Healthcare Training Institute - Quality Education since 1979
CE for Psychologist, Social Worker, Counselor, & MFT!!
Alcohol-related learning (both instrumental and classical) appears to be an important factor in accounting for alcohol consumption variability. The way in which alcohol-related information, stored in memory, is processed is likely to be similar in individuals at different points of the continuum of consumption. (Indeed, it is a feature of social learning and social cognition theory that there is continuity of process: Maisto, Carey & Bradizza, 1999.) This means that there should be value in extending the use of the cue-reactivity paradigm from the pole of dependent (clinical) consumption, through the (subclinical) regions where there is no longer dependence but there are still consumption-related problems, to the problem-light (nonclinical) pole. There should be value that goes beyond simply providing a baseline control against which cue-reactivity at the dependent pole can be assessed. The current experiment is designed to add to the knowledge provided by those researchers who have recognized this (e.g. Walitzer & Sher, 1990; Greeley et al, 1993) by increasing both the sensitivity and the range of the dependent variables they have used.
Design: A 2 x 2 between-subjects design was used for the cue exposure experiment, with 'drink cue' (two levels: soft (S) and alcoholic (A)) and 'order' (two levels: 'desire' questionnaire first (DE) and 'expectancy' questionnaires first (ED)) as the between-subject factors and with random assignment of subjects to cells. This crossing generated four independent groups each with 22 participants. During cue exposure participants completed a 'taste preference' questionnaire, and were then assessed on the dependent variables, desire to drink alcohol and alcohol outcome expectancies.
Measures and cue exposure stimuli: For the cue exposure, participants had a choice of one from either three soft drinks (cans) or three alcoholic drinks (bottles) according to group allocation. The 'taste preference' questionnaire, applicable to both soft and alcoholic drinks, took participants systematically through the stages of cue exposure (sight, smell, taste), systematically directing the participants' attention to the drink cues by asking a range of questions about the drink. The cue exposure/ taste preference was designed to last 10 minutes. Desires/urges were assessed with a modified version of the Desire for Alcohol Questionnaire (DAQ: Love et al., 1998), which consists of 14 items on four subscales: (i) strong desires and intentions; (ii) negative reinforcement; (iii) control over drinking; and (iv) mild desires to drink. Responses were measured on a seven-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Alcohol expectancies were assessed using the Negative Alcohol Expectancy Questionnaire (NAEQ: Jones & McMahon, 1994, 1995) and the positive Alcohol Expectancy Questionnaire (AEQ: Brown et al., 1987). The NAEQ has three subscales representing 60 items of negative expectancy that (a) surround the period of consumption (subscale 'same day'), that (b) relate to the following day (subscale 'next day') and that (c) relate to the longer term (months and years) should consumption continue at the current level (subscale 'continued drinking'). The AEQ has six subscales that represent 64 items of positive effects of drinking: 'global positive change', 'physical and social pleasure', 'sexual enhancement', 'social assertiveness', 'relaxation and tension reduction' and 'arousal and aggression'. Responses to NAEQ and AEQ items were measured on five-point Liken scales ranging from 1 ('highly unlikely') to 3 ('possible') to 5 ('highly likely'). An adaptation of the Timeline Follow-back procedure (Sobell & Sobell, 1992) was used to collect information on the previous week's alcohol consumption and derive the number of units of alcohol consumed in the week. Demographic measures were taken.
Procedure: Before the experiment, participants were informed that the 'taste preference' experiment may or may not involve drinking up to a unit of alcohol (8 g of absolute alcohol). They agreed to take part by signing a consent form.
The finer-grain analysis shows that cognitions represented by the subscale 'strong intentions and desires' also react to the alcohol cues and this replicates Schulze & Jones's (1999) earlier finding with this subscale. In their report they noted that two of the DAQ's four subscales comprised principally positive alcohol outcome expectancies: 'mild desires' comprised positive outcome expectancies that were positively reinforcing; 'negative reinforcement' comprised positive outcome expectancies that were negatively reinforcing. They also showed that the subscale 'mild desires' was alcohol cue-reactive (an increase in desire) but the subscale 'negative reinforcement' was not. This differential reactivity on positive expectancies supports Glautier & Tiffany's (1995) criticism that subjective alcohol cue-reactivity research requires a more fine-grain representation if theory is to be advanced--for a single item representation such as the DAQ total or a single numerical or analogue judgement (as described above) would not have captured this. However, although the differential reactivity was replicated in the current experiment, the direction of the difference was reversed. The lack of any significant alcohol cue response with the explicit positive expectancy construct (the AEQ total or the six AEQ subscales) in the current experiment does not help resolve this inconsistency and the extent to which positive alcohol expectancies might be alcohol cue-reactive needs further investigation. Just as alcohol cue-reactivity was not shown by the positive expectancy assessments (AEQ), it was also not shown by the negative expectancy assessments (NAEQ). One conclusion is that alcohol outcome expectancies are relatively stable, representing trait rather than state constructs (they are, after all, derived from memory structures that are the result of prolonged learning). However, Darkes & Goldman (1998) have shown that positive expectancies represented by the AEQ can, indeed, be changed in the relatively short term (hours, using an 'expectancy challenge' procedure) and Jones & McMahon (1998) have shown the same for negative expectancies represented by the NAEQ (days, using a 'motivational interviewing' procedure). This, coupled with the finding that the (implicit) positive expectancy components of the DAQ have demonstrated alcohol cue-reactivity in the current experiment and Schulze & Jones's (1999) earlier experiment, suggests that the state nature of expectancies within cue-reactivity paradigms warrants further investigation.
It has been one of the goals of contemporary alcohol researchers (basic and applied) to develop representations of alcohol motivations that integrate all relevant information into a 'final common path' (as, for example, described by Cox & Klinger, 1987). In the same vein (although within a much more limited framework), there has been a recognition of the need for a theoretical integration of learning manifest as cue-reactivity and learning manifest as outcome expectancy (e.g. Glautier & Remington, 1995). A better understanding of the variability in alcohol consumption might come from the collaboration of expectancy and cue-reactivity approaches--and within a single common framework provided by cognitive psychology, associative networks (Glautier & Spencer 1999).
Reflection Exercise #4