Interactions between implicit and explicit cognition and working memory capacity in the prediction of alcohol use in at-risk adolescents
Introduction
Several dual process models predict that both more reflective explicit and more impulsive implicit cognitive processes influence behavior (e.g. Fazio and Towles-Schwen, 1999, Kahneman, 2003, Strack and Deutsch, 2004). Implicit cognitions represent more automatic underlying motivational processes, whereas explicit cognitions are related to more deliberate thought processes (Greenwald and Banaji, 1995, Kahneman, 2003). Recently, there has been increased interest in the role of implicit cognitions in the development of addictive behaviors. These implicit alcohol-related cognitions represent individual differences in memory associations between alcohol-related cues (e.g. presence of alcohol), outcomes (e.g. excitement), and behaviors (e.g. drinking). These associations if strengthened over time become motivationally significant and guide behavior relatively automatically (Stacy, 1997). The mesolimbic dopamine reward system has been associated with these relatively automatic motivational processes, which are believed to play an important role in the development of addictive behavior (e.g. Bechara, 2005, Kalivas and Volkow, 2005). Implicit cognitions have been shown to predict unique variance in current and prospective alcohol use after controlling for explicit cognitions (e.g. Jajodia and Earleywine, 2003, Palfai and Wood, 2001, Stacy, 1997, Thush and Wiers, 2007, Wiers et al., 2002).
A second assumption of several dual process models is that the influence of implicit processes on subsequent behavior is moderated by explicit processes if motivation and the opportunity to do so are present (e.g. Fazio and Towles-Schwen, 1999, Kahneman, 2003, Strack and Deutsch, 2004). Indeed, neurobiological addiction research has shown that the prefrontal cortex and associated areas are involved in more reflective decision making and in the moderation of impulses (e.g. Bechara, 2005, Kalivas and Volkow, 2005, Wilson et al., 2004). Dual process models of addiction specifically predict that the influence of implicit appetitive cognitions on subsequent addictive behavior might be dependent on the level of executive functioning (e.g. Stacy et al., 2004, Wiers et al., 2007).
Executive functions can be described as a set of cognitive skills relevant to goal-directed behavior involving different abilities such as shifting, updating and inhibition (Miyake et al., 2000). Working memory capacity has been proposed to be a central construct that possibly binds these different but related executive functions (Kane and Engle, 2002). The relationship between executive functions and alcohol use has been shown to be bidirectional. Poorer executive functioning can be considered a risk factor for developing addictive behaviors such as drinking alcohol (e.g. Finn and Hall, 2004, Peterson et al., 1992, Tapert et al., 2002). Additionally, alcohol abuse has been shown to negatively affect the maturation of brain regions (e.g., De Bellis et al., 2000), to impair neuropsychological functioning (e.g., Brown et al., 2000) and to alter processing on executive functioning tasks (Tapert et al., 2004). During adolescence, when executive functions and associated brain regions are still developing, alcohol induced damage in the prefrontal cortex can lead to inhibitory and attentional control problems which, in turn, may influence continued alcohol use (Crews et al., 2000, Wiers et al., 2007). This bidirectional nature might be more apparent in at-risk adolescents. It is also possible that these at-risk adolescents may start with poorer executive functions and begin drinking at earlier ages, which, in turn, further interferes with their ability to control their drinking behavior.
