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Drinking Motives and Attentional Bias to Affective Stimuli in Problem and Non-Problem Drinkers

Article (PDF Available) inPsychology of Addictive Behaviors 29:312-316 · January 2015with66 Reads
Laura Lambe at Queen's University
  • 13.04
  • Queen's University
Amanda Hudson at Dalhousie University
  • 19.06
  • Dalhousie University
Sherry H Stewart at Dalhousie University
  • 44.77
  • Dalhousie University
Abstract
Problem drinking may reflect a maladaptive means of coping with negative emotions or enhancing positive emotions. Disorders with affective symptoms are often characterized by attentional biases for symptom-congruent emotionally valenced stimuli. Regarding addictions, coping motivated (CM) problem gamblers exhibit an attentional bias for negative stimuli, whereas enhancement motivated (EM) problem gamblers exhibit this bias for positive stimuli (Hudson, Jacques, & Stewart, 2013). We predicted that problem drinkers would show similar motive-congruent attentional biases. Problem and non-problem drinkers (n � 48 per group) completed an emotional orienting task measuring attentional biases to positive, negative, and neutral stimuli. As predicted, EM problem drinkers showed an attentional bias for positive information (i.e., reduced accuracy for positively cued trials). However, CM problem drinkers displayed a general distractibility (i.e., reduced accuracy, regardless of cue valence). The results add further support for Cooper et al.’s (1992) motivational model of alcohol use, and indicate potential motivation-matched intervention targets. Current Study Given the importance of emotional cues in understanding craving-related processes in EM and CM drinkers, the current study extended the findings of Hudson et al. (2013) from problem gamblers to problem drinkers. We hypothesized that performance would vary as a function of drinking motives and problem drinking status with EM and CM problem drinkers showing attentional biases for positive and negative cues, respectively. Attentional biases for emotional cues were not predicted for SM problem drinkers, or for non-problem drinkers regardless of motives group.
BRIEF REPORT
Drinking Motives and Attentional Bias to Affective Stimuli in Problem
and Non-Problem Drinkers
Laura Lambe, Amanda Hudson, and Sherry H. Stewart
Dalhousie University
Problem drinking may reflect a maladaptive means of coping with negative emotions or enhancing
positive emotions. Disorders with affective symptoms are often characterized by attentional biases for
symptom-congruent emotionally valenced stimuli. Regarding addictions, coping motivated (CM) prob-
lem gamblers exhibit an attentional bias for negative stimuli, whereas enhancement motivated (EM)
problem gamblers exhibit this bias for positive stimuli (Hudson, Jacques, & Stewart, 2013). We predicted
that problem drinkers would show similar motive-congruent attentional biases. Problem and non-problem
drinkers (n48 per group) completed an emotional orienting task measuring attentional biases to
positive, negative, and neutral stimuli. As predicted, EM problem drinkers showed an attentional bias for
positive information (i.e., reduced accuracy for positively cued trials). However, CM problem drinkers
displayed a general distractibility (i.e., reduced accuracy, regardless of cue valence). The results add
further support for Cooper et al.’s (1992) motivational model of alcohol use, and indicate potential
motivation-matched intervention targets.
Keywords: alcohol, attentional bias, drinking motives, problem drinking
Motivational models propose substance abuse results from mal-
adaptive attempts to regulate affect. In Cooper, Russell, Skinner,
and Windle’s (1992) model of alcohol use, coping-motivated (CM)
drinking reflects a maladaptive means of avoiding/reducing neg-
ative affect, whereas enhancement-motivated (EM) drinking re-
flects an inappropriate way of achieving/enhancing positive affect;
socially motivated (SM) drinking is unrelated to an affective state.
SM are less risky, as they correlate less strongly with alcohol
problems. However, both EM and CM are predictive of alcohol
problems – CM are directly related to problems, whereas EM are
related to problems via heavier alcohol use (Kuntsche, Knibbe,
Gmel, & Engels, 2005).
