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Summary GGZ3025 - Addiction - Task 5
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GGZ3025 VerslavingTASK 5 – TWEE PROCESSEN
AUTOMATIC AND CONTROLLED PROCESSES IN ADDICTION
Bron: Field & Wiers (2012)
Learning objectives and abstract
Alcohol consumption is influenced by controlled cognitive processes, such as rational
decision-making and outcome expectancies for alcohol effects. Heavy drinking is associated
with alterations in automatic cognitive processing, such as implicit memory association and
attentional bias. These processes make unique contributions to future alcohol consumption,
over and above those attributed to controlled cognitive processes. Heavy drinking is also
associated with increased impulsivity and impaired executive function; this may reflect both
a consequence of chronic alcohol exposure and a cause of loss of control over alcohol-seeking
behavior. Furthermore, it is likely to interact with controlled and automatic cognitive
processes to produce further impairments in the loss of control over drinking.
Thus, heavy drinking is associated with a cluster of cognitive processes, which have been
termed controlled processes (rational decision-making and alcohol outcome expectancies),
automatic processes (implicit memory associations and attentional bias) and executive
dysfunction (which includes working memory and impulsivity).
Controlled processes: decision-making, alcohol outcome expectancies and related cognitions
To an extent, alcohol use is the outcome of a controlled decision-making process; individuals
who perceive the beneficial effects of alcohol to outweigh its negative consequences will
drink alcohol more frequently or intensively. The causal role of this controlled process is
illustrated by alcohol outcome expectancies (AOEs). These are beliefs about the effects of
alcohol, and can be assessed with self-report questionnaires. A variety of AOEs has been
described, including beliefs that alcohol increases positive affect (positive reinforcement
expectancies), reduces negative affect (negative reinforcement expectancies), increases
arousals and has negative consequences.
Young people hold AOEs even before they begin to use alcohol, and individual differences in
AOEs predict the extent of alcohol involvement at subsequent time points. Besides, studies
suggest that AOEs may be an important mediator of the initiation into alcohol use among
youth produced by other well-known factors as peer influence, sensation-seeking, exposure to
portrayals of alcohol use and family history of alcoholism. After many years of drinking,
problem drinkers report an increase in their negative AOEs. Therefore, increased negative
AOEs may lead to a reduction in alcohol consumption among heavy drinkers.
Self-reported reasons to drink (RFD) are related to AOEs, although they may explain
additional variance in alcohol consumption and alcohol problems. RFD questionnaires require
respondens to indicate the reasons why they drink, or the anticipated outcomes of drinking
which motivate them to consume it. RFD can be separated into positive reinforcement
motives (e.g. desire to drink to elevate positive mood) and negative reinforcement motives
(e.g. desire to drink to alleviate negative mood).
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The observed close association between AOEs and RFD and the quantity and frequency of
alcohol consumed is consistent with the theory of planned behavior in that it suggests that
alcohol consumption can be the outcome of a controlled decision making process; alcohol
involvement is largely dictated by individual differences in beliefs about the effects of alcohol
consumption (AOEs) and in the perceived utility of those effects (RFS). However, these
controlled processes do not explain the majority of variance in alcohol consumption. For
example, the ability of AOEs to predict subsequent drinking seems to diminish with age;
although AOEs are a robust predictor of alcohol involvement in youth, their predictive utility
is reduced in older age groups.
Automatic processes: implicit memory associations, action tendencies and attentional bias
Indirect measures do not rely on participants’ self-reports to make inferences about their
cognitions. Instead, these measures rely on alternative responses, typically reaction time and
spontaneous associations, to make inferences about the underlying cognitive processes.
For example, one study employed memory association tasks in which participants were asked
to provide their first association to a variety of prime words that were ambiguously realted to
alcohol. Findings indicated that the extend to which alcohol-related words were
spontaneously generated in response to the ambiguous primes was a robust predictor of
subsequent drinking. Convergent findings were obtained in another study, in which heavy and
light drinkers were asked if they would endorse various positive (e.g. fun) and negative (e.g.
violent) associates of alcohol. Heavy drinkers endorsed more positive alcohol associates than
light drinkers, although heavy and light drinkers did not differ in their endorsement of
negative alcohol associates. Reaction times were also measured; heavy drinkers were faster to
endorse positive rather than negative alcohol associaties, whereas for light drinkers the
opposite was true.
