State disinhibition and heavy drinking

Even when sober, people with alcohol problems tend to be more 'disinhibited', or impulsive, than healthy individuals. It seems that disinhibition arises partly as a consequence of heavy drinking, but it is also responsible for the development, maintenance and worsening of alcohol problems. While disinhibition can be seen as a fairly stable trait - some people are just more disinhibited than others - recent research indicates that it also functions as a state that fluctuates within individuals, i.e. a given individual might be more disinhibited in some situations than in others. For example, things such as acute stress and the presence of alcohol-related cues can increase disinhibition in heavy drinkers. Importantly, recent research suggests that heavy drinking is more likely when people are in a state of high disinhibition. We propose to comprehensively investigate the significance of state fluctuations of disinhibition in heavy drinkers, with a view to developing new clinical interventions which might help heavy drinkers to gain control over their drinking behaviour. We propose several studies. In the first, heavy drinkers recruited from the local community will carry handheld electronic devices (similar to the IPhone) that will measure their disinhibition several times per day, in their natural environment (e.g. at work and at home). We will also measure their alcohol consumption each day and this will enable us to examine if people tend to drink more on days when they are more disinhibited. Studies two and three will be conducted in a 'bar lab' on the University campus; the aim of these studies is to investigate if acute stress (study 2) and alcohol 'cues' (study 3) lead to temporary increases in disinhibition, and if these increases in disinhibition are responsible for the increased drinking behaviour that occurs in response to stress and cues. In study 4 we will attempt to strengthen inhibitory control processes (i.e., reduce disinhibition) among heavy social drinkers. Over a period of several weeks, participants will complete multiple computerised training sessions over the internet, the goal of which is to strengthen their general level of inhibitory control (in one group of participants), or to strengthen their inhibitory control but only when in the presence of alcohol-related cues (in a different group). A control group of participants will receive placebo training in which they are repeatedly exposed to alcohol-related cues, but they will not receive any inhibition training. We predict that repeated training of inhibitory control (either general training or cue-specific training) will lead to significant reductions in the volume of alcohol consumed. These studies will advance our understanding of the clinical significance of disinhibition in alcohol problems (and in addiction problems more generally), and they may inform future behavioural treatments for alcohol problems.

Individual differences in disinhibition are associated with addiction (including alcohol abuse and dependence). Recent work suggests that disinhibition can fluctuate within individuals, and that heavy drinking occurs when individuals are in a disinhibited state. We will characterise the influence of state fluctuations in disinhibition on heavy drinking in non-dependent heavy drinkers. We will achieve this through a combination of laboratory-based experimental studies, and assessments and interventions conducted using ecological momentary assessment (EMA) and internet-based inhibition training. Study 1 will use EMA techniques to investigate the relationship between naturally-occurring fluctuations in disinhibition and daily drinking in non-dependent heavy drinkers. In studies 2 and 3 we will experimentally manipulate acute stress (study 2) or alcohol cue exposure (study 3) before measuring disinhibition and alcohol-seeking behaviour. We hypothesise that acute stress and alcohol cue exposure will increase both disinhibition and alcohol-seeking behaviour, and that the effects on alcohol-seeking behaviour will be partially mediated by the effects on disinhibition. In study 4 we will examine the efficacy of inhibition training as an intervention to reduce drinking among non-dependent heavy drinkers who are motivated to quit. Participants will complete multiple sessions of inhibition training on the internet over a three week period. Participants will be randomly allocated to receive general inhibition training, inhibition training that is specific to alcohol cues, or a control manipulation. We predict that inhibition training will lead to robust reductions in the frequency and quantity of alcohol consumption, and that these effects will be larger with alcohol-specific inhibition training compared to general inhibition training. This training technique has the potential to be adapted as an adjunct behavioural treatment for problem drinking.

The primary beneficiaries of this research are academic researchers, particularly those who conduct research into the cognitive processes that contribute to heavy drinking (and other substance use) in non-dependent adults. Moreover, because the proposed project will study a specific process (state disinhibition), it is likely that the results will be of interest to researchers studying determinants of heavy drinking and other substance use in other populations such as adolescents, and adults with alcohol dependence. Numerous research groups in the UK and elsewhere conduct research on this and related-topics, so they are likely to benefit from this research. More broadly, disinhibition is known to be an important feature of various psychological disorders including depression, psychosis, and developmental disorders such as attention deficit disorders. This research will characterise the importance of state fluctuations in disinhibition and it is likely that these advances in knowledge will stimulate interest in the significance of similar fluctuations in disinhibition in other psychological disorders, as well as in 'normal' psychological function. The research will also contribute to the development and wider adoption of novel methodologies in psychological assessment and interventions, including ecological momentary assessment, and computerised assessments and interventions delivered via smartphones and the internet. Finally, the research will contribute to the training of highly skilled researchers with expertise in advanced statistical and experimental techniques, and the use of modern technology for psychological assessments and interventions.

Additional beneficiaries include alcohol charities and treatment services, who will be kept informed of this research (see Pathways to Impact document) and will be able to disseminate these results to heavy drinkers who are concerned about their drinking and wish to gain insight into the psychological processes that contribute to it. Wide dissemination of the research findings through the media will ensure that heavy drinkers benefit from these insights even if they are not in direct contact with alcohol charities or treatment services. Importantly, heavy drinking is a problem worldwide, and is thus intensively studied worldwide. Therefore, beneficiaries of this project will not be limited to those in the UK.

Economic and societal impacts of this research include improvements in health and well-being. Given the detrimental effects of heavy drinking to physical and mental health, social relationships and educational and occupational achievement, it is important to fully understand the psychological mechanisms that contribute to heavy drinking and to adapt this knowledge into future clinical interventions. Study 4 of the proposed project will be a first attempt at examining the feasibility of an intervention based on the training of inhibitory control processes. If the hypotheses of study 4 are confirmed, future research proposals will move towards clinical trials of this type of intervention, in order to compare it with existing treatments for alcohol problems and to fully characterise its efficacy as a treatment to reduce heavy drinking, most likely in combination with existing treatments.