Prior research has suggested that the influence of implicit automatic processes, on other behaviors, indeed, is moderated by executive control (e.g. Feldman-Barrett et al., 2004, Payne, 2005), as has also been proposed for addictive behaviors (e.g. Stacy et al., 2004, Wiers et al., 2007). Grenard et al. (manuscript under review) evaluated the interaction between working memory capacity and spontaneous memory associations assessed with word association tasks (an alternative indirect assessment of implicit cognitive processes) among at-risk youth and found evidence that drug-relevant associations were stronger predictors of alcohol and cigarette use among those with lower working memory capacity than among those with higher working memory capacity. Finn and Hall (2004) proposed that two mechanisms might be responsible for the moderating influence of executive functioning on the implicit processes-behavior relationship. First, low activating capacity of working memory makes it difficult to shift attention away from highly activated stimuli to stimuli that are less salient. Second, short term positive associations with behavior tend to be highly activated (salient), whereas the long term negative associations with behavior are usually weakly activated. Consequently, in high-risk situations, such as being at a party where alcohol is readily available, an individual needs to be able to switch to less immediately salient goals and attend to them – such as the intention to not drink large amounts of alcohol or binge drink – while distracting salient information in the current high-risk situation is more automatically activated (e.g., the urge to feel intoxicated or to give in to peer pressure). This relationship between executive functioning and behavior suggests that adolescents who are less able to actively manage less salient but adaptive goals when faced with distracting information are more likely to let their behavior be influenced by distracting salient information that is triggered in the current situation (e.g. Stacy et al., 2004, Wiers et al., 2007).
Conversely, research suggests that explicit positive expectancies might be moderated by executive functioning in the opposite direction. In addiction research, alcohol expectancies have been shown to be good predictors of concurrent and, to a lesser extent, prospective alcohol use (e.g., Goldman and Darkes, 2004, Jones et al., 2001, Sher et al., 1996, Stacy et al., 1991). Tapert et al. (2003) showed that explicit positive alcohol expectancies predicted alcohol use in substance use disorder adolescents with good verbal skills, but not in substance use disorder adolescents with poor verbal skills. Verbal skills are needed for developing internal language-based reasoning skills (Luria, 1961) and predictive of positive alcohol expectancies (Deckel et al., 1995). Verbal skill tasks such as the verbal fluency task are commonly regarded as measuring frontal-lobe processing (Deckel et al., 1995) and verbal executive functioning (Tapert et al., 2003). Tapert et al. (2003) concluded that positive alcohol expectancies require encoding and deep processing in order for them to affect decision making and thus drinking. However, other studies have found that adolescents who show good executive functioning (e.g. good inhibitory neural processing) generally had fewer positive and more negative outcome alcohol expectancies (Anderson et al., 2005) and that verbal skills sometimes are also negatively predictive of positive expectancies (Deckel et al., 1995). Thus, there are still some questions about whether positive alcohol expectancies might be moderated by executive functioning in the opposite direction than implicit appetitive associations.
Hence, from a dual process perspective we hypothesized that the influence of implicit appetitive associations (both positive-arousal and positive-sedation) on subsequent drinking behavior is stronger in adolescents with low working memory capacity than in adolescents with high working memory capacity. Conversely, the influence of explicit positive-arousal alcohol-related processes on subsequent drinking behavior is hypothesized to be stronger in adolescents with high working memory capacity compared with adolescents with low working memory capacity. The current study investigated these two interactions between alcohol-related cognition and working memory capacity in the prediction of alcohol use after 1 month in at-risk youth.
Section snippets
Participants
A total of 88 Dutch adolescents (51 male) in the age range of 14–20 (mean age = 16.34, S.D. = 1.34) were recruited from four low-level vocational schools (Thush et al., in press). Based on a Dutch national health survey among high school adolescents, low-level vocational schools showed the highest prevalence of alcohol and drug use as well as behavioral problems. Hence, at the group level, these students are considered to be at risk for developing substance-related problems. Participants
Outliers
Analyses included only those participants reporting that they had consumed alcohol in their lifetime. Two participants reported that they had never consumed alcohol and were therefore eliminated from further analyses. In addition, five participants were excluded from further analysis because they exceeded the mean error scores in the reaction time task by more than 3 standard deviations. The SOPT scores of participants that exceeded the mean by more than 3 standard deviations were recoded to
Discussion
This study showed that the interaction between implicit and explicit positive-arousal cognitions and working memory capacity predicted 1-month follow-up alcohol use in our sample of at-risk adolescents. Results from a hierarchical regression analysis showed that both interactions predicted unique variance in 1-month follow-up alcohol use after controlling for the main effects and background variables. Interestingly, the signs of these interactions were in the opposite direction. That is,
Conflict of Interest
All other authors declare that they have no conflicts of interest
Acknowledgements
The authors wish to thank Frans Feron and Femke van Lambaart for their support on this project concerning the recruitment of participant and data collection.
