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Fluctuations in Real-Life Drinking in Alcohol Use Disorder: A 1-Year Longitudinal Study Using Gamified Tasks of
Hilmar Zech1, Maria Waltmann2, Dominic Reichert3
1Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, University of Würzburg, Würzburg, Germany.
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 participants 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. This 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.
