Article

Differentiating the Contribution of Pharmacological from Alcohol Expectancy Effects to Changes in Subjective Response and Priming Over Successive Drinks

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Abstract

Background: Alcohol consumption can prime motivation to continue drinking and may contribute to excessive drinking. Most alcohol administration research assesses the effect of a single alcohol dose on outcome measures; however, this differs from typical drinking occasions in which several drinks are consumed over time. This research tracks priming measures (alcohol urge, latency to first sip, and consumption time) and subjective effects (intoxication, stimulation, and sedation) across consumption of 5 drinks, over a period of 2.5 hours. Alcohol, placebo, and no-alcohol (i.e., soft drink) conditions are compared with isolate the effects of alcohol expectancies and differentiate these from alcohol's pharmacological effects. Methods: Alcohol urge and subjective state were measured before and after an initial drink was consumed (preload: alcohol, placebo, or no-alcohol). Four additional drinking phases followed whereby participants had access to 2 drinks (alcohol/no-alcohol, or placebo/no-alcohol). Experimental priming (urge, latency to first sip, consumption time) and subjective effect (intoxication, stimulation, and sedation) outcomes were recorded after each drink. Results: The pattern of alcohol urge following placebo drinks differed compared with alcohol and no-alcohol consumption, Fs(1, 90) > 4.10, ps < 0.003. There was a linear decrease in urge in the no-alcohol condition, while in the alcohol condition urge increased after the first few drinks before decreasing. Urge ratings showed the opposite pattern in the placebo condition (a decrease followed by an increase). Alcohol produced the highest ratings of lightheadedness, F(5, 440) = 2.8, p < 0.02, but both alcohol and placebo produced increased sedated feelings, Fs ≥ 19.05, ps ≤ 0.001. After placebo, urge was positively related to liking and enjoying the "alcoholic" drinks and feeling more stimulated (rs ≥ 0.31, ps ≤ 0.01). Conclusions: In social drinkers, different factors may affect priming during different stages of a drinking episode. For example, the pharmacological effects of alcohol appear involved in priming during the initial stages of drinking. When alcohol expectancies are activated, blocking access to alcohol can increase urge, supporting Tiffany's cognitive processing model of craving.

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... Furthermore, although the placebo-alcohol increased subjective feelings of lightheadedness supporting previous research (e.g. Rose et al. 2013), there was no difference in beer consumption following the placebo-alcohol and control as predicted. Nevertheless, this replicates the findings of Christiansen et al. (2012) and implies that the pharmacological effects (not the anticipated effects) of alcohol are key to the priming effect on subsequent motivation to consume alcohol. ...
... Although contradictory to our hypothesis and previous findings (e.g. Christiansen et al. 2012;Fatseas et al. 2015;Field and Jones 2017;Rose et al. 2013), this suggests that alcohol seeking can increase without an accompanied increase in self-reported craving, which has also been reported in previous studies (e.g. Wiers et al. 2010; see also Tiffany 1990; Wiers et al. 2007). ...
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Rationale Alcohol intoxication and alcohol cue exposure impair ‘reactive’ inhibitory control and increase motivation to drink. However, inhibitory control is a multi-component process that also comprises signal detection and proactive control. It is unknown whether intoxication and cue exposure selectively influence these subprocesses in heavy drinkers. Objectives In two pre-registered studies, we investigated whether exposure to alcohol-related cues (study 1) and alcohol priming (study 2) impair each of these subprocesses of inhibitory control and increase motivation to drink. Methods In study 1, 64 heavy drinkers completed a modified stop-signal task in an alcohol context (with embedded alcohol cues) and a neutral context (with embedded neutral cues) followed by a subjective measure of craving and a bogus taste test to measure ad libitum alcohol consumption. In study 2, 36 heavy drinkers consumed an alcoholic beverage (0.6 g/kg body weight), an alcohol-placebo beverage, and water on a within-subjects basis, followed by the modified stop-signal task and a bogus taste test. Results In study 1, alcohol cue exposure did not impair inhibitory control subprocesses. Reactive control was unexpectedly better following alcohol cue exposure (compared to neutral cue exposure). However, craving and ad libitum consumption increased as expected. In study 2, reactive control was significantly impaired following the alcohol and control primes, relative to the placebo, but there was no effect on proactive slowing or signal detection. As expected, intoxication increased motivation to drink and ad libitum consumption (compared to placebo and control). Conclusions Alcohol intoxication and cue exposure increase motivation to drink in the absence of impairments in subcomponents of inhibitory control.
