Subjective alcohol response across drinking contexts: a systematic review with bayesian meta-analysis

Alcohol subjective response (SR) predicts drinking behaviour and risk for alcohol use disorder, but there is limited consensus on how SR differs across contexts, research settings, and alcohol problem severity.

This systematic review and meta-analysis examined how alcohol SR differs across (1) commercial (e.g., bar/club/restaurant) versus non-commercial (e.g., home) settings and (2) social versus solitary drinking contexts, and if these effects are moderated by (3) laboratory versus naturalistic study setting and (4) non-problem versus problem alcohol use.

Studies assessing alcohol SR across drinking contexts were systematically identified and synthesized. Outcomes included four SR quadrants (HIGH+, HIGH-, LOW+, LOW-) and alcohol reward (hedonic, motivational) and were analysed using random-effects Bayesian meta-analytic models.

Across k = 15 studies, social and commercial contexts (versus solitary, non-commercial) were associated with enhanced HIGH + and alcohol reward (hedonic, motivational) effects, with potential LOW- attenuated effects. HIGH+ effects were stronger when drinking socially (versus alone) across research settings, with naturalistic environments possibly enhancing this effect. LOW- effects were potentially attenuated during social drinking only in naturalistic settings. Participants with problem alcohol use (versus non-problem) showed possible attenuation of LOW- effects while drinking socially (versus alone). Several planned analyses were limited by insufficient data.

Alcohol SR varies by context and may be underestimated in laboratory settings. Limited studies, including heterogeneous effects (e.g., LOW+), were identified, underscoring the need to refine laboratory context manipulations, integrate ecologically valid approaches, and address gaps in how contextual features, SR domains, and problem severity shape alcohol SR.