Implicit Alcohol Associations Research Articles

How executive functioning moderates the relation between implicit alcohol associations and heavy episodic drinking: The roles of planning and working memory.

Heavy episodic drinking (HED) is common among college students and poses risks for negative consequences. Evidence suggests that HED is more frequent among those with stronger implicit alcohol associations, and the impact of these implicit associations on drinking may be moderated by executive functioning. This study examined the role of two executive function components-working memory (WM) and planning-as moderators of implicit alcohol-approach associations and HED among college students who drink alcohol. One hundred forty-one participants completed measures of alcohol use, implicit alcohol-approach associations, WM, and planning. Regression analyses were conducted to examine the respective two-way and three-way interactions between implicit alcohol associations, WM, and planning on HED. Results showed that WM and planning each moderated the relation between alcohol implicit association test (IAT) and HED. IAT scores were positively associated with HED when WM and planning were low (-1 SD) but not high (+1 SD). Although results from the three-way interaction exhibited a nonsignificant trend, the pattern of results showed that the association between IAT and HED was stronger at lower levels of WM, but only when planning was also low, not high. Findings support the view that HED among college students who drink alcohol may be a function of automatic alcohol associations and that these associations may be stronger among those with lower WM and planning abilities. These results replicate and extend our understanding of how executive functioning may moderate the impact of implicit alcohol cognitions on risky drinking and suggests potential intervention targets. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Supplemental Material for How Executive Functioning Moderates the Relation Between Implicit Alcohol Associations and Heavy Episodic Drinking: The Roles of Planning and Working Memory

Supplemental Material for How Executive Functioning Moderates the Relation Between Implicit Alcohol Associations and Heavy Episodic Drinking: The Roles of Planning and Working Memory

Disentangling the within- and between-person aspects of implicit alcohol associations on hazardous drinking.

Indirect measures have been used to assess the strength of automatically activated, alcohol-related associations and their relation to hazardous drinking. However, little is known about the longitudinal contributions of between-person and within-person components of implicit alcohol associations (IAAs) to college students' hazardous drinking over time. This study examined how within- and between-person variability in three measures of IAA (drinking identity, alcohol approach, and alcohol excite) are related to hazardous drinking while controlling for their explicit, self-report counterparts. First- and second-year U.S. college students (N = 506; 57% female) completed web-based assessments once every 3 months up to eight assessments, which included IAA measures (Implicit Association Tests), explicit counterparts of the IAAs, and self-reported hazardous drinking (alcohol consumption, problems, and risk of alcohol use disorder). Bayesian generalized multilevel models were used to examine between- and within-person associations among IAA, their explicit counterparts, and hazardous drinking. Results showed that between persons, mean levels of all three IAAs were positively associated with hazardous drinking over time. Once their explicit, self-report counterparts were included, however, only drinking identity IAA remained significant. Within persons, increases in drinking identity IAA were associated with increases in subsequent hazardous drinking risk, even after controlling for its explicit counterpart. These results suggest the importance of disentangling and simultaneously investigating between- and within-person processes in IAAs. Although the between-person component of IAAs may play a larger role in the prediction of hazardous drinking, examining the within-person component of IAA, at least for drinking identity, also appears to be important. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Working memory moderates the relation between implicit alcohol associations and heavy episodic drinking in moderate-to-heavy drinking men who have sex with men

IntroductionHeavy episodic drinking poses a risk for HIV-infection, particularly among men who have sex with men (MSM). Previous research suggests implicit associations may play a role in heavy episodic drinking and that various executive functions (EF) may moderate the relation between implicit associations and heavy episodic drinking. This study investigated the role of two EF – working memory (maintaining and updating information) and response inhibition (inhibiting prepotent responses) – as moderators of the relation between implicit alcohol approach associations and heavy episodic drinking among moderate-to-heavy drinking MSM. MethodsTwo-hundred and fifty-one participants completed measures of implicit alcohol associations (the implicit alcohol approach association test - IAT), working memory, and response inhibition, as well as a self-report questionnaire assessing heavy episodic drinking. Regression analyses were conducted to examine whether the association between the IAT and heavy episodic drinking was moderated by working memory and response inhibition. ResultsResults showed that working memory moderated the relation between the alcohol IAT and heavy episodic drinking such that IAT alcohol approach scores were positively associated with heavy episodic drinking among those low in working memory but not those high in working memory. Response inhibition did not moderate the association between IAT scores and heavy episodic drinking. ConclusionsResults suggest that the relation between implicit alcohol approach associations and heavy episodic drinking is stronger among moderate-to-heavy drinking MSM with lower working memory capacity compared to those with higher working memory capacity, and these individuals may particularly benefit from alcohol intervention approaches that target automatic alcohol responses.

