Proximal and Distal Associations between Alcohol Demand, Subjective Craving, and Alcohol-Related Outcomes using an Ad-Lib Paradigm

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Project Summary Heavy alcohol use among young adults (YA) is a major public health concern and is associated with well- documented short- and long-term consequences. Recent data suggest that a third of YA engage in heavy alcohol use, and that moderate and severe alcohol use disorders (AUD) have an earlier age of onset compared to mild AUD. These data highlight the importance of understanding risk factors for heavy alcohol use and the development of AUD among YA. Behavioral economic theory combines operant and economic principles to posit that alcohol’s reinforcing value (RV) is the final pathway to alcohol consumption and explains the persistence of alcohol use despite the associated negative consequences. Alcohol demand is a quantitative measure of alcohol’s RV and can provide useful information about patterns of heavy alcohol use and associated risk for development of AUD among YA. Alcohol demand has been cross-sectionally associated with greater quantity and frequency of alcohol use, alcohol dependence, and poor treatment outcomes among YA. Further, alcohol demand may help explain the inconsistent relationship between subjective craving and alcohol-related outcomes, as subjective craving and alcohol demand appear to represent unique facets of motivation. It is theorized that increased alcohol demand may be more proximal to alcohol consumption than subjective craving, but more research is necessary to elucidate this relationship. While demand has been associated with alcohol-related outcomes, alcohol demand is known to fluctuate over time, and few studies have assessed the proximal and distal associations between alcohol demand, subjective craving, and alcohol-related outcomes as a function of acute intoxication. These data would fill an important gap in the literature by demonstrating the relationship between alcohol demand, subjective craving, and alcohol consumption within a drinking episode and longitudinally, which has implications for understanding the unique roles of these variables in YA alcohol use, as well as who might be at greatest risk for the development of AUD. Relatedly, these data have important implications for prevention and intervention efforts aimed at YA. Specifically, findings from the proposed study could inform brief interventions aimed at reducing within drinking session demand with the goal of reducing risk of the development of AUD over time. Using a multimethod research design, the proposed study will fill an important gap in the behavioral economic and subjective craving literature with the following aims: 1) to assess the proximal temporal relationship between demand for alcohol, subjective craving, and subsequent alcohol consumption in an ad-lib drinking paradigm; 2) To examine the distal temporal relationship between alcohol demand, subjective craving, and drinking outcomes following a period of acute intoxication. In addition to addressing these specific aims, the applicant will also receive training in: 1) the etiology of alcohol use among young adults, more broadly, 2) development and management of alcohol administration studies, 3) advanced statistical methods, and 4) scientific writing.