Low sensitivity to, and craving for, alcohol in naturalistic and laboratory settings

Abstract

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT REQUEST OF AUTHOR.] Low sensitivity to alcohol is a well-established risk factor for the development of an alcohol use disorder. This risk is transmitted along several routes included, but not limited to, differences in alcohol expectancies, association with heavier drinking peers, and differences in motivations for drinking. A recent line of inquiry drawing on the Incentive Sensitization Theory of Addiction has emerged as another potential factor through which alcohol sensitivity interfaces with alcohol use disorder. The Incentive Sensitization Theory of Addiction posits that formerly neutral cues become imbued with incentive salience through their repeated pairing with drug use and become highly sought after in their own right. Psychophysiological laboratory work has produced promising results that suggest that this process is stronger for low sensitivity drinkers relative to their higher sensitivity peers. The present work attempts to extend these laboratory results into drinkers' natural environment. Participants completed a 10-day period of Ecological Momentary Assessment where they reported on their exposure to cues for alcohol use, levels of craving for alcohol, and their use of alcohol. Results indicated that lower sensitivity drinkers were exposed to alcohol cues more frequently, were more likely to drink, and to drink more heavily when drinking. Cue exposure was a robust predictor of momentary craving, which in turn was a predictor of the likelihood of drinking and marginally associated with the heaviness of drinking. Contrary to hypotheses, alcohol sensitivity was not a moderator of any associations between cue exposure and drinking or craving and drinking. Despite the lack of the expected moderating effects of alcohol sensitivity, the results indicate that craving is a substantial predictor for drinking behavior in an at-risk population. This association between craving and drinking in the "real world" in a non-clinical population has only been rarely documented previously and presents an exciting avenue for continued research.