Expectancy theory: a two-process model of alcohol use and abuse

In recent years, cognitive-behavioral approaches to drinking behavior have postulated the importance of alcohol expectancy and drinking refusal self-efficacy in the development and maintenance of problem drinking. However, despite a growing number of publications, the structure and role of these constructs have not been clearly explicated in theoretical terms to date. This article proposes a two-process theory of alcohol use and abuse. It is suggested that the acquisition and maintenance phases of drinking behavior are governed by different principles of learning and involve different decision-making processes. The acquisition phase is though to be a time of instrumental learning, in which decision making involves controlled processing by means of a kind of "mental algebra". The maintenance phase is described as subject to the principles of classical conditioning, with automatic processing playing a major role in the making of decisions. Integral to both phases, though differing in structure and function from the first to the second, is the concept of alcohol expectancies. Another cognitive construct, drinking refusal self-efficacy, is also hypothesized to play a role in decisions to drink or not to drink. It is suggested that the development of drinking behavior is best explained in terms of associative models of learning and memory. Implications for prevention and treatment of problem drinking are discussed.