It is well established that addiction-relevant cues trigger craving
(Carter & Tiffany, 1999). However, even in the absence of alcohol
cues, emotional cues can also induce alcohol craving in non–
treatment-seeking alcoholics (Mason, Light, Escher, & Drobes,
2008), a finding that corresponds with neurological evidence (Lee
et al., 2013). Attentional biases to emotional cues might help
explain why EM and CM problem drinkers drink in response to
positive and negative emotions, respectively (Carrigan, Samoluk, &
Stewart, 1998). Indeed, disorders with prominent affective symptoms
are often characterized by selective attention to emotional stimuli
(e.g., Murphy et al., 1999).
Few studies have examined links between attentional biases and
drinking motives. Using a primed Stroop task, Stewart, Hall,
Wilkie, and Birch (2002) examined the effects of emotional prim-
ing on attention to alcohol stimuli. CM drinkers had longer laten-
cies for alcohol than control targets on negative (and positive)
prime trials. A similar bias occurred for EM drinkers following
positive primes. Relatedly, Field and Powell (2007) showed that
heavy CM drinkers (compared with low CM drinkers) selectively
attend to alcohol cues following anxiety induction. Hence, different
mood states affect alcohol processing in CM and EM drinkers in
different ways. However, there remains a need to examine attention to
emotional cues themselves. Colder and O’Connor (2002) showed
that, compared with SM and CM drinkers, EM drinkers preferentially
attend to reward cues. This study provides some support for motive-
congruent attentional biases to emotional stimuli, but did not distin-
guish problem versus non-problem drinkers.
Moreover, attentional biases in CM versus EM drinkers have not
been assessed using more stringent methods such as the emotional
orienting task, which can examine initial attentional preferences,
reorienting, and disengagement biases (i.e., the expected atten-
tional biases may exist for one or several of these biases; Hudson
This article was published Online First August 18, 2014.
Laura Lambe and Amanda Hudson, Department of Psychology and
Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada; Sherry
H. Stewart, Department of Psychology and Neuroscience and Department
of Psychiatry, Dalhousie University.
This research was supported by a grant from the Social Sciences and
Humanities Research Council of Canada to Sherry H. Stewart, a Canada
Graduate Scholarship - Doctoral fellowship from the National Sciences and
Engineering Research Council of Canada to Amanda Hudson, and a
Faculty of Science Undergraduate Summer Research Award to Laura
Lambe. We thank Allie Bartlett, Lily Duong, Yhana Elwin, Jennifer
Swansburg, and Alexandra Ticlea for assistance with participant screening,
recruitment, and data entry.
Correspondence concerning this article should be addressed to Sherry H.
Stewart, Psychology and Neuroscience Department, Dalhousie University,
Halifax, Nova Scotia, Canada B3H 2E2. E-mail: sstewart@dal.ca
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Psychology of Addictive Behaviors © 2014 American Psychological Association
2015, Vol. 29, No. 2, 312–316 0893-164X/15/$12.00 http://dx.doi.org/10.1037/adb0000021
312
et al., 2013). Thus, this task is advantageous compared with more
traditional (e.g., Stroop) tasks that cannot make these distinctions
(Fox, Russo, Bowles, & Dutton, 2001). Recently, this task has
been used to examine relations between gambling motives and
attention to emotional pictures in problem and non-problem gam-
blers (Hudson et al., 2013). CM problem gamblers were quick to
reorient to places where negative pictures had appeared, and EM
problem (and non-problem) gamblers exhibited a similar bias for
positive stimuli. Additionally, CM problem gamblers struggled to
disengage from negative pictures. Task performance did not vary by
valence for CM or SM non-problem gamblers. Given that problem
drinking and problem gambling are characterized by similar motiva-
tions (Stewart & Zack, 2008), problem drinkers may also exhibit
motive-congruent attentional biases for emotional stimuli.
