Fluctuating Disinhibition: Implications for the Understanding and Treatment of Alcohol and Other Substance Use Disorders

Abstract

Disinhibition is present in various maladaptive behaviors, including substance use disorders. Most previous research has assumed that disinhibition is a psychological construct that is relatively stable within individuals. However, recent evidence suggests that the ability to inhibit behavior fluctuates in response to environmental and psychological triggers. In this review we discuss some of the factors that cause (dis)inhibition to fluctuate, we examine whether these fluctuations contribute to subjective craving and substance consumption, and we ask if they might increase the risk of relapse in those who are attempting to abstain. The research that we discuss has furthered our understanding of the causal relationships between disinhibition and substance use disorders, and it also highlights opportunities to develop novel treatment interventions. We conclude that substance misusers and their therapists should be made aware of the triggers that can cause disinhibition to fluctuate, and we highlight the need for more research to investigate the effectiveness of inhibitory control training in clinical settings.

The influence of groups and alcohol consumption on individual risk-taking

“…Often viewed as a trait ability that is independent of contextual influences (Gladstone & Parker, 2005), it could be assumed that inhibitory control cannot be affected by situational or external cues (such as intoxication or peers). Yet, both chronic and acute alcohol consumption have been found to alter the ability to inhibit behaviour (Jones, Christiansen, Nederkoorn, Houben, & Field, 2013), suggesting fluctuations (opposed to stability) in disinhibition. In support of chronic alcohol consumption effects on risky behaviour, persistent heavy alcohol use appears to be associated with changes in brain structures linked to behavioural control, such as frontal lobe functioning alternations and neurodegeneration (Crews & Boettiger, 2009).…”

“…Although these findings imply possible fluctuations in disinhibition, the inability to inhibit behaviour may still serve as both a determinant and consequence of alcohol consumption (as opposed to one or the other) (c.f., Jones et al, 2013). Supporting this supposition, the concept of ego depletion builds upon the assumption that inhibitory control is sourced from a finite reserve which, if overly-exerted, is said to result in diminished self-control resources (Baumeister, Muraven, & Tice, 2000; 4 .…”

The role of anticipation in drug addiction and reward

“…59 Temporal discounting and disinhibition are well-established features of substance use disorders. 60,61 Importantly, both components of impulsivity are related to the effects of drug expectancy on drug users.…”

On the automaticity of response inhibition in individuals with alcoholism

“…However, such effects are small and short-lived (Jones et al, 2013;Stevens et al, 2015;Verbruggen et al, 2013), which could potentially explain why some studies failed to observe fartransfer effects (e.g. Redick et al, 2013).…”

“…Therefore, capitalizing on preserved learning of stimulus-stop associations seems a promising way to achieve better inhibitory control in a real-word context. For instance, in hazardous (non-dependent) alcohol drinkers, training people to stop responding to alcohol cues reduced weekly alcohol intake (for a review, see Jones et al 2013). Similarly, pairing of food-related pictures to stopping in a go/no-go or stop-signal-paradigm reduces subsequent food consumption Lawrence, Verbruggen, et al, 2015), and may even lead to weight loss (Lawrence, O'Sullivan, et al, 2015;Veling et al, 2014) (for recent meta-analyses, see Allom et al, 2015;Jones et al, 2016).…”