Motor inhibition and impulsivity in alcohol use disorder and at-risk drinking: A systematic review and meta-analysis

Harmful alcohol use is a global health problem, with deficits in impulse control, encompassing motor inhibition and motor impulsivity, associated with its development and persistence. We aimed to synthesise performance-based motor inhibition and self-reported impulsivity in individuals with alcohol use disorder (AUD) and at-risk drinkers, relative to controls, and to compare the two alcohol-use groups.

Pre-registered systematic review and subgroup meta-analysis. PubMed, PsycINFO, EMBASE, MEDLINE and CINAHL were searched to 31 December 2024, supplemented by reference-list searching and snowballing. Adults with diagnosed AUD or at-risk drinking were compared with healthy or low-severity drinking controls across 110 independent datasets. Impulse control was measured using performance-based motor inhibition tasks (go/no-go and stop-signal tasks) and self-report motor impulsivity questionnaires (Barratt Impulsiveness Scale; BIS). Primary outcomes were go/no-go commission errors, stop-signal reaction time and BIS total and motor scores.

The combined alcohol-use group exhibited poorer motor inhibition than controls on go/no-go commission errors [g = -0.27, 95% confidence interval (CI) = -0.43 to -0.11] and stop-signal reaction time (g = -0.20, 95% CI = -0.36 to -0.05); and higher self-reported Barratt total (g = -0.77, 95% CI = -0.97 to -0.58) and motor impulsivity scores (g = -0.68, 95% CI = -0.80 to -0.55). Individuals with AUD reported higher impulsivity than at-risk drinkers on Barratt total and motor scores (P < 0.001 and P = 0.022, respectively). The AUD and at-risk groups did not differ significantly in stop-signal reaction time (P = 0.247), whereas the commission-error effect was larger among at-risk drinkers (P = 0.033).

Alcohol use disorder and at-risk drinking appear to be associated with poorer performance-based inhibition and higher self-reported impulsivity compared with healthy or low-severity drinking, with consistently larger effects on self-reported impulsivity. Unexpectedly, the two alcohol groups (alcohol use disorder and at-risk drinking) in this study were better differentiated by self-reported motor impulsivity than by performance-based motor-inhibition measures.