The Neurophysiology of Implicit Alcohol Associations in Recently Abstinent Patients With Alcohol Use Disorder: An Event-Related Potential Study Considering Gender Effects.

BackgroundNeuroscientific models of alcohol use disorders (AUDs) postulate an imbalance between automatic, implicit, and controlled (conscious) processes. Implicit associations towards alcohol indicate the automatically attributed appeal of alcohol‐related stimuli. First, behavioral studies indicate that negative alcohol associations are less pronounced in patients compared to controls, but potential neurophysiological differences remain unexplored. This study investigates neurophysiological correlates of implicit alcohol associations in recently abstinent patients with AUD for the first time, including possible gender effects.MethodsA total of 62 patients (40 males and 22 females) and 21 controls performed an alcohol valence Implicit Association Test, combining alcohol‐related pictures with positive (incongruent condition) or negative (congruent condition) words, while brain activity was recorded using 64‐channel electroencephalography. Event‐related potentials (ERPs) for alcohol‐negative and alcohol‐positive trials were computed. Microstate analyses investigated the effects of group (patients, controls) and condition (incongruent, congruent); furthermore, possible gender effects in patients were analyzed. Significant effects were localized with standardized low‐resolution brain electromagnetic topography analysis.ResultsAlthough no behavioral group differences were found, ERPs of patients and controls were characterized by distinct microstates from 320 ms onwards. ERPs between conditions differed only in patients with higher signal strength during incongruent trials. Around 600 ms, controls displayed higher signal strength than patients. A gender effect mirrored this pattern with enhanced signal strength in females as opposed to male patients. Around 690 ms, a group‐by‐valence interaction indicated enhanced signal strength in congruent compared to incongruent trials, which was more pronounced in controls.ConclusionsFor patients with AUD, the pattern, timing, and source localization of effects suggest greater effort regarding semantic and self‐relevant integration around 400 ms during incongruent trials and attenuated emotional processing during the late positive potential timeframe. Interestingly, this emotional attenuation seemed reduced in female patients, thus corroborating the importance of gender‐sensitive research and potential treatment of AUD.

Predicting relapse in patients with severe alcohol use disorder: The role of alcohol insight and implicit alcohol associations

Low insight is reported as a risk factor for relapse among patients treated for alcohol use disorders. However, to date, little is known on why patients with low insight are at higher risk for relapse. In this study, we tested the hypothesis that an implicit preference for alcohol over abstinence predicts relapse in patients with low, but not high, alcohol insight. Participants consisted of 77 patients who had received treatment for severe alcohol use disorder in a hospital in France. During hospitalization, they completed a self-report measure of insight and an implicit association test to assess implicit preference for alcohol over abstinence. The primary outcome was relapse assessed one month after discharge. Control variables were gender, age, cognitive deficit, anxiety, depression, craving, and impulsivity. Data were analysed using logistic regression analysis. After adjusting for demographic and clinical variables, relapse was predicted by the interaction between insight and implicit preference for alcohol but not by their main effects alone. Implicit preference for alcohol predicted relapse among patients with relatively low insight, but not among those with relatively high insight. These findings suggest that patients with low insight and strong implicit preference for alcohol are at a higher risk of relapse. Clinicians may therefore focus on and tailor specific interventions to prevent relapse in this vulnerable and at-risk population.

Change in implicit alcohol associations over time: Moderation by drinking history and gender

Implicit measures of alcohol-related associations or implicit alcohol associations are associated with drinking outcomes over time and can be understood as vulnerability markers for problem drinking. Longitudinal research remains rare, leaving open questions about how implicit alcohol associations themselves change over time and what factors moderate that change. We examined these questions with data from a larger study of first and second year U.S. college students. We investigated how these implicit alcohol associations change over time and potential moderators of those changes (gender, lifetime drinking history, family history of problem drinking, and class standing). A sample of 506 students (57% women) completed baseline demographic measures and implicit measures (variants of the Implicit Association Test [IAT]) assessing associations with drinking and the self [drinking identity], alcohol and excite [alcohol-excite], and alcohol and approach [alcohol-approach]). IATs were completed at 3-month intervals for a total of 8 assessments. Results indicated small, but significant, change in alcohol-excite and alcohol-approach IAT scores over time, and mixed findings for hypothesized moderators. Drinking history moderated change in drinking identity IAT scores, with increases over time among individuals with no history of drinking or no history of intoxication and decreases among individuals with a history of intoxication. Gender moderated change in alcohol-excite IAT scores with greater change among women (vs. men). No significant moderators of change in alcohol approach IAT scores were found. Results point to the importance of evaluating implicit associations’ trajectories and identifying additional factors that predict those trajectories and concomitant vulnerability to problem drinking.

