Reward sensitivity, attentional bias, and executive control in early adolescent alcohol use
Introduction
There is considerable evidence supporting the view that alcohol-related stimuli capture the attention of people who use or abuse alcohol (see for review, Field & Cox, 2008). Using the Visual Probe Task (VPT), previous studies have demonstrated an alcohol-related attentional bias in heavy users of alcohol when picture pairs were presented for a longer period of time, such as 500–2000 ms (e.g., Field et al., 2004, Miller and Fillmore, 2010, Townshend and Duka, 2001). In addition, recent studies have found that controlled executive processes (e.g., Executive Control, EC) moderate the relationship between automatic appetitive processes (e.g., attentional bias) and alcohol use. These findings suggest that relatively weak executive functioning increases the influence of appetitive processes on alcohol use, and that especially people with weak EC are at risk to develop excessive alcohol use (Farris et al., 2010, Friese et al., 2010, Houben and Wiers, 2009, Peeters et al., 2012, Peeters et al., 2013, Thush et al., 2008). However, not much is known about the role of attentional bias and the possible moderating influence of EC in (early) adolescent alcohol use.
It has been hypothesized that an alcohol-related attentional bias develops by the process of classical conditioning. That is, by repeated experience of the rewarding effects of drug-taking, alcohol-related cues would become associated with these rewarding effects and would consequently acquire the ability to grab the user's attention (e.g., Franken, 2003, Robinson and Berridge, 1993, Robinson and Berridge, 2001). Following this perspective, adolescents with high reward sensitivity could be especially at risk for developing attentional bias for alcohol cues. Germane to this, it has been argued that people's responding to appetitive cues in the environment depends on their trait reward sensitivity (Gray, 1970, Gray, 1982). People high on reward sensitivity are sensitive to stimuli that signal unconditioned reward and the relief from punishment. In the development of early adolescent alcohol use this would imply that the initial responses to alcohol-related cues would vary as a function of adolescents' reward sensitivity, whereas the repeated experience of the effects of alcohol use would subsequently shape the development of alcohol-related attentional bias. In line with this view, previous research has found a consistent link between adolescent substance use and high reward sensitivity (Knyazev, 2004, Lopez-Vergara et al., 2012, O'Connor and Colder, 2005, Pardo et al., 2007, van Hemel-Ruiter et al., 2013). Moreover, reward sensitivity has been found to be a significant predictor of reactivity to alcohol cues (Glautier et al., 2000, Kambouropoulos and Staiger, 2001, Kambouropoulos and Staiger, 2004, Zisserson and Palfai, 2007). Of the few studies that have examined attentional bias for alcohol cues in adolescents, none have included measures of reward sensitivity. Thus it remains to be tested whether individuals with high reward sensitivity also show stronger alcohol attentional bias and whether the previous findings of a relationship between reward sensitivity and alcohol use might be (partly) mediated by attentional bias for alcohol cues. Therefore, the first aim of this study was to test further the interrelationships between reward sensitivity, attentional bias for alcohol cues, and early adolescent alcohol use.
The few studies that have examined attentional bias for alcohol cues in adolescent samples found evidence for an attentional bias in heavy drinking adolescents (16–18 years: Field, Christiansen, Cole, & Goudie, 2007), and high-risk adolescents (12–16 years: Pieters et al., 2011; 15–20 years: Zetteler, Stollery, Weinstein, & Lingford-Hughes, 2006), but not in an unselected group of adolescents (15–21 years: Willem, Vasey, Beckers, Claes, & Bijttebier, 2013). The results of the latter study showed a moderating role for self-reported attentional control in the relationship between attentional bias and alcohol use such that the relation between attentional bias and alcohol use was significant for participants with strong attentional control but not for those with weak attentional control. The direction of this finding was unexpected and is difficult to explain. Given the debate regarding whether self-report methods are adequate assessments of EC capacity (cf., Reinholdt-Dunne et al., 2009, Wiers et al., 2010), the present study used a performance measure of EC to test further if EC moderates the relationship between attentional bias for alcohol cues and common adolescent alcohol use. Based on previous research investigating the moderating role of EC processes on automatic processes (Farris et al., 2010, Friese et al., 2010, Houben and Wiers, 2009, Peeters et al., 2012, Peeters et al., 2013, Thush et al., 2008) we expected that especially adolescents with weak EC capacity would show a relationship between alcohol attentional bias and alcohol use. Thus the present study extends previous research in two important ways. First, this study examines the relationship between reward sensitivity and alcohol attentional bias and tests whether the previously reported relationship between reward sensitivity and adolescent alcohol use is mediated by attentional bias. Second, the study investigates the potential moderating role of EC on the relationship between alcohol-related attentional bias and alcohol use in (young) adolescents by using a performance measure instead of a self-report (subjective) index of EC.
In short the present study tested if i) reward sensitivity would be positively related to adolescent alcohol use, ii) this relationship would be mediated by attentional bias for alcohol pictures, and iii) EC moderates the relationship between attentional bias for alcohol pictures and alcohol use, such that the relation is demonstrated in individuals with weak (but not strong) EC.
Section snippets
Participants and recruitment
Participants were recruited from two different Dutch secondary schools. A total of 88 adolescents in between 12 and 18 years of age agreed to participate and returned the signed informed consent forms. One participant was excluded because of more than 25% missing on the SPSRQ, and one because of more than 25% errors on the ANT. This resulted in a total of 86 participants (37 male and 49 female; mean age = 14.86, SD = 1.37). Descriptive statistics are presented in Table 1.
Self-reported alcohol use
Alcohol use was measured
Bivariate analyses
First, we performed a bivariate correlation analysis to explore the relationship between age, gender, RS and PS, alcohol attentional bias, EC and alcohol use. Table 4 shows that alcohol use was positively correlated with age, and RS, and negatively with gender and PS. It further shows that AB was unrelated to RS and PS. Thus the present findings were inconsistent with the hypothesis that a relationship between reward sensitivity and alcohol use would be mediated by alcohol attentional bias. In
Discussion
This study examined the relation between alcohol use, EC and attentional biases toward alcohol cues. The major results can be summarized as follows: (i) alcohol use was related to strong reward sensitivity, ii) among the predictor variables, reward sensitivity predicted unique variance of alcohol use, (iii) attentional bias toward alcohol cues was not related to reward sensitivity, and (iv) alcohol attentional bias and drinking were related in participants with weak EC but not in those with
Role of funding sources
This study has been financially supported by a grant from the ZonMw Risk Behavior and Dependence grant (60-60600-97-202) and the Heymans Institute for Psychological Research.
Contributors
The first, second and fourth author contributed to the design of the study. The first author took the lead in data collection and statistical analysis and wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgments
We are very grateful for all the participants for their participation in this study. We wish to thank the master students Jessica Stapper and Juliëtte Schouten for their help with the recruitment of participants and the data-collection for this study.
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