... Stimulus substitution models argue that placebos produce drug-like effects when the unconditioned stimuli (the vehicle a drug is delivered in; e.g., a liquid that tastes and smells like alcohol) evokes conditioned responses after repeated pairings (Wickramasekera, 1980), although this is dependent upon conscious expectations of an effect (Montgomery & Kirsch, 1997). Significantly, both increased ad lib consumption and craving has been found following the administration of placebo-alcohol (e.g., Christiansen et al., 2013;Marlatt, Demming, & Reid, 1973;Rose, Hobbs, & Drummond, 2013). Moreover, Leeman, Corbin, and Fromme, (2009) demonstrated that levels of craving following a placebo (but not alcohol) predicted ad lib consumption. ...
... thermore, the anticipated effects of alcohol also increased craving in the current study (see also Christiansen et al., 2012;Rose et al., 2013), and can prime ad lib consumption (Marlatt et al., 1973). Taken together, this is indicative of participants exhibiting conditioned responses to placebo-alcohol. ...
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... However, ad-lib consumption was assessed after an hour-long battery of cognitive tasks, by which time when the placebo effect had dissipated. Rose et al. (2013) attempted to disentangle the anticipated from pharmacological effects of alcohol on alcohol craving and found that craving was increased (compared to a control drink) by both alcohol and placebo; however, the increase following alcohol was immediate and then dissipated, whereas it followed the opposite pattern after the placebo. One other study (Leeman et al. 2009) demonstrated that levels of craving following a placebo (but not alcohol) predicted ad-lib consumption. ...
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... An alternative possibility involves our inclusion of a placebo group. Previous work has shown that alcohol priming measures differ depending on whether real or placebo alcohol has been consumed (Rose et al. 2013). It is possible that the lack of a pharmacological alcohol effect when alcohol was expected may have somehow disrupted BART performance, resulting in the discrepancies observed between our data and others, and this is something for future research to determine. ...
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Twenty hospitalized alcoholics served as their own controls in a study which sought to compare psychophysiological and cognitive factors as mediating influences on the priming effect of alcohol. Ten subjects were independently assessed by a psychiatrist as being severely dependent on alcohol and ten as mildly or moderately alcohol dependent. Physiological, behavioural and subjective indices of the motivation to drink alcohol were employed 15 and 60 min after subjects had consumed beverages on four separate occasions corresponding to four priming conditions. These priming drinks contained either 60 ml vodka in heavy dilution or just tonic water, and in each of these conditions subjects were either led to believe that the beverages contained alcohol or they had no alcohol. The severely-dependent group displayed a degree of concordance between the indices of motivation to drink, and the levels of these tended to be significantly higher than in the less-dependent subjects. The results suggest that severely alcohol-dependent subjects were more disposed to drink 60 min after consuming alcoholic drinks than after soft drinks, regardless of whether they believed that the priming drinks had contained alcohol. Cognitive factors assumed greater importance for the drinking behaviour of less-dependent subjects, although there was evidence of discordance across behavioural, physiological and subjective measures for this group.
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Although drinking urges and cravings are commonly reported by alcoholics, prospective studies have found inconsistent associations between such urges and drinking relapses. Previous studies have measured drinking urges by use of single-item ratings of alcohol craving or other measures of unknown reliability and validity. To permit improved evaluation of hypotheses regarding alcohol craving, a 49-item questionnaire that reflects several urge-related domains was developed and pretested. Items assessed subjects' desire for a drink, expectations of positive effects following drinking, relief of withdrawal and negative affect following drinking, and intention to drink. Exploratory and confirmatory factor analyses of the responses of 351 abstinent, treatment-seeking alcoholics indicated that alcohol urges are best described by a single factor. Based on these analyses, an internally consistent, reliable, and psychometrically valid 8-item scale, the Alcohol Urge Questionnaire (AUQ), was developed. Data indicated that AUQ scores were strongly related to alcohol dependence severity and to cognitive preoccupation with alcohol, and that they declined with prolonged abstinence. The AUQ may be useful in alcoholism treatment research and in laboratory studies of reactivity to alcohol or other manipulations.
