An Examination of Motivation to Change and Neural Alcohol Cue Reactivity Following a Brief Intervention

Abstract

Background: Brief interventions represent a promising psychological intervention targeting individuals with heavy alcohol use. Motivation to change represents an individual’s openness to engage in a behavior change strategy and is thought to be a crucial component of brief interventions. Neuroimaging techniques provide a translational tool to investigate the neurobiological mechanisms underlying potential mediators of treatment response, including motivation to change. Therefore, this study aimed to examine the effect of a brief intervention on motivation to change drinking behavior and neural alcohol taste cue reactivity. Methods: Non–treatment-seeking heavy drinkers were randomized to receive a brief drinking intervention (n = 22) or an attention-matched control (n = 24). Three indices of motivation to change were assessed at baseline and after the intervention or control session: importance, confidence, and readiness. Immediately following the intervention or control session, participants also underwent an functional magnetic resonance imaging (fMRI) during which they completed an alcohol taste cues paradigm. Results: There was a significant effect of the brief intervention on increasing ratings of importance of changing drinking behavior, but not on ratings of confidence or readiness to change. Ratings of importance after the intervention or control session were associated with neural alcohol taste cue reactivity, but notably, this effect was only significant for participants who received the intervention. Individuals in the intervention condition showed a positive association between ratings of importance and activation in the precuneus, posterior cingulate, and insula. Conclusions: The brief drinking intervention was successful at improving one dimension of motivation to change among non–treatment-seeking heavy drinkers. The brief intervention moderated the relationship between ratings of importance and brain activation in circuitry associated with interoceptive awareness and self-reflection. Together, findings represent an initial step toward understanding the neurobiological mechanisms through which a brief intervention may improve motivation to change.

Preliminary study of alcohol problem severity and response to brief intervention

“…Our results are in line with recent findings examining the role of problem severity in the context of brief alcohol interventions [ 19 , 20 ]. As reported previously by our group, this BI did not significantly reduce drinking more than the control condition [ 23 ]. Although not assessed in the current study, BIs are thought to be well-suited as an initial treatment contact for non-treatment seeking individuals with risky alcohol use that may prepare them to engage in later specialty treatment.…”

“…Notably, one participant was excluded from the current analyses for missing 12 days of Timeline FollowBack (TLFB) data, resulting in a final sample of 51 participants. This sample size differs from previous reports on this trial having 46 completers, as usable functional magnetic resonance imaging (fMRI) scan data was a requirement for previous but not current analyses [ 22 , 23 ].…”

“…Individuals were excluded if they were seeking treatment for alcohol use or reported serious alcohol withdrawal symptoms, as determined by a score ≥ 10 on the Clinical Institute Withdrawal Assessment for Alcohol Revised (CIWA-AR) [ 25 ]. Full inclusion and exclusion criteria have been previously described, see [ 22 , 23 ]. In-person screening included 120 individuals, 60 of whom either did not meet inclusion criteria or decided not to participate.…”

“…The PROCESS macro (Model 14) was used to conduct three conditional process analyses (i.e., moderated mediation; [ 42 ]). Consistent with a previous report on this trial [ 23 ], separate models were run for each of the three post-intervention motivation to change rulers (i.e., importance, confidence, and readiness). As such, the effect of intervention (dichotomous focal predictor; 0 = control condition, 1 = brief alcohol intervention) on follow-up average alcoholic drinks per day (continuous outcome variable) through motivation to change (continuous mediator) were examined (see Fig.…”

“…While there was no overall intervention effect on drinking or neural activation to alcohol cues, both the BI and attention-control groups displayed lower drinking rates following participation in the study [ 22 ]. Moreover, one dimension of motivation, namely importance of change, was significantly related to neural alcohol cue-reactivity in those who received the BI, as compared to the control condition [ 23 ]. These findings advanced our understanding of the neural mechanisms underlying motivation to change elicited by BI but did not account for intervention effects on behavior change in this sample.…”