Self-control, implicit alcohol associations, and the (lack of) prediction of consumption in an alcohol taste test with college student heavy episodic drinkers.

The high levels of problematic drinking in college students make clear the need for improvement in the prediction of problematic drinking. We conducted a laboratory-based experiment that investigated whether implicit measures of alcohol-related associations, self-control, and their interaction predicted drinking. Although a few studies have evaluated self-control as a moderator of the relationship between implicit measures of alcohol-related associations and drinking, this study extended that work by using a previously-validated manipulation that included a more (vs. less) cognitively demanding task and incentive to restrain drinking and by evaluating multiple validated measures of alcohol-related associations. Experimental condition was expected to moderate the relationship between implicit measures of alcohol-related associations and drinking, with a more positive relationship between alcohol-related associations and drinking among participants who completed the more (vs. less) cognitive demanding task. Secondary aims were to evaluate how individual differences in control factors (implicit theories about willpower and working memory capacity) might further moderate those relationships. One hundred and five U.S. undergraduate heavy episodic drinkers completed baseline measures of: drinking patterns, three Implicit Association Tests (evaluating drinking identity, alcohol excite, alcohol approach associations) and their explicit measure counterparts, implicit theories about willpower, and working memory capacity. Participants were randomized to complete a task that was more (vs. less) cognitively demanding and were given an incentive to restrain their drinking. They then completed an alcohol taste test. Results were not consistent with expectations. Despite using a previously validated manipulation, there was no evidence that one condition was more demanding than the other, and none of the predicted interactions reached statistical significance. The findings raise questions about the relation between self-control, implicit measures of alcohol-related associations, and drinking, as well as the conditions under which implicit measures of alcohol-related associations predict alcohol consumption in the laboratory.

"Implicit alcohol associations, especially drinking identity, predict drinking over time": Correction to Lindgren et al. (2016).

A sample of 506 undergraduates completed 8 online assessments of IAAs, explicit measures of the IAA constructs, and hazardous drinking (i.e., consumption, problems, and risk of alcohol-use disorders) every 3 months over a 21-month period. Retention rates, ordered by follow-up time points, were 90%, 76%, 76%, 77%, 72%, 67%, and 66%, respectively. Half of the participants were nondrinkers at baseline; 21% were above clinical cutoffs for hazardous drinking. Drinking-identity and alcohol-excitement associations predicted future alcohol consumption and problems after controlling for previous drinking and explicit measures; drinking identity also predicted future risk of alcohol-use disorder. Relative to the other IAAs, drinking identity predicted alcohol consumption for the longest duration (i.e., 21 months). Alcohol-approach associations rarely predicted variance in drinking. IAAs vary in their utility as prospective predictors of college-student hazardous drinking. Drinking identity and, to a lesser extent, alcohol excitement, emerged as robust prospective predictors of hazardous drinking. Intervention and screening efforts could likely benefit from targeting those associations. (PsycINFO Database Record

A Declaration of Independence: Implicit Alcohol Associations Have Independent, not Interactive, Relationships with Alcohol Consumption and AUD Risk.