Article
Results from a study using the balanced placebo design to assess alcohol's effects on anxiety raise serious doubts about the utility of the design even at moderate blood alcohol concentrations. Despite being informed that they were not drinking alcohol, 44% of the subjects who were administered alcohol reported consuming at least some alcohol. Moreover, subjects' scores on the Marlowe-Crowne Social Desirability Index (MCSD) were associated with deception success, suggesting that individual differences in reporting bias influence the manipulation. In contrast, only 6% of subjects who were told that they had consumed alcohol but were given tonic water were not deceived. Among subjects in this placebo condition, scores on the MCSD were not associated with success of the deception. These data suggest that at a moderate dose of alcohol, drink deception in the antiplacebo condition is much more difficult to execute than in the placebo condition, and that deception in the former condition may be confounded with experimenter demand.
Article
Alcohol produces stimulant and sedative effects, and both types of effect are thought to influence drinking practices. This article describes the development and preliminary validation of the Biphasic Alcohol Effects Scale (BAES), a self-report, unipolar adjective rating scale designed to measure both stimulant and sedative effects of alcohol. An initial pool of 12 stimulant and 12 sedative items was derived from previous alcohol effect measures, and from descriptors of intoxication generated by subjects during interviews conducted on both the ascending and descending limbs of the blood alcohol curve. This item pool was administered to a sample of sober college students twice, with a 2-week inter-test interval. Items that were difficult to comprehend, or that had high ratings or low test-retest reliability, were eliminated, resulting in a seven-item stimulant subscale and a seven-item sedative subscale. These subscales showed high internal consistency in a sober state, which was not improved by additional item deletion. The data from this study also provided a basis for revising the instructions for the BAES. The new 14-item instrument was then given to 30 male and 12 female nonalcoholics on the ascending and descending limbs of the blood alcohol curve, after the administration of either 0.75 ml/kg alcohol (males) or 0.65 ml/kg alcohol (females). Internal consistency was high for both BAES subscales on both limbs of the blood alcohol curve (Cronbach's alpha = 0.85 to 0.94), and was not improved by additional item deletion. Factor analyses conducted on both limbs of the blood alcohol curve supported the proposed factor structure of the BAES.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Alcohol and illicit drug use are increasing among school children and young adults in the UK. Such increases have also been noted among university students and there is a need for a large survey across different universities and faculties. We report such a survey. Information about drinking, use of cannabis and other illicit drugs, other lifestyle variables, and subjective ratings of anxiety and depression was obtained by questionnaire in a cross-faculty sample of 3075 second-year university students (1610 men, 1447 women, 18 sex not stated) from ten UK universities. The questionnaire was personally administered during scheduled lecture hours and almost all the students participated. The sample reflected the interfaculty and sex distribution and the proportion of non-white students at UK universities. 11% of the students were non-drinkers. Among drinkers, 61% of the men and 48% of the women exceeded "sensible" limits of 14 units per week for women and 21 for men. Hazardous drinking (> or = 36 units per week for women, > or = 51 for men) was reported by 15% of the drinkers. Binge drinking was declared by 28% of drinkers. 60% of the men and 55% of the women reported having used cannabis once or twice and 20% of the sample reported regular cannabis use (weekly or more often). Experience with other illicit drugs was reported by 33% of the sample, most commonly LSD (lysergic acid diethylamide), amphetamines, Ecstasy (methylenedioxymethamphetamine), and amyl/butyl nitrate which had each been used by 13-18% of students. 34% of these had used several drugs. Drug use had started at school in 46% of the sample; 13% began after entering university. The overwhelming reason given for taking alcohol or drugs was pleasure. Subjective ratings of anxiety on the hospital anxiety depression scale were high, and sleep difficulties were common, but neither related to alcohol or drug use. There is a need for better education about alcohol, drugs, and general health in universities. Such education should include all faculties. It remains unclear whether university students' lifestyles are carried over into later life.
