMID: 19769429
ALDH2; ADH1B; genetic; alcohol expectancies; Asian Americans; college students
20.  Disruptions in Functional Network Connectivity during Alcohol Intoxicated Driving 
Driving while under the influence of alcohol is a major public health problem whose neural basis is not well understood. In a recently published fMRI study (Meda et al, 2009), our group identified five, independent critical driving-associated brain circuits whose inter-regional connectivity was disrupted by alcohol intoxication. However, the functional connectivity between these circuits has not yet been explored in order to determine how these networks communicate with each other during sober and alcohol-intoxicated states.
In the current study, we explored such differences in connections between the above brain circuits and driving behavior, under the influence of alcohol versus placebo. Forty social drinkers who drove regularly underwent fMRI scans during virtual reality driving simulations following two alcohol doses, placebo and an individualized dose producing blood alcohol concentrations (BACs) of 0.10%.
At the active dose, we found specific disruptions of functional network connectivity between the frontal-temporal-basal ganglia and the cerebellar circuits. The temporal connectivity between these two circuits was found to be less correlated (p <0.05) when driving under the influence of alcohol. This disconnection was also associated with an abnormal driving behavior (unstable motor vehicle steering).
Connections between frontal-temporal-basal ganglia and cerebellum have recently been explored; these may be responsible in part for maintaining normal motor behavior by integrating their overlapping motor control functions. These connections appear to be disrupted by alcohol intoxication, in turn associated with an explicit type of impaired driving behavior.
PMCID: PMC2858246  PMID: 20028354
Motor; Fronto-Striatal; Virtual Reality; Driving while intoxicated; Cerebellum
21.  Effects of alcohol on verbal processing: An ERP study 
Behavioral studies suggest that alcohol intoxication impairs speed and accuracy of word recognition and categorization, but alcohol’s effects on the brain during verbal cognitive processing have not been adequately understood. Using event-related potentials (ERP) and a word recognition paradigm, this study investigated the effects of alcohol intoxication on prelexical, semantic, and mnemonic aspects of verbal processing.
Concurrent measures of ERPs and skin conductance responses (SCRs) were obtained in a word repetition priming task and permitted a comparison of the effects of alcohol on the central and autonomic physiological systems. Social drinkers participated in all four cells of the within-subjects balanced placebo design in which effects of alcohol and instructions as to the beverage content (expectancy) were manipulated. The average peak blood alcohol level was raised to 0.045%.
None of the manipulations affected behavioral performance and expectancy had no effect on any of the measures. In contrast, alcohol ingestion attenuated the temporo-parietal N180 suggesting an impairment in prelexical pattern recognition processes. Alcohol significantly increased the amplitude of N450 and the latency of P580, particularly on trials evoking sympathetic arousal as measured with SCRs.
Although behavioral measures were unaffected, ERPs showed that a moderately low alcohol dose affected verbal processing during both early, prelexical and late, semantic stages. Alcohol significantly increased the difficulty of semantic access and integration as reflected in larger N450 amplitude and longer P580 latency. This effect was particularly prominent on arousal-related trials, suggesting that alcohol impairs processes that modulate cognitive functioning. The lack of an interaction between the factors of repetition and beverage suggests that a moderately low alcohol dose exerts these effects via the semantic and integration systems rather than via memory processes.
PMCID: PMC3746793  PMID: 15084899
Alcohol; Verbal processing; Event-related potentials; N400; Electrodermal activity
22.  Cognitive Processes in Alcohol Binges: A Review and Research Agenda 
Current drug abuse reviews  2008;1(3):263-279.
Alcohol abuse is associated with a cluster of long-term changes in cognitive processes, as predicted by contemporary models of addiction. In this paper we review evidence which suggests that similar changes may occur during an alcohol binge, and as such they may play an important role in explaining the loss of control over alcohol consumption that occurs during alcohol binges. As a consequence of both acute alcohol intoxication (alcohol ‘priming’ effects) and exposure to environmental alcohol-related cues, we suggest that a number of changes in cognitive processes are likely. These include increased subjective craving for alcohol, increased positive and arousing outcome expectancies and implicit associations for alcohol use, increased attentional bias for alcohol-related cues, increased action tendencies to approach alcohol, increased impulsive decision-making, and impaired inhibitory control over drives and behaviour. Potential reciprocal relationships between these different aspects of cognition during an alcohol binge are discussed. Finally, we discuss the relationship between the current model and existing models of cognitive processes in substance abuse, and we speculate on the implications of the model for the reduction binge drinking and its consequences.