The current study aimed to test for potential interactive effects of three implicit alcohol-related associations (drinking identity, alcohol approach and alcohol excitement) in predicting concurrent and prospective alcohol consumption and risk of alcohol use disorders (AUDs) in two samples of the US undergraduate drinkers and non-drinkers. We investigated the independent and interactive effects of three implicit associations on alcohol consumption and risk of AUD in two US undergraduate student samples. We found that implicit associations had independent but not interactive effects on concurrent and subsequent alcohol consumption and risk of AUD in two independent samples. Implicit drinking identity, alcohol approach and alcohol excitement associations were assessed in two US undergraduate student samples (Sample 1: N = 300, 55% female; Sample 2: N = 506, 57% female). Alcohol consumption and risk of AUD were assessed at baseline (Samples 1 and 2) and 3 months later (Sample 2). We fit zero-inflated negative binomial models to test for independent and interactive effects of the three implicit associations on alcohol consumption and risk of AUD. Although we found multiple, unique main effects for alcohol associations, we found minimal evidence of interactions between implicit alcohol-related associations. There was no reliable evidence of interactions in models in predicting alcohol consumption or risk of AUD, concurrently or prospectively, in either sample. Contrary to expectations, results from both studies indicated that implicit alcohol-related associations in the US undergraduate samples generally have independent, not interactive, relationships with alcohol consumption and risk of AUD.

Early alcohol use with parental permission: Psychosocial characteristics and drinking in late adolescence

The earliest experiences with alcohol for many children occur in the family context with parental supervision. The current study examined individual and sociocultural characteristics associated with early (prior to age 13years) sipping and tasting alcohol with parental permission in two longitudinal community samples. Early sipping/tasting was also tested as a predictor of frequency and quantity of alcohol use, and alcohol-related problems seven years later in late adolescence. Early sipping/tasting with parental permission was associated with a sociocultural context supportive of alcohol use (e.g., parental alcohol use, permissive rules about alcohol use in the home, parental attitudes about underage drinking, perceived peer norms), adolescent sensation seeking and disinhibition (e.g., surgency, externalizing behavior) and appraisals of alcohol (negative outcome expectancies and negative implicit alcohol associations). Early sipping/tasting predicted increased frequency and quantity of alcohol consumption, and increased alcohol-related problems in late adolescence, even after controlling sociocultural and individual difference variables. Findings suggest that early sipping/tasting with parental permission is not benign and is a viable target for preventive interventions.

The role of implicit associations and explicit expectancies related to alcohol use: a comparison of Lithuanian and US college samples

ABSTRACTThe purpose of the current study was to (1) explore for cultural differences in harmful alcohol use and (2) examine whether explicit alcohol expectancies and implicit alcohol associations predict use. University students from Lithuania (n = 63) and the USA (n = 81) completed explicit and implicit measures regarding alcohol use. We found that compared to Lithuanian college students, US college students reported higher harmful alcohol use, endorsed more positive alcohol expectancies and had significantly fewer negative implicit alcohol associations. For both samples, both positive expectancies and implicit associations predicted harmful use.

Affective decision-making moderates the effects of automatic associations on alcohol use among drug offenders

ABSTRACTBackground: This study used a dual-process model of cognition in order to investigate the possible influence of automatic and deliberative processes on lifetime alcohol use in a sample of drug offenders. Objective: The objective was to determine if automatic/implicit associations in memory can exert an influence over an individual’s alcohol use and if decision-making ability could potentially modify the influence of these associations. Methods: 168 participants completed a battery of cognitive tests measuring implicit alcohol associations in memory (verb generation) as well as their affective decision-making ability (Iowa Gambling Task). Structural equation modeling procedures were used to test the relationship between implicit associations, decision-making, and lifetime alcohol use. Results: Results revealed that among participants with lower levels of decision-making, implicit alcohol associations more strongly predicted higher lifetime alcohol use. Conclusion: These findings provide further support for the interaction between a specific decision function and its influence over automatic processes in regulating alcohol use behavior in a risky population. Understanding the interaction between automatic associations and decision processes may aid in developing more effective intervention components.

Context Effects of Alcohol Availability at Home: Implicit Alcohol Associations and the Prediction of Adolescents' Drinking Behavior.

Recent studies suggest that the predictive effect of implicit alcohol associations is context dependent. Findings indicate that implicit associations are more easily retrieved in an alcohol-associated setting or context (e.g., bar) compared with a neutral setting. In line with this reasoning, we hypothesized that alcohol availability at home might moderate the relationship between implicit alcohol associations and future drinking behavior of adolescents. Participants were 262 at-risk adolescents (235 boys, 27 girls, adolescents with externalizing behavioral problems) with a mean age of 14.11 years (SD = 0.86, age range: 12-16 years) at baseline. Adolescents completed a questionnaire and a modified version of the Implicit Association Test (i.e., Single Category Implicit Association Test; SC-IAT). Stronger implicit alcohol associations predicted increase in frequency of alcohol use, only in adolescents who indicated that alcohol was available at home. No moderating effects were found for increase in quantity of alcohol use and problematic alcohol use, suggesting that implicit alcohol associations particularly influence the decision of whether to drink in adolescence. The findings illustrate that the availability of alcohol in the home setting influences adolescents' implicit alcohol associations and consequently affects the frequency of alcohol use. In this way, alcohol availability at home may be an important contextual factor to consider when examining the effect of implicit alcohol associations on the future drinking behavior of adolescents.