Current Study
Given the importance of emotional cues in understanding
craving-related processes in EM and CM drinkers, the current
study extended the findings of Hudson et al. (2013) from problem
gamblers to problem drinkers. We hypothesized that performance
would vary as a function of drinking motives and problem drinking
status with EM and CM problem drinkers showing attentional
biases for positive and negative cues, respectively. Attentional
biases for emotional cues were not predicted for SM problem
drinkers, or for non-problem drinkers regardless of motives group.
Method
Participants
Seventy undergraduates and 26 community individuals were
recruited through website postings and media advertisements. Par-
ticipants fell into six groups, based on problem drinking status and
primary drinking motive; recruitment source did not differ be-
tween groups, p.59. Inclusion criteria (collected by self-report)
were normal or corrected-to-normal vision, English fluency, phys-
ical ability to make responses, and no diagnosis of a serious
psychological disorder.
All potential participants were telephone-screened using the
Alcohol Use Disorders Identification Test (AUDIT; Babor,
Higgins-Biddle, Saunders, & Monteiro, 2001). Using an extreme
groups design, individuals who met the criterion for hazardous/
harmful drinking (AUDIT 8) were included in the problem
drinking group; individuals who met criterion for low-risk drink-
ing (AUDIT 4) were included in the non-problem drinking group
(Babor et al., 2001). Individuals scoring 5–7 were ineligible.
Stimuli
Pictures were from the International Affective Pictures System
(IAPS; Lang, Bradley, & Cuthbert, 1995) and were identical to
Hudson et al. (2013). Normative data for picture ratings (e.g.,
valence) can be accessed through IAPS. Valence ratings (1
unpleasant to9pleasant), were significantly different for neg-
ative, neutral, and positive cues, Ms(SDs) 2.95 (.79), 5.03 (.37),
and 7.22 (.57), respectively; all ps.001.
Targets were identical to Hudson et al. (2013) and consisted of
indoor/outdoor words from the University of Western Australia, Psy-
chology Department Psycholinguistics Database and from the Irvine
Phonotactic Online Dictionary (IPhOD). Length and Kucˇera–Francis
(1967) written frequencies were balanced across valence. The average
length was 5.5 and average written frequency was 31.4.
Measures
The Alcohol Use Disorders Identification Test (AUDIT; Ba-
bor et al., 2001). The 10-item AUDIT assesses problem drinking
(e.g., How often do you have six or more drinks on one occasion?)
and was used to select participants as problem and non-problem
drinkers. The AUDIT has strong psychometric properties (Babor et
al., 2001).
The Drinking Motives Questionnaire (DMQ; Cooper et al.,
1992). The 15-item DMQ assesses the frequency with which
participants drink for each of three motives: EM (e.g., Because it’s
exciting), SM (e.g., To be sociable), and CM (e.g., To relax)ona
1– 4 scale. The DMQ scales have good psychometric properties
(Cooper et al., 1992).
Positive and Negative Affect Schedule (PANAS; Watson,
Clark, & Tellegen, 1988). The 20-item PANAS was used to
measure trait mood. Participants indicated to what extent they had
felt each of 10 positive and 10 negative emotions in general on a
5-point scale. The PANAS is both reliable and valid (Watson et al.,
1988).
Procedure
Following consent, demographics were collected, and question-
naires were administered. Participants proceeded to the emotional
orienting task, presented using Super Lab Pro 4.5, in which they were
first shown a fixation cross in the center of the computer screen (5 s),
followed by a pictorial cue to the left or right of the screen (260 ms).
A brief interstimulus interval (ISI; 180 ms) was followed by a target
word (180 ms), either in the same or opposite position as the cue. The
task advanced to the next trial following a response.
The task was completed under two conditions: suppress and
attend. In the suppress condition, participants were asked to avoid
looking at the picture, as most target words would appear in the
opposite location. The target appeared in this uncued location on
80% of trials (predicted trials). In the attend condition, participants
were requested to look at the picture because most target words
would appear in that location. Targets appeared in this cued
location 80% of the time (predicted trials). In both conditions,
participants were instructed to categorize the target word as indoor
or outdoor by key press, as quickly and accurately as possible
(ensuring they did not respond slowly to make the task easier).