PMCID: PMC3066447  PMID: 19630725
Alcohol; binge drinking; priming; cues; craving; attentional bias; implicit cognition; impulsivity; inhibitory control; outcome expectancies
23.  Explicit and Implicit Measures of Expectancy and Related Alcohol Cognitions: A Meta-Analytic Comparison 
Implicit measures assess the influence of past experience on present behavior in the absence of respondents’ awareness of that influence. Application of implicit measurement to expectancy and related alcohol cognition research has helped elucidate the links between alcohol-related experiences, the functioning of alcohol-related memory, and alcohol-related behavior. Despite these advances, a coherent picture of the role of implicit measurement has been difficult to achieve due to the diversity of implicit measures used. Two central questions have emerged: do implicit measures assess a distinct aspect of the alcohol associative memory domain not accessible via explicit measurement; and, when compared to explicit measurement, do they offer unique prediction of alcohol consumption? To the end of addressing these questions, a meta-analysis of studies using both implicit and explicit measures of alcohol expectancy and other types of alcohol-related cognition is conducted. Results indicate that implicit and explicit measures are weakly related, and while they predict some shared variance in drinking, each also contributes a unique component. Results are discussed in the context of the theoretical distinction made between the two types of measures.
PMCID: PMC2845325  PMID: 20307108
Alcohol Expectancy; Implicit Memory; Implicit Cognition; Meta-analysis; Alcohol-related cognition
24.  Synchrony of corticostriatal-midbrain activation enables normal inhibitory control and conflict processing in recovering alcoholic men 
Biological Psychiatry  2011;71(3):269-278.
Alcohol dependence is associated with inhibitory control deficits, possibly related to abnormalities in frontoparietal cortical and midbrain function and connectivity.
We examined functional connectivity and microstructural fiber integrity between frontoparietal and midbrain structures using a Stroop Match-to-Sample task with functional MRI and diffusion tensor imaging in 18 alcoholics and 17 controls. Manipulation of color cues and response repetition sequences modulated cognitive demands during Stroop conflict.
Despite similar lateral frontoparietal activity and functional connectivity in alcoholics and controls when processing conflict, controls deactivated the posterior cingulate cortex (PCC), whereas alcoholics did not. Posterior cingulum fiber integrity predicted the degree of PCC deactivation in controls but not alcoholics. Also, PCC activity was modulated by executive control demands: activated during response switching and deactivated during response repetition. Alcoholics showed the opposite pattern: activation during repetition and deactivation during switching. Here, in alcoholics, greater deviations from the normal PCC activity correlated with higher amounts of lifetime alcohol consumption. A functional dissociation of brain network connectivity between the groups further showed that controls exhibited greater corticocortical connectivity between middle cingulate, posterior cingulate, and medial prefrontal cortices than alcoholics. By contrast, alcoholics exhibited greater midbrain-orbitofrontal cortical network connectivity than controls. Degree of microstructural fiber integrity predicted robustness of functional connectivity.
Thus, even subtle compromise of microstructural connectivity in alcoholism can influence modulation of functional connectivity and underlie alcohol-related cognitive impairment.
PMCID: PMC3253929  PMID: 22137506
Functional connectivity; functional MRI; diffusion tensor imaging; white matter fiber tractography; Stroop task; Alcohol Use Disorder
25.  A Population-Based Study on Alcohol and High-Risk Sexual Behaviors in Botswana 
PLoS Medicine  2006;3(10):e392.
In Botswana, an estimated 24% of adults ages 15–49 years are infected with HIV. While alcohol use is strongly associated with HIV infection in Africa, few population-based studies have characterized the association of alcohol use with specific high-risk sexual behaviors.
Methods and Findings
We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana using a stratified two-stage probability sample design. Multivariate logistic regression was used to assess correlates of heavy alcohol consumption (>14 drinks/week for women, and >21 drinks/week for men) as a dependent variable. We also assessed gender-specific associations between alcohol use as a primary independent variable (categorized as none, moderate, problem and heavy drinking) and several risky sex outcomes including: (a) having unprotected sex with a nonmonogamous partner; (b) having multiple sexual partners; and (c) paying for or selling sex in exchange for money or other resources. Criteria for heavy drinking were met by 31% of men and 17% of women. Adjusted correlates of heavy alcohol use included male gender, intergenerational relationships (age gap ≥10 y), higher education, and living with a sexual partner. Among men, heavy alcohol use was associated with higher odds of all risky sex outcomes examined, including unprotected sex (AOR = 3.48; 95% confidence interval [CI], 1.65 to 7.32), multiple partners (AOR = 3.08; 95% CI, 1.95 to 4.87), and paying for sex (AOR = 3.65; 95% CI, 2.58 to 12.37). Similarly, among women, heavy alcohol consumption was associated with higher odds of unprotected sex (AOR = 3.28; 95% CI, 1.71 to 6.28), multiple partners (AOR = 3.05; 95% CI, 1.83 to 5.07), and selling sex (AOR = 8.50; 95% CI, 3.41 to 21.18). A dose-response relationship was seen between alcohol use and risky sexual behaviors, with moderate drinkers at lower risk than both problem and heavy drinkers.
