This competing continuation application follows-up on the major findings from our last five years of funding that showed that alcohol dependence (AD) with high levels of co-occurring antisocial psychopathology (AP) was consistently associated with higher levels of disinhibited impulsive decision making, risky decisions to drink, and reduced executive working memory capacity (eWMC) compared with those with alcohol use disorders (AUDs) with low levels of AP and co-occurring externalizing psychopathology (EXT). Furthermore, our results showed that reduced eWMC played a key role in the disinhibited, impulsive decision making in those with AD and high AP, and compromising eWMC via a cognitive load significantly increased impulsive decision making and risky decisions to drink to extreme levels in those with AD and high AP. This application proposes to further investigate the role / mechanisms of eWMC in impulsive decision-making in AD with high AP by systematically studying the effects (on impulsive decision making and risky drinking decisions) of manipulations designed (i) to deplete eWMC (via WM - cognitive load), (ii) offset the effects of WM load depletion (via an attentional shifting - refocus technique), and (iii) augment aspects of eWMC (via adaptive eWMC training). Although not a clinical trial, this study lays the foundation for the development of cognitive interventions designed to reduce impulsive decision making and behavioral disinhibition in AD with high AP. The first specific aim is to systematically study the effect of an attentional shifting - refocusing technique to offset the impact of a WM load on impulsive decision making and risky drinking decision making in those with AD and high AP compared with those with AUDs and low AP, and controls without any EXT. The second specific aim is to investigate the effects of an adaptive eWMC training program on 1. impulsive decision making/risky drinking decisions and alcohol consumption, 2. measures of eWMC, 3.other measures of executive function associated with attention (flanker/stroop) and motor inhibition, and 4. the effects of negative and positive affect/urgency on decision making. Computational models are used to identify key cognitive processes associated with disinhibited, impulsive decision making and eWMC that may be affected by cognitive load and the two training manipulations. The third specific aim is to investigate the personality, cognitive, subjective, and symptom-level predictors of the effectiveness of the attentional shifting - refocusing technique and eWMC training on decision making. This study has high clinical relevance and potential for clinical impact. The results of the study will have direct implications for the development and refinement of cognitive interventions to modify impulsive, risky decision making (a core vulnerability) in those with AD and EXT in general, and for understanding the factors that may predict the positive impact of these two interventions on impulsivity in those with AD and EXT in general.

Public Health Relevance

Early-onset alcohol dependence is associated with profound deficits in self-control. This project investigates the mechanisms by which reduced working memory capacity is associated with impulsive decision-making in early-onset alcohol dependence by systematically studying the effects of two training manipulations designed to: (i) increase working memory capacity and (ii) offset the deleterious impact of a working memory load on decision making. This project lays the foundation for the development of interventions to reduce impulsive decision making and excessive drinking in those with alcohol dependence and has high clinical relevance.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
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Study Section
Child Psychopathology and Developmental Disabilities Study Section (CPDD)
Program Officer
Witt, Ellen
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Indiana University Bloomington
Schools of Arts and Sciences
United States
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Gunn, Rachel L; Gerst, Kyle R; Wiemers, Elizabeth A et al. (2018) Predictors of Effective Working Memory Training in Individuals with Alcohol Use Disorders. Alcohol Clin Exp Res 42:2432-2441
Bailey, Allen J; Gerst, Kyle; Finn, Peter R (2018) Delay discounting of losses and rewards in alcohol use disorder: The effect of working memory load. Psychol Addict Behav 32:197-204
Wiemers, Elizabeth A; Redick, Thomas S (2018) Working memory capacity and intra-individual variability of proactive control. Acta Psychol (Amst) 182:21-31
Wiemers, Elizabeth A; Redick, Thomas S (2018) The influence of thought probes on performance: Does the mind wander more if you ask it? Psychon Bull Rev :
Cheng, Hu; Kellar, Derek; Lake, Allison et al. (2018) Effects of Alcohol Cues on MRS Glutamate Levels in the Anterior Cingulate. Alcohol Alcohol 53:209-215
Gunn, Rachel L; Gerst, Kyle R; Lake, Allison J et al. (2018) The effects of working memory load and attention refocusing on delay discounting rates in alcohol use disorder with comorbid antisocial personality disorder. Alcohol 66:9-14
Redick, Thomas S; Unsworth, Nash; Kane, Michael J et al. (2017) Don't Shoot the Messenger: Still No Evidence That Video-Game Experience Is Related to Cognitive Abilities-A Reply to Green et al. (2017). Psychol Sci 28:683-686
Finn, Peter R; Gerst, Kyle; Lake, Allison et al. (2017) Decisions to Attend and Drink at Party Events: The Effects of Incentives and Disincentives and Lifetime Alcohol and Antisocial Problems. Alcohol Clin Exp Res 41:1622-1629
Gerst, Kyle R; Gunn, Rachel L; Finn, Peter R (2017) Delay Discounting of Losses in Alcohol Use Disorders and Antisocial Psychopathology: Effects of a Working Memory Load. Alcohol Clin Exp Res 41:1768-1774
Forster, Sarah E; Finn, Peter R; Brown, Joshua W (2017) Neural responses to negative outcomes predict success in community-based substance use treatment. Addiction 112:884-896

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