Condition order was counterbalanced.
Trials were grouped into blocks (40 trials per block) by cue
valence for each condition. The order of block administration did
not differ across groups, p.98.
Analyses
ANOVAs were conducted on response accuracy (proportion of
correct trials) and response times (ms) for correct response trials.
1
1
Only correct response trials were examined, because there is often a
trade-off between speed and accuracy in reaction time paradigms.
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313
AFFECTIVE BIASES IN PROBLEM DRINKERS
Response accuracy was roughly normally distributed. However,
correct response times were corrected using log transformations to
bring skew and kurtosis within acceptable limits. Condition (at-
tend, suppress), valence (positive, neutral, negative), and trial type
(predicted, non-predicted) were within-subject factors; problem
group (problem, non-problem) and motives group (coping, social,
enhancement) were between-subjects factors.
Results
Participant Demographics and Clinical Status
Drinking motives groups were created for each of the three
DMQ subscales. Participants were assigned to the motives group
for which they had the highest standardized score (see Hudson et
al., 2013),
2
and were also grouped by AUDIT scores. Problem
drinkers scored higher than non-problem drinkers on all three
DMQ subscales (ps.001; see Table 1 for group sizes). The
majority of the sample was female (77.1%), and participants
averaged 22.01 (SD 2.86) years of age.
For positive trait mood, a problem group motives group
ANOVA revealed no significant effects (ps.25). Negative trait
mood differed between the problem and non-problem drinkers,
p.05 (see Table 1). Although the interaction between motives
group and problem group was nonsignificant (p.07),
3
when we
explored the effect of motives group within each problem drinker
group separately, there was a significant effect on trait negative
mood for problem drinkers only, p.002, with CM problem
drinkers reporting more negative trait mood than both EM and SM
problem drinkers, ps .01 (see Table 1).
Accuracy
There was a main effect of trial type, F(1, 90) 430.98, MSE
.04, p.001, partial
2
.83, with better accuracy for predicted
than non-predicted trials, Ms(SDs) .83 (.11) and .57 (.11),
respectively, corroborating prior findings (Hudson et al., 2013).
There was a significant main effect of valence, F(2, 180) 13.27,
MSE .02, p.001, partial
2
.13. Participants had lower
accuracy for positively- than neutrally- or negatively cued targets
(ps.001; Figure 1). Overall, the positive cues appeared more
distracting, as participants were unable to focus their attention on
targets following these cues. Unexpectedly, a main effect of prob-
lem group was found, F(1, 90) 7.42, MSE .09, p.01, partial
2
.08, where problem drinkers were more accurate than non-
problem drinkers, possibly reflecting greater task engagement due
to stimulation by the emotional cues.
A significant valence by trial type interaction was observed,
F(2, 180) 5.06, MSE .02, p.01, partial
2
.05. There was
a significant effect of valence only for non-predicted target accu-
racy, p.001, partial
2
.10 (predicted target accuracy, partial
2
.03): positive trial accuracy was lower than neutral or
negative trial accuracy, Ms(SDs) .52 (.15), .59 (.15), and .60
(.12), respectively; ps.001. Thus, positive cues were distracting
on non-predicted trials.
There was also a significant interaction between valence, prob-
lem group, and motives group, F(4, 180) 4.06, MSE .02, p
.004, partial
2
.08 (see Figure 1). Valence and motives group
interacted for problem drinkers only, p.001, partial
2
.12
(non-problem drinkers, partial
2
.01), in which a significant
effect of valence was observed for EM problem drinkers only, p
.001, partial
2
.49 (all other ps.25, partial
2
s.11). The
EM problem drinkers performed significantly worse on positive
trials (ps.005) compared with both neutral and negative trials.
4
Thus, positive cues were especially distracting among EM problem
drinkers.
There was a significant problem group by motives group inter-
action, F(2, 90) 3.71, MSE .09, p.03 partial
2
.08.
