Slow associative learning in alcohol dependence and the alcohol cue exposure treatment paradox.

Carl Buckfield,Steven Glautier,Julia M A Sinclair

doi:10.1111/add.15210

Abstract

To examine two explanations for the observation that cue-exposure treatment has not been clearly effective in the treatment of alcohol dependence: do alcohol-dependent individuals have either (1) slower extinction and/or (2) greater contextual specificity of extinction than non-dependent individuals? In two exploratory laboratory experiments we used mixed factorial designs with two-group between-subjects factors and within-subjects factors corresponding to performance in different parts of a computer-based learning task. University of Southampton psychology research laboratories and two addiction treatment services in the city of Southampton, UK. Experiment 1: 74 (54 female) undergraduates from the University of Southampton (age mean=20.4years). Experiment 2: 102 (40 female) participants from the University of Southampton, the local community, and from two Southampton alcohol treatment services (age mean=41.3years). The Alcohol Use Disorders Identification Test, a 1-week time-line follow-back alcohol consumption questionnaire, the Barratt Impulsiveness Scale (11th edn), and a computerized learning task. Experiment 2 additionally used the 44-item Big Five Inventory, a drug use history checklist, and the Hospital Anxiety and Depression Scale. Experiment 1: light and heavy drinkers did not differ significantly in extinction [extinction block×drinking status interaction, P=0.761, , 95% confidence interval (CI)= (0,0.028)] or on contextual control of extinction [recovery block×drinking status interaction, P=0.514, , 95% CI=(0,0.084)]. Experiment 2: slower extinction in abstinent alcohol-dependent participants compared with light drinkers [extinction block×drinking status interaction, P=0.023, , 95% CI=0,0.069)] but no significant difference on contextual control of extinction [recovery block×drinking status interaction, P=0.069, , 95% CI=(0,0.125)]. Abstinent alcohol-dependent people may have slower extinction learning for alcohol-related cues than non-dependent light drinkers.

Highlights

Pavlovian and instrumental learning play a critical role in alcohol dependence (AD) [1]
Experiment 1 Hypotheses (1) extinction and (2) recovery Figure 2 displays the mean proportion of X responses to cue A across acquisition, extinction and recovery phases
Personality variables with a significant difference between light and dependent drinkers (BIS11, Hospital Anxiety and Depression Scale (HADS)‐D, HADS‐A, 44BFI‐N, 44BFI‐A and 44BFI‐C) were used as parallel mediators, with group as a direct effect variable

Summary

Introduction

Pavlovian and instrumental learning play a critical role in alcohol dependence (AD) [1]. Through Pavlovian conditioning, discrete environmental stimuli and contexts (e.g. sight and smell of alcohol or a bar‐room setting) become conditioned stimuli (CSs) by their association with the effects of alcohol, an unconditioned stimulus (US). The consequence is that exposure to alcohol CSs can produce conditioned responses (CRs) and craving, increasing the probability of drinking [2–4]. Extinction of Pavlovian conditioning occurs when CSs are repeatedly presented without the US. Extinguished alcohol cues produce weaker craving than they did pre‐extinction in social [5], heavy [6] and dependent drinkers [7, 8]. An extinction‐based treatment is a theoretically grounded potential intervention for treating alcohol dependence (AD). Despite strong theoretical support and support from some clinical trials [9, 10] meta‐analyses

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