Implicit alcohol associations, especially drinking identity, predict drinking over time.

There is considerable excitement about implicit alcohol associations (IAAs) as predictors of college-student hazardous drinking; however, few studies have investigated IAAs prospectively, included multiple assessments, or controlled for previous drinking. Doing so is essential for showing the utility of these associations as predictors, and ultimately, targets for screening or intervention. Therefore, 3 IAAs (i.e., drinking identity, alcohol approach, and alcohol excitement) were evaluated as prospective predictors of drinking in 1st- and 2nd-year undergraduates in the United States. A sample of 506 undergraduates completed 8 online assessments of IAAs, explicit measures of the IAA constructs, and hazardous drinking (i.e., consumption, problems, and risk of alcohol-use disorders) every 3 months over a 21-month period. Retention rates, ordered by follow-up time points, were 90%, 76%, 76%, 77%, 72%, 67%, and 66%, respectively. Half of the participants were nondrinkers at baseline; 21% were above clinical cutoffs for hazardous drinking. Drinking-identity and alcohol-excitement associations predicted future alcohol consumption and problems after controlling for previous drinking and explicit measures; drinking identity also predicted future risk of alcohol-use disorder. Relative to the other IAAs, drinking identity predicted alcohol consumption for the longest duration (i.e., 21 months). Alcohol-approach associations rarely predicted variance in drinking. IAAs vary in their utility as prospective predictors of college-student hazardous drinking. Drinking identity and, to a lesser extent, alcohol excitement, emerged as robust prospective predictors of hazardous drinking. Intervention and screening efforts could likely benefit from targeting those associations. (PsycINFO Database Record

The effect of acute alcohol on motor-related EEG asymmetries during preparation of approach or avoid alcohol responses

Alcohol-approach tendencies have been associated with heavy drinking and play a role in the transition to alcohol abuse. Such cognitive biases might predict future alcohol use better under a low dose of alcohol. The aim of this prospective study was to investigate both the magnitude and the predictive power of alcohol-induced changes on approach-avoidance bias and bias-related cortical asymmetries during response preparation across heavy and light drinking adolescents. In heavy drinking adolescents greater approach-related asymmetry index in the beta-band was observed for soft-drink cues compared to alcohol ones and this increase was associated with increase in difficulty to regulate alcohol intake. Earlier findings demonstrated that young heavy drinkers hold both positive and negative implicit alcohol associations, reflecting an ambiguity towards alcohol. The increase in approach related beta-lateralization for soft-drink cues measured in this study may represent a compensatory effort for the weaker S–R mapping (approaching soft drink). The MRAA findings in this study may highlight a mechanism related to overcompensation due to ambivalent attitudes towards drinking in our heavy drinking sample who had greater problems to limit their alcohol intake compared to light drinkers. Moreover, a relatively strong approach soft-drink and weak approach alcohol reaction-time bias after alcohol predicted decreasing drinking; suggesting that the capacity to control the bias under alcohol could be a protective factor.

Attempted Training of Alcohol Approach and Drinking Identity Associations in US Undergraduate Drinkers: Null Results from Two Studies.

There is preliminary evidence that approach avoid training can shift implicit alcohol associations and improve treatment outcomes. We sought to replicate and extend those findings in US undergraduate social drinkers (Study 1) and at-risk drinkers (Study 2). Three adaptations of the approach avoid task (AAT) were tested. The first adaptation – the approach avoid training – was a replication and targeted implicit alcohol approach associations. The remaining two adaptations – the general identity and personalized identity trainings – targeted implicit drinking identity associations, which are robust predictors of hazardous drinking in US undergraduates. Study 1 included 300 undergraduate social drinkers. They were randomly assigned to real or sham training conditions for one of the three training adaptations, and completed two training sessions, spaced one week apart. Study 2 included 288 undergraduates at risk for alcohol use disorders. The same training procedures were used, but the two training sessions occurred within a single week. Results were not as expected. Across both studies, the approach avoid training yielded no evidence of training effects on implicit alcohol associations or alcohol outcomes. The general identity training also yielded no evidence of training effects on implicit alcohol associations or alcohol outcomes with one exception; individuals who completed real training demonstrated no changes in drinking refusal self-efficacy whereas individuals who completed sham training had reductions in self-efficacy. Finally, across both studies, the personalized identity training yielded no evidence of training effects on implicit alcohol associations or alcohol outcomes. Despite having relatively large samples and using a well-validated training task, study results indicated all three training adaptations were ineffective at this dose in US undergraduates. These findings are important because training studies are costly and labor-intensive. Future research may benefit from focusing on more severe populations, pairing training with other interventions, increasing training dose, and increasing gamification of training tasks.

