Alcohol craving in adolescents: bridging the laboratory and natural environment

Abstract

Rationale Initial lab studies suggest that adolescent drinkers crave alcohol when presented with alcohol cues. Whether this effect generalizes to the natural environment, however, remains unknown, and studies have not examined whether craving predicts drinking among youths. Objectives This study builds on existing research by pairing controlled lab-based cue reactivity assessments with data collected in the natural environment using ecological momentary assessment (EMA) methods. We examined whether alcohol cues evoke craving among adolescent drinkers in the lab and natural environment, and tested the clinical relevance of craving during adolescence by examining the prospective association between craving and alcohol use. Methods Non-treatment-seeking adolescent drinkers (N = 42; ages 15 to 20 years) completed a lab-based cue reactivity assessment followed by a 1-week EMA monitoring period. During the EMA period, youth were prompted randomly throughout the day to record momentary data on craving and contextual factors (e.g., alcohol cues, peers present). Results Alcohol cues elicited craving in the lab, and this effect generalized to the natural environment, especially among adolescents with more alcohol problems. In addition, craving predicted subsequent drinking levels in the natural environment. Conclusions This study demonstrates the utility of pairing lab paradigms with EMA methods to better characterize adolescents’ reactivity to alcohol cues. Results implicate craving as a clinically meaningful motivator for drinking among adolescents and highlight a potentially important target of pharmacological or behavioral intervention.

Brief and extended alcohol-cue-exposure effects on craving and attentional bias.

“…That is, exposure to alcohol cues increased attentional bias towards the alcohol stimuli in the visual probe task for both Groups SE and LE. This finding is consistent with past work in which increases in attentional bias were observed following manipulations that increase craving (Cox et al, 1999; Ramirez et al, 2014). It is also noteworthy that the current effects of alcohol cue exposure on attentional bias occurred in a sample of UCSDs that reported relatively low mean rates of alcohol consumption and related problems.…”

“…Future research will need to include manipulations that successfully reduce subjective reports of craving to determine whether reductions in craving are associated with reductions in attentional bias. Although other studies have demonstrated simultaneous reductions in craving and attentional bias for alcohol (Rose et al, 2013; Taylor et al, 2013), nicotine (Oh & Taylor, 2014; Szasz et al, 2012; Van Rensburg et al, 2009) and food (Oh & Taylor, 2013; 2014), current evidence to support a positive relationship between alcohol craving and attentional bias for alcohol is limited to studies that report reciprocal increases in these constructs (Ramirez et al, 2014). …”

A Smartphone App to Assess Alcohol Consumption Behavior: Development, Compliance, and Reactivity (Preprint)

“…With the advent of smartphones, researchers have, increasingly, been programming study-specific applications (apps) for use in such studies. In most cases, this involves either providing participants with a phone preloaded with the app [12,13], or loading the app onto participants' own phones and downloading the data at end of the experimental period [14].…”

Emerging Pharmacologic Treatments for Adolescent Substance Use: Challenges and New Directions

“…The relevance of these mechanisms to adolescent substance misuse, however, is largely speculative. For example, the relevance of craving, a major focus of adult research, to adolescent substance misuse was, until recently, largely under studied (77). Moreover, even with evidence that adolescents experience craving, questions remain about its relevance to addiction in this age group (77).…”

“…Momentary assessments are particularly important when the phenomena of interest are subject to rapid change, as are substance use, craving, and the acute subjective effects of alcohol and other drugs. We (and many others) have used this approach to study precursors and consequences of drinking alcohol (i.e., mood, cognitions) with adult and adolescent social and heavy drinkers, as well as patterns and effects of nicotine use with heavy smokers (77, 81-91). Notably, studies show that self-monitoring using EMA has little or no effect on drug use (92, 93).…”