Alcohol use is associated with multiple risks for HIV transmission among both men and women. The findings of this study underscore the need to integrate alcohol abuse and HIV prevention efforts in Botswana and elsewhere.
Alcohol use is associated with multiple risks for HIV transmission in men and women. The findings underscore the need to integrate alcohol abuse and HIV prevention efforts in Botswana and elsewhere.
Editors' Summary
Human immunodeficiency virus (HIV), the cause of acquired immunodeficiency syndrome (AIDS), is most commonly spread through unprotected sex with an infected partner. HIV enters the body through the lining of the sex organs, rectum, or mouth, and destroys immune system cells, leaving the infected person susceptible to other viruses and bacteria. Although HIV education and prevention campaigns emphasize the importance of safe sex in reducing HIV transmission, people continue to become infected by having unprotected sex (that is, not using a condom) with either a nonmonogamous partner or multiple sexual partners, or in situations where they are paying for or selling sex. Research in different populations suggested that heavy alcohol use is associated with risky sexual behaviors. This is because alcohol relaxes the brain and body, reduces inhibitions, and diminishes risk perception. Drinking alcohol may further increase the risk of becoming infected with HIV through its suppressive effects on the immune system.
Why Was This Study Done?
Alcohol abuse is widespread in sub-Saharan Africa where most HIV infections occur and has been associated with risky sexual behaviors. It may therefore be one of the most common, potentially modifiable HIV risk factors in this region. However, research to date has concentrated on the association between alcohol consumption and risky sex in people attending HIV-treatment clinics or recruited at beer halls, and these populations may not be representative of the general population of sub-Saharan Africa. In this study, the researchers have investigated the potential role of alcohol in perpetuating the HIV epidemic by undertaking a population-based study on alcohol use and high-risk sexual behaviors in Botswana. Nearly a quarter of adults are infected with HIV here, and alcohol abuse is also common, particularly in the townships.
What Did the Researchers Do and Find?
The researchers recruited a random cross-section of people from the five districts of Botswana with the highest number of HIV-infected individuals and interviewed all 1,268 participants using a questionnaire. This included general questions about the participants (for example, their age and marital status) and questions about alcohol use, sexual behavior, and knowledge of HIV. Overall, 31% of the men in the study and 17% of the women were heavy drinkers—more than 21 drinks/week for men, 14 for women; a drink is half a pint of beer or a glass of wine. Heavy alcohol use was associated with being male, being in an intergenerational relationship (at least 10 years age difference between partners; intergenerational sex facilitates the continued spread of HIV in sub-Saharan Africa), having had more education, and living with a sexual partner. Among men, those who drank heavily were three to four times more likely to have unprotected sex or multiple partners or to pay for sex than nondrinkers. Among women, there was a similar association between heavy drinking and having unprotected sex or multiple partners, and heavy drinkers were eight times as likely to sell sex as nondrinkers. For both men and women, the more they drank, the more likely they were to have risky sex. The study did not address behavior among same-sex partnerships.
What Do These Findings Mean?
This study indicates that heavy alcohol consumption is strongly and consistently associated with sexual risk behaviors in both men and women in Botswana. Because of the study design, it does not prove that heavy alcohol use is the cause of such behaviors but provides strong circumstantial evidence that this is the case. It is possible that these results may not apply to neighboring African countries—Botswana is unique in being relatively wealthy and in its government being strongly committed to tackling HIV. Nevertheless, taken together with the results of other studies, this research strongly argues for the need to deal with alcohol abuse within HIV prevention programs in sub-Saharan Africa. Strategies to do this could include education campaigns that target both alcohol use and HIV in schools and in social venues, including beer halls. But, stress the researchers, any strategy that is used must consider the cultural and social significance of alcohol use (in Botswana, alcohol use is a symbol of masculinity and high socioeconomic status) and must simultaneously tackle not only the overlap between alcohol use and risky sexual behavior but also the overlap between alcohol and other risk behaviors such as intergenerational sex.
Additional Information
Please access these Web sites via the online version of this summary at
US National Institute of Allergy and Infectious Diseases factsheet on HIV infection and AIDS
US Department of Health and Human Services information on AIDS
US Centers for Disease Control and Prevention information on HIV/AIDS
US National Institute on Alcohol Abuse and Alcoholism patient information on alcohol and HIV/AIDS]
Aidsmap, information on HIV and AIDS provided by the charity NAM,which includes some information on HIV infections and alcohol
AVERT information on HIV and AIDS in Botswana
PMCID: PMC1592342  PMID: 17032060

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