There findings indicate that alcohol-related cognitions, particularly cognitions relating to the
positive aspects of alcohol use, may be activated relatively automatically in heavy drinkers
compared to lighter drinkers.
The implicit association test (IAT), a reaction time measure, has been used to probe
individual differences in associations between alcohol and various target concepts (e.g.
positive vs. negative, or arousal vs. sedation). On each trial of the task, participants rapidly
categorise visually presented words by pressing keys on a computer keyboard. For example,
they may be instructed to press the left response key when an alcohol-related word or a
positive word is presented, but to press the right response key in response to alcohol-unrelated
or negative words. The rationale for the task is that if participants automatically evaluate
alcohol as positive rather than negative they should be quicker to respond when “alcohol”
and “positive” words share the same response key (as in the example), compared to another
block of the task where “alcohol” and “negative” words share the same response key.
Given the research into explicit alcohol-related cognitions (AOEs), which are generally more
positive than negative in heavy drinkers, it is surprising that IAT studies have consistently
demonstrated stronger alcohol-negative associations than alcohol-positive associations, in
both heavy and light drinkers. This may be at least partially attributable to general (negative)
social norms concerning alcohol use: the IAT may be detecting automatic negative alcohol
associations (which should be present in everybody, irrespective of their experience with or
beliefs about alcohol), and these may be masking positive alcohol associations, which one
would expect to see in heavy drinkers only.
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As such, heavy drinkers may have ambivalent alcohol associations (both positive and
negative) which may influence their performance on a positive-negative IAT. Studies have
demonstrated that negative associations are stronger but unrelated to individual
differences in alcohol consumption, whereas positive associations are weaker but positively
correlated with individual differences in alcohol consumption
The IAT has also been used to assess the strength of automatic associations between alcohol
and the concepts of arousal (vs. sedation). Several studies demonstrated that heavy drinkers,
but not light drinkers, have strong associations between alcohol and arousal. Similarly, the
tendency to associate alcohol with approach concepts (rather than avoidance concepts) during
an approach-avoidance IAT is associated with aspects of problem drinking.
Importantly, individual differences in implicit alcohol-related memory associations explained
unique variance in alcohol consumption, over and above that explained by more explicit
measures, such as AOE questionnaires. Therefore, although explicit measures (e.g. AOEs)
and implicit measures (e.g. IATs) are likely to be measuring the same underlying construct,
to an extent, the associations between automatic cognitive processes and alcohol
consumption may be stronger than the association between cotrolled cognitive processes
and alcohol consumption.
Heavy alcohol consumption and alcohol problems are also associated with attentional bias
for alcohol-related cues; such cues tend to capture attention in heavy drinkers. For example,
studies using the alcohol Stroop task have demonstrated that alcoholics and heavy drinkers
are slow to name the colour in which alcohol-related pictures or words are presented. Other
studies have used the visual probe task, which provides a more direct measure of visuo-
spatial attention. Results demonstrate that heavy drinkers are faster to respond to probes that
appear in the location of alcohol-related pictures, which suggests that ehavy drinkers direct
their spatial attention toward the location of the alcohol pictures.
At present, there is no evidence to suggest that attentional biases operate below the
threshold of conscious awareness, although results obtained using the alcohol Stroop
task suggests that distraction from alcohol-related cues occurs automatically.
However, in visual probe task studies, heavy drinkers tend to show attentional biases
for alcohol stimuli only when they are presented for relatively long exposure
durations (>500ms), but not when presented briefly (200ms).
Among alcohol-dependent inpatients, if the stimuli are presented for 500ms or longer,
attentional avoidance of those stimuli is seen. This approach-avoidance pattern of
attentional bias that is observed among treatment-seeking alcoholics may reflect motivational
conflict or ambivalence; the initial orienting may reflect sensitisation of the incentive value
of alcohol, whereas the subsequent avoidance may occur because alcohol-related cues are
aversive when presented in a treatment context.
However, a recent study suggests that subjective craving is positively correlated
with the latter component of attentional bias (delayed disengagement of attention),
but not with the earlier component (rapid initial orienting). Given this, the approach-
avoidance pattern of attentional bias among patients in treatment may actually reflect
aversive properties of alcohol cues in treatment context (leading to rapid initial
orienting towards alcohol cues) coupled with diminished subjective craving (leading to
a diminution or even reversal of the bias to maintain attention on alcohol-related cues).
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