Contributors: All authors contributed to the design of this study. Carolien Thush undertook the statistical analysis and wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.
Funding for this study was provided by the Dutch Health Care Research Organization (ZON-Mw; 31000065) and the
References (59)
A structural and process analysis of the Implicit Association Test
J. Pers. Soc. Psychol.
(2001)- et al.
Brief intervention for substance use among at-risk adolescents: a pilot study
J. Adolesc. Health
(2007) - et al.
And deplete us not into temptation: automatic attitudes, dietary restraint, and self-regulatory resources as determinants of eating behavior
J. Exp. Soc. Psychol.
(2007) - et al.
Assessing implicit alcohol associations with the Implicit Association Test: fact or artifact?
Addict. Behav.
(2006) - et al.
Computerized training of working memory in children with ADHD: a randomized clinical trial
J. Acad. Child Adolesc. Psychiatry
(2005) - et al.
The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis
Cognit. Psychol.
(2000) - et al.
Deficits on subject-ordered tasks after frontal- and temporal-lobe lesions in man
Neuropsychologia
(1982) - et al.
Approach and avoidance in fear of spiders
J. Behav. Ther. Exp. Psychiatry
(2007) - et al.
Attention dysfunction predicts substance involvement in community youths
J. Am. Acad. Child Adolesc. Psychiatry
(2002) - et al.
Explicit and implicit alcohol-related cognitions and the prediction of current and future drinking in adolescents
Addict. Behav.
(2007)
Automatic and controlled processes and the development of addictive behaviors in adolescents: a review and a model
Pharmacol. Biochem. Behav.
Comparison of indirect assessments of association as predictors of marijuana use among at-risk adolescents
Exp. Clin. Psychopharmacol.
Examining personality and alcohol expectancies using functional magnetic resonance imaging (fMRI) with adolescents
J. Stud. Alcohol
Double dissociation between implicit and explicit personality self-concept: the case of shy behavior
J. Pers. Soc. Psychol.
Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive perspective
Nat. Neurosci.
Experimental Run Time System (ERTS), Version 3.18
Neurocognitive functioning of adolescents: effects of protracted alcohol use
Alcohol. Clin. Exp. Res.
Binge ethanol consumption causes differential brain damage in young adolescent rats compared with adult rats
Alcohol. Clin. Exp. Res.
Hippocampal volume in adolescent-onset alcohol use disorders
Am. J. Psychiatry
Relationship between alcohol-related expectancies and anterior brain functioning in young men at risk for developing alcoholism
Alcohol. Clin. Exp. Res.
The Extrinsic Affective Simon Task
Exp. Psychol.
The MODE model of attitude-behavior processes
Individual differences in working memory capacity and dual-process theories of the mind
Psychol. Bull.
Cognitive ability and risk for alcoholism: short-term memory capacity and intelligence moderate personality risk for alcohol problems
J. Abnorm. Psychol.
Alcohol expectancy multiaxial assessment: a memory network-based approach
Psychol. Assessment
Implicit social cognition: attitudes, self-esteem, and stereotypes
Psychol. Rev.
Measuring individual differences in implicit cognition: The Implicit Association Test
J. Pers. Soc. Psychol.
Understanding and using the implicit association test. 1. An improved scoring algorithm
J. Pers. Soc. Psychol.
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Present address: Radboud University, Nijmegen, The Netherlands; The Dutch Addiction Research Institute (IVO), Rotterdam, The Netherlands.