Fluctuations in Real-Life Drinking in Alcohol Use Disorder: A 1-Year Longitudinal Study Using Gamified Tasks of Decision Making and Cognitive Control

BACKGROUND: Alcohol use disorder (AUD) is a major contributor to global disability and mortality. Cross-sectional studies have linked AUD to reduced cognitive control and heightened risky decision making. However, the temporal direction of these effects remains unknown: are cognitive-behavioral alterations a consequence or a precursor of
changes in drinking?
METHODS: We deployed a battery of smartphone-based, gamified tasks in a 1-year longitudinal ecological momentary assessment study of 603 carticipants diagnosed with mostly mild-to-moderate AUD. Tasks measured cognitive control (working memory, response inhibition) and decision making (risk-taking, information sampling). Participants completed tasks monthly and reported alcohol consumption every 2 days.
RESULTS: We found that monthly fluctuations in aspects of decision making predicted subsequent consumption. Specifically, participants shifted to higher monthly alcohol consumption when their risk-taking was higher in a mixed gambling context and lower in a loss context in the preceding month. Furthermore, when information sampling
biases decreased, participants consumed more alcohol in the subsequent month. ... mehrThis temporal direction—that within-subject fluctuations in task outcomes preceded changes in monthly drinking—was specific, was not observed vice versa, and survived correction for autocorrelation in drinking, indicating risky decision making as a
precursor to subsequent drinking. Fluctuations in cognitive control and risk-taking in a win context were not associated with fluctuations in drinking.
CONCLUSIONS: Our findings offer novel insights into the cognitive-behavioral forces driving changes in alcohol consumption in AUD: specific alterations in decision making precede changes in consumption. These findings suggest that smartphone-based gamified tasks show promise in identifying periods of heightened risk, paving the
way for mechanism-based, real-time interventions in AUD.