Real-world alcohol cue exposure and drinking risk in alcohol use disorder

Alcohol-related cues are thought to contribute to drinking in alcohol use disorder (AUD), but their contribution in daily life remains difficult to separate from changing social contexts and internal states. We used ecological momentary assessment in two independent cohorts of non-treatment-seeking individuals, comprising a discovery cohort with AUD (17-62 years; n = 73) and a young-adult replication cohort screened for risky drinking (19-35 years; n = 56), to test whether alcohol cue exposure was associated with momentary drinking after simultaneous multivariable adjustment for social context, affective states, and event appraisal. In logistic mixed-effects models, within-person exposure to alcohol-related cues was significantly and reproducibly associated with higher odds of drinking in both cohorts. Being in company, exposure to drinking companions, and higher energetic arousal also showed reproducible within-person associations with drinking. Exploratory clustering of participant-specific slopes suggested meaningful alcohol cue-reactive and social context-reactive risk profile candidates. These findings identify alcohol cue exposure as a robust daily-life correlate of drinking and suggest candidate phenotypes motivating future validation studies of more personalized, context-aware interventions for AUD.