Article
Discriminative stimulus properties of low doses of ethanol were evaluated in humans using established behavioural drug discrimination procedures. Twenty-five moderate drinkers (12 females and 13 males) were trained to discriminate placebo from 0.2 g/kg ethanol in 200 ml tonic water mixed with Tabasco sauce and drunk in portions of 50 ml every 15 s. Seventeen of the subjects (ten females and seven males) were able to reach criterion performance (at least 80% correct responses). Generalisation responding across ethanol doses of 0 (placebo), 0.025, 0.05, 0.1 and 0.2 g/kg was examined the day after training using a procedure in which subjects reported the extent to which the test stimulus resembled the training dose. At the end of each generalisation session, self ratings of mood changes, physiological responses and performance in a working memory and a time estimation task were evaluated. Subjects were able to distinguish the three higher doses of ethanol from placebo. Self ratings indicated that subjects' ability to distinguish ethanol from placebo was related, at the highest dose, to change of taste, but to feelings of light-headedness at the lower doses. Ethanol administration influenced skin conductance measurements but there was no relationship found between changes in skin conductance and the ethanol discriminative stimulus. These data suggest a difference in the nature of the discriminative stimulus of ethanol between high (training) and low (generalising) doses as indicated in the subjective reports.
Article
Research is reviewed on the association between alcohol outcome expectancies and consumption which has led many to argue that manipulating expectancies might be a route to manipulating consumption for problem prevention and treatment. Studies indirectly and directly evaluating this latter position are reviewed. Expectancies predicting treatment outcome: two studies have shown that the more positive expectancies held at treatment, the poorer is treatment outcome, but five other studies have failed to find this. Three related studies have shown that the more negative expectancies held at treatment, the better the treatment outcome. This evaluation provides evidence inconsistent with the main position for positive expectancy and limited support for negative. Expectancy manipulations and ad libitum consumption: three studies in the laboratory have shown that increasing positive expectancies through word priming increases subsequent consumption and two studies have shown that increasing negative expectancies decreases it. A single study in the field showed a similar relationship. This evaluation provides evidence consistent with the main position but is limited by measuring consumption changes over only 1-2 hours. Prevention programmes with expectancy components: seven projects are reviewed in which positive expectancies were targeted, but only two report an expectancy change analysis and in both cases the expectancy change did not relate to subsequent consumption. This evaluation provides evidence inconsistent with the main position. Expectancy challenge: two related studies are reviewed in which positive expectancy challenges reduce subsequent consumption but changes in expectancy were not evaluated as predictors of consumption change. Two studies are reviewed which found a reduction in positive expectancy following expectancy challenge but no reduction in consumption. One study is reviewed in which when negative expectancy was increased in treatment there was a better treatment outcome at 3 months follow-up than when it was not. This evaluation provides evidence inconsistent with the main position for positive expectancy and limited consistent evidence for negative. It is concluded that the research has still to be done that securely links expectancy manipulations with subsequent changes in consumption, and fulfils the early promise from association studies.
Article
This study showed that normal social drinkers were more likely to consume ethanol after receiving a "priming" (preload) dose of ethanol. Twenty-eight non-problem drinkers (average consumption 9 drinks/week) participated in a six-session, double-blind choice procedure. On the first two sessions they sampled beverages containing ethanol (0.8g/kg) or placebo (mix alone), between which they would choose on subsequent choice sessions. On the third session ("dummy" choice session) subjects were first asked to indicate verbally which beverage they preferred. If they chose the ethanol-containing beverage the experimenter negotiated with each subject to determine the minimum amount of money (from 1to1 to 30) needed to switch his or her choice from ethanol to placebo. Once this amount was determined it remained fixed for the subsequent three preload/choice sessions. Thus, on choice sessions subjects chose between the beverage which contained ethanol, and placebo plus the amount of money established in Session 3. On the preload/choice test sessions (Sessions 4-6) subjects received preloads of ethanol (0, 0.25 or 0.5g/kg) 1h before being given the choice between the sampled ethanol beverage and the placebo beverage plus money. The frequency of ethanol choice was the primary dependent variable. Subjective drug effects, including ratings of desire for the sampled substances, were also measured. Twenty subjects initially chose ethanol on Session 3 and switched their choice with a monetary incentive. Of these 20 subjects, four chose ethanol after the placebo preload, seven chose ethanol after the low-dose ethanol preload, and 11 chose ethanol after the higher ethanol preload (significant linear trend, Mantel-Haenszel test, p < 0.03). Ratings of desire for the ethanol-containing beverage increased after the higher preload. These results suggest that ingestion of a moderate dose of ethanol increases the tendency to continue drinking, even among normal social drinkers.
