State disinhibition and heavy drinking

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Even when sober, people with alcohol problems tend to be more 'disinhibited', or impulsive, than healthy individuals. It seems that disinhibition arises partly as a consequence of heavy drinking, but it is also responsible for the development, maintenance and worsening of alcohol problems. While disinhibition can be seen as a fairly stable trait - some people are just more disinhibited than others - recent research indicates that it also functions as a state that fluctuates within individuals, i.e. a given individual might be more disinhibited in some situations than in others. For example, things such as acute stress and the presence of alcohol-related cues can increase disinhibition in heavy drinkers. Importantly, recent research suggests that heavy drinking is more likely when people are in a state of high disinhibition. We propose to comprehensively investigate the significance of state fluctuations of disinhibition in heavy drinkers, with a view to developing new clinical interventions which might help heavy drinkers to gain control over their drinking behaviour. We propose several studies. In the first, heavy drinkers recruited from the local community will carry handheld electronic devices (similar to the IPhone) that will measure their disinhibition several times per day, in their natural environment (e.g. at work and at home). We will also measure their alcohol consumption each day and this will enable us to examine if people tend to drink more on days when they are more disinhibited. Studies two and three will be conducted in a 'bar lab' on the University campus; the aim of these studies is to investigate if acute stress (study 2) and alcohol 'cues' (study 3) lead to temporary increases in disinhibition, and if these increases in disinhibition are responsible for the increased drinking behaviour that occurs in response to stress and cues. In study 4 we will attempt to strengthen inhibitory control processes (i.e., reduce disinhibition) among heavy social drinkers. Over a period of several weeks, participants will complete multiple computerised training sessions over the internet, the goal of which is to strengthen their general level of inhibitory control (in one group of participants), or to strengthen their inhibitory control but only when in the presence of alcohol-related cues (in a different group). A control group of participants will receive placebo training in which they are repeatedly exposed to alcohol-related cues, but they will not receive any inhibition training. We predict that repeated training of inhibitory control (either general training or cue-specific training) will lead to significant reductions in the volume of alcohol consumed. These studies will advance our understanding of the clinical significance of disinhibition in alcohol problems (and in addiction problems more generally), and they may inform future behavioural treatments for alcohol problems.