Habit doesn't make the predictions stronger: Implicit alcohol associations and habitualness predict drinking uniquely

IntroductionAs research on implicit (in the sense of fast/reflexive/impulsive) alcohol associations and alcohol advances, there is increasing emphasis on understanding the circumstances under which implicit alcohol associations predict drinking. In this study, we investigated habitualness of drinking (i.e., the extent to which drinking is automatic or occurs without thinking) as a moderator of the relations between several measures of implicit alcohol associations and key drinking outcomes. MethodA sample of 506 participants (57% female) completed web-based measures of implicit alcohol associations (drinking identity, alcohol approach, and alcohol excitement), along with indicators of habitualness, and typical alcohol consumption, alcohol problems, and risk of alcohol use disorders. ResultsAs expected, implicit alcohol associations, especially drinking identity, were positively associated with, and predicted unique variance in, drinking outcomes. Further, habitualness emerged as a consistent, positive predictor of drinking outcomes. Contrary to expectations, habitualness rarely moderated the relation between implicit alcohol associations and drinking outcomes. ConclusionsAlthough moderation was rarely observed, findings indicated that even mild levels of habitualness are risky. Findings also continue to support implicit alcohol associations, particularly drinking identity, as a risk factor for hazardous drinking. Collectively, this suggests the importance of targeting both in prevention and intervention efforts.

Transcranial direct current stimulation, implicit alcohol associations and craving

Previous research has shown that stimulation of the left dorsolateral prefrontal cortex (DLPFC) enhances working memory (e.g. in the n-back task), and reduces craving for cigarettes and alcohol. Stimulation of the right inferior frontal gyrus (IFG) improves response inhibition. The underlying mechanisms are not clearly understood, nor is it known whether IFG stimulation also reduces craving. Here, we compared effects of DLPFC, IFG, and sham stimulation on craving in heavy drinkers in a small sample (n=41). We also tested effects of tDCS on overcoming response biases due to associations between alcohol and valence and alcohol and approach, using implicit association tests (IATs). Mild craving was reduced after DLPFC stimulation. Categorization of valence attribute words in the IAT was faster after DLPFC stimulation. We conclude that DLPFC stimulation can reduce craving in heavy drinkers, but found no evidence for tDCS induced changes in alcohol biases, although low power necessitates caution.

Alcohol dependent patients have weak negative rather than strong positive implicit alcohol associations

RationaleAlcohol dependence is characterised by motivational conflict (or ambivalence) in controlled cognitive processes, but it is unclear if ambivalence also exists within automatic cognitive processes, and if ambivalence operates between controlled and automatic processes.ObjectiveTo investigate ambivalence operating within and between controlled and automatic processes in alcohol dependence.MethodAlcohol-dependent patients who had recently completed inpatient alcohol detoxification (N = 47) and social drinking controls (N = 40) completed unipolar implicit association tests and self-report measures of alcohol approach and avoidance motivation and alcohol outcome expectancies.ResultsAs predicted, both positive and negative alcohol outcome expectancies were stronger in alcohol-dependent patients compared to controls, indicative of ambivalence. Groups did not differ on implicit alcohol-positive associations, but alcohol-dependent participants had significantly weaker alcohol-negative associations than controls. Regression analyses revealed that implicit negative associations accounted for unique variance in group membership after controlling for alcohol outcome expectancies.ConclusionsOur findings demonstrate that alcohol dependent patients possess weak automatic alcohol-negative associations but not strong automatic alcohol-positive associations, and they suggest the presence of conflict between controlled and automatic processes with regard to negative alcohol cognitions.Electronic supplementary materialThe online version of this article (doi:10.1007/s00213-013-3066-0) contains supplementary material, which is available to authorized users.