Article
This research examined alcohol-induced motivation to drink as a factor that contributes to preoccupation with drinking. Forty undergraduates rated their degree of preoccupation with drinking. The author determined the relationship between the undergraduates' preoccupation and the degree to which alcohol primed their motivation to drink by having them rate their desire for alcohol after they consumed a dose of alcohol or a placebo. Results showed that individual differences in preoccupation were predicted by the priming effects displayed after alcohol was consumed. More preoccupied individuals reported greater priming effects. Priming effects following placebo were minimal and were not related to preoccupation. The research shows that reinforcing effects of alcohol may contribute to cognitive preoccupation with drinking and promote patterns of alcohol abuse.
Article
Most studies of risk factors for alcohol-related problems have focused on biological family history as a primary risk factor. However, other factors, such as early-age heavy drinking, are also risk factors for sustained or progressive heavy consumption. Little is currently known about the mechanisms underlying binge or heavy drinking. This study examined the acute subjective and objective effects of ethanol in heavy drinkers versus light drinkers. Thirty-four subjects participated in this within-subjects study consisting of three early-evening testing sessions in which subjects consumed a beverage containing either 0.8 or 0.4 g/kg ethanol or placebo. Compared with lighter drinkers, heavy drinkers were more sensitive to the positive stimulant-like effects of ethanol (p < 0.05), especially during the increasing limb of the blood alcohol curve. Heavy drinkers also showed less sedation and cortisol response after alcohol than the light drinkers (p < 0.05). The results indicate that young adult binge drinkers show a biphasic alcohol response, with heightened sensitivity to stimulant-like alcohol effects and greater tolerance to sedative alcohol effects compared with their light-drinking counterparts.
Article
The Alcohol Use Disorders Identification Test (AUDIT) was examined by employing confirmatory factor analytic techniques to data from two samples collected 1998-1999: college students (n = 465) and court-referred, substance use treatment outpatients (clinical sample; n = 135). Despite the fact that the AUDIT was originally designed as a three-factor measure (consumption, dependence, and consequences), previous studies have lent support to one- and two-factor models. The results of this study support a two-factor model (alcohol consumption and dependence/consequences) in both samples. As further evidence that the two-factor model is appropriate, a psychometric evaluation suggested that the AUDIT generated reliable scores in both groups when used as either a one- or two-factor measure, but not when three scores are derived in the student sample.
Article
Research with non-Latinos has shown that alcohol expectancies ("the anticipated effects of alcohol use") are associated with drinking behaviors; however, prior studies have not fully examined such relations in Latino college students. This investigation examines positive alcohol expectancies and their association with contextual drinking and alcohol-related problem behaviors in a sample of 107 Mexican American college students (mean age=25; 54% female) who completed self-report surveys. Results showed that students who endorsed expectancies of physical and social pleasure and increased social assertiveness were likely to engage in frequent heavy drinking and imbibe in less personal settings. Furthermore, gender (being male) and the expectancy of enhanced sexual performance and experience were associated with involvement in risk behaviors due to drinking. This study highlights the link between specific alcohol expectancies and alcohol-related problem behaviors in Mexican American college students. Intervention approaches aimed at modifying drinking expectancies in physical, social, and sexual domains could prove useful in this population.
Article
Interoceptive drug cues, through associations with the drug's reinforcing properties, may act as conditioned stimuli and elicit conditioned responses. For instance, a dose of alcohol, given to alcohol-experienced people, can lead to an enhancement of alcohol drinking, a phenomenon known as the priming effect. The present study aimed to investigate the alcohol priming effect in non-dependent social drinkers with respect to the dose of alcohol preload and the time of testing after preload. Fifteen social drinkers participated in five daily consecutive sessions. On days 1 and 2 (training sessions), participants consumed a 500 ml beverage of either 0.6 g/kg of alcohol or placebo (50 ml aliquots) presented in 10 colour-coded cups. During days 3, 4 and 5 (testing sessions), a preload of placebo, 0.3 or 0.6 g/kg of alcohol was given (in randomized sequence) in 10 opaque colourless cups. Thirty, 60 and 90 min following the preload, participants responded to an imagery script referring to the drinks sampled at training including a question on the number of aliquots participants would consume from each of the drinks if given the opportunity (hypothetical choice). Participants completed questionnaires evaluating mood and alcohol desires at baseline (before the beverages were given) and after the hypothetical choice. The hypothetical choice showed significant interactions between dose and time: the greatest number of alcohol aliquots were wanted 30 min following the 0.6 g/kg dose of alcohol preload. Ratings from the Desires for Alcohol Questionnaire also showed that alcohol desires peaked 30 min following the 0.6 g/kg of alcohol preload. These data support previous evidence that priming with alcohol can occur and indicate that dose of, and time after preload might affect the strength of, the priming effect for alcohol-related behaviours.