Accuracy varied by motives group for the problem drinkers only,
p.04, partial
2
.15 (non-problem drinkers, partial
2
.09).
CM problem drinkers underperformed SM problem drinkers, p
.01, with EM problem drinkers falling in between these groups,
p.10 (see Figure 1). However, when trait negative mood was
entered as a covariate, all problem drinkers performed similarly,
p.88.
Response Times
A parallel mixed measures ANOVA conducted on response
times revealed significant main effects of condition, F(1, 86)
6.10, MSE .02, p.02, partial
2
.07, and trial type, F(1,
86) 89.80, MSE .01, p.001, partial
2
.51. Response
times were longer for the attend than the suppress condition, Ms
(SDs) 3.28 (.08) and 3.26 (.08), respectively, and were faster for
non-predicted than predicted trials, Ms(SDs) 3.24 (.08) and 3.31
(.06), respectively. No other significant effects were observed.
Discussion
The purpose of this study was to examine whether attentional
biases to emotional stimuli varied in a motive-congruent manner in
problem and non-problem drinkers. Contrary to hypotheses,
motive-congruent attentional biases to negative emotional stimuli
were not observed among the CM drinkers. However, CM problem
drinkers, but not EM problem drinkers, had poor overall accuracy
compared with SM problem drinkers, suggesting they are more
distracted in general. This is similar to findings that CM drinkers
had delayed responses for alcohol words when they followed both
negative and positive primes (Stewart et al., 2002). Additional
analyses revealed that the reduced performance was attributable to
CM problem drinkers’ increased trait negative mood. This finding
fits with previous work showing that anxiety impairs performance
on attentional tasks (Eysenck & Calvo, 1992).
As predicted, task performance varied by valence for the EM
problem drinkers. EM problem drinkers had the lowest target
2
Our approach to grouping by highest standardized score holds advan-
tages in that it considers how participants’ motives for drinking rank
relative to other drinkers, as well as relative to their own other motives for
drinking. Some motives for drinking are more socially acceptable than
others (e.g., social motives are more highly endorsed than coping). Thus,
our method of grouping gives a reflection of relative reasons for drinking
with respect to normative reasons.
3
This interaction was explored because it was expected a priori (see
recommendations by Winer, 1971, for relaxing alpha in the case of pre-
dicted interactions because of the greater power necessary to observe
interactions).
4
The impairing effect of positive cues on EM problem drinkers’ target
accuracy cannot be attributed to mood given that EM and SM problem
drinkers did not differ in the mood analyses, and EM only differed from
CM problem drinkers on trait negative mood.
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314 LAMBE, HUDSON, AND STEWART
accuracy on positively cued trials, suggesting an attentional bias
for positive stimuli. However, as this effect did not vary by trial
type or condition, which would allow identification of specific
reorienting or disengagement effects (see Hudson et al., 2013), this
bias might reflect a general distracting influence of positive stimuli
on EM problem drinkers (Stewart et al., 2002). EM problem
gamblers show a similar bias for positive information on this same
emotional orienting task (Hudson et al., 2013). Also as hypothe-
sized, motive-congruent attentional biases were not seen in the SM
problem drinkers, or in the non-problem drinkers regardless of
motive.
Limitations and Future Directions
The present sample consisted mainly of young, female students.