Article
The Alcohol Urge Questionnaire (AUQ) is a promising multi-item measure of self-reported urges to drink in human laboratory studies; however, its factor structure has not been examined during an acute urge state. This study sought to validate the AUQ's factor structure under neutral conditions and during a cue-elicited urge state in heavy drinkers. Participants (248 heavy drinkers; 70% male) completed the AUQ, the Alcohol Dependence Scale (ADS), and the Positive and Negative Affect Scale (PANAS) under neutral conditions. A randomly selected subsample (n=61; 74% male) then underwent a multimodal alcohol cue exposure and completed the AUQ and PANAS a second time. Under neutral conditions, confirmatory factor analysis (CFA) replicated the previously reported single-factor structure, on which all items significantly loaded (p<0.001). Alcohol urges, as measured by the AUQ, exhibited significant positive associations with drinks per week and severity of dependence. Following the alcohol cue exposure, participants exhibited a significant increase in urge on the AUQ. Confirmatory factor analysis of the AUQ during the cue-elicited urge state also supported the single factor structure, on which all items significantly loaded (p<0.001). Positive and negative affect were positively associated with urges across the experimental protocol, but at greater magnitudes during an acutely elevated urge state. These results further validate the use of the AUQ for real-time measurement of alcohol craving in human laboratory research.
Article
Evidence suggests that alcohol-related problems are associated with impulsivity and disinhibited behavior. Less certain is whether disinhibited behavior is due to an impulsive disposition or alcohol's ability to disinhibit some people more than others. There are a range of disinhibited behaviors associated with alcohol, including excessive alcohol consumption, bingeing. The study tested whether nondependent alcohol bingers showed more disinhibition after placebo and/or alcohol relative to nonbingers and whether this was related to enhanced motivation to drink following a priming dose of alcohol. Twenty participants (10 bingers) attended the laboratory twice. Baseline measures included impulsivity, alcohol-related cognitions, alcohol urge, and mood. Participants were preloaded with alcohol (male: 0.6 g/kg, female: 0.5 g/kg) and placebo (counterbalanced). After a 20-minute rest, participants completed 2 impulsivity tasks (Two Choice & Time Estimation) separated by second urge and mood ratings. Bingers did not show greater impulsivity characteristics but were more concerned about their drinking (p = 0.02) and ability to control drinking (p = 0.04). A priming effect was found: alcohol urge increased after alcohol but not placebo (p = 0.006). Bingers reported greater tolerance to the sedative (p = 0.05) and lightheaded (p = 0.04) effects of alcohol, relative to nonbingers. Binge status was not associated with impulsivity task performance, while preload type (alcohol/placebo) supported only marginal associations. Risk of binge drinking in nondependent individuals is not strongly affected by impulsive personality characteristics or alcohol's ability to induce behavioral disinhibition. However, alcohol did lead to a priming effect and bingers were more tolerant to the sedative and lightheaded effects of alcohol relative to placebo. Risk of binge drinking is associated with the subjective effects of a priming dose of alcohol.
Cognitive preoccupation with alcohol and binge drink-ingin college students: alcohol-induced priming of the motivationtodrink Comprehensive effects of alcohol: development and psychometric assessment of a new expectancy question-naire
  • Rose Fillmore
  • Al Rfromme K
  • E Stroot
  • Kaplan
Fillmore MT (2001) Cognitive preoccupation with alcohol and binge drink-ingin college students: alcohol-induced priming of the motivationtodrink. Psychol Addict Behav 15:325–332. 8 ROSE ET AL. rFromme K, Stroot E, Kaplan D (1993) Comprehensive effects of alcohol: development and psychometric assessment of a new expectancy question-naire. Psychol Assess 5:19–26
Statistic on Alcohol: England , 2012. The Information Centre for Health and Social Care
Health and Social Care Information Centre (2012) Statistic on Alcohol: England, 2012. The Information Centre for Health and Social Care, UK.
Biphasic alcohol response differs in heavy versus light drinkers
  • King
A review of expectancy theory and alcohol consumption
  • Jones