Future studies should use this task with clinical problem drinkers,
where motive-congruent attentional biases may be more promi-
nent. Additionally, the DMQ has been revised to separate CM into
CM-depression and CM-anxiety (Grant, Stewart, O’Connor,
Blackwell, & Conrod, 2007). The emotional orienting task in-
cluded both threatening and depressive negative cues; this may
explain why the distractibility observed among the CM problem
drinkers was not motive-specific. Future research could replicate
this study using the Modified DMQ-R (Grant et al., 2007) and a
modified emotional orienting task to examine biases for more
specific emotional stimuli. This study was also limited by unequal
cell sizes across groups (i.e., CM and EM non-problem drinkers
n11; SM non-problem drinkers n26), which reflects nor-
mative reasons for drinking within the population (Cooper et al.,
1992). Cell sizes for CM and EM tended to be larger for the
problem drinkers, possibly because these motives are associated
with greater alcohol problems (Cooper et al., 1992). Admittedly,
there are variables other than drinking motives that may affect
drinkers’ attentional responses to emotional cues (e.g., approach
and avoidance tendencies involving behavioral inhibition and ac-
tivation systems; Elliot & Thrash, 2002). Future work should
address this possibility. Last, this study did not simultaneously
examine attentional biases specifically toward alcohol cues, which
would have allowed us to compare the magnitude of attentional
biases for emotional material to biases for alcohol cues (Field &
Cox, 2008).
Conclusions
Nevertheless, our results have several clinical implications. Tar-
geted interventions for preventing and intervening early with prob-
lem drinking are showing promising results (e.g., Conrod, Stewart,
Comeau, & Maclean, 2006). Interventions with EM problem
drinkers could attempt to modify biases for positive cues in their
environment, or to help these individuals resist impulsive respond-
ing in the face of such cues. Indeed, targeting alcohol attentional
biases can reduce alcohol consumption among harmful drinkers
(Fadardi & Cox, 2009). Future research should extend these treat-
ments to target motive-congruent attentional biases among EM
problem drinkers and general distractibility (as well as dispositions
toward negative mood) among CM problem drinkers.
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0
0.1
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0.6
0.7
0.8
0.9
1
EM CM SM EM CM SM
Problem Non-problem
Targ et A ccu rac y
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*
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the positively cued trials compared with both neutrally and negatively cued
trials.
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Received March 11, 2014
Revision received June 30, 2014
Accepted June 30, 2014
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
316 LAMBE, HUDSON, AND STEWART
  • ... Por tanto, la ausencia de una deceleración en personas con dependencia al alcohol podría reflejar una implica- ción deficiente con las emociones de valencia negativa durante la visualización de imágenes negativas, y una baja prominencia de las motivaciones de los refuerzos natura- les durante la visualización de imágenes positivas. Estos resultados son coherentes con estudios sobre los sesgos de atención hacia los estímulos afectivos en la adicción; estos estudios han mostrado que las señales relacionadas con la adicción son objeto de mayor atención, y que los estímulos cotidianos positivos tienen baja prominencia motivacional en personas con adicción, incluyendo las personas con adicción al juego (Hudson , Jacques y Stewart, 2013), usua- rios de opioides (Lubman, Peters, Mogg, Bradley y Deakin, 2000;Robbins y Ehrnan, 2004), y personas con dependen- cia al alcohol (Garfield, Allen, Cheetham, Simmons y Lubman, 2015;Lambe, Hudson y Stewart, 2015). ...
  • ... Of note, using the identical task, we previously did not observe an association between affective attentional control and PTSD symptom severity, when mTBI was not comorbid (Amick et al., 2013). Overall, study results extend previous literature showing individual effects of PTSD and SUD symptoms on disrupted behavioral responding using tasks requiring attentional control (e.g.,Field and Cox, 2008;Lambe et al., 2014;Esterman et al., 2013;DeGutis et al., 2015). It is possible that the affective go/no-go task, with its specific demands upon inhibitory processes in addition to affective information processing may be more sensitive to the subtle effects of co-occurring SUD on attention and inhibitory control. ...
    ... Future studies with larger sample sizes should investigate the effects of different SUDs on the relation between PTSD and attentional processing. This may be particularly important given results suggesting variable effects of SUD on attentional processing among individuals with alcohol, nicotine, heroin, and cocaine use disorders (e.g.,Rzetelny et al., 2008;Lambe et al., 2014). In addition, future research should explore more complex, three-way interactions among PTSD and co-occurring conditions with established effects on attentional bias (e.g., mTBI;Amick et al., 2013), such as depression, anxiety, and sleep disorders. ...
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