State disinhibition and heavy drinking

即使在清醒的时候，有酒精问题的人也比健康人更容易“去抑制”或冲动。似乎抑制解除部分是由于大量饮酒造成的，但它也要对酒精问题的发展、维持和恶化负责。虽然去抑制可以被视为一种相当稳定的特征——有些人只是比其他人更容易去抑制——但最近的研究表明，它也是一种个体内部波动的状态，也就是说，一个特定的个体在某些情况下可能比在其他情况下更容易去抑制。例如，急性压力和酒精相关线索的存在可以增加重度饮酒者的抑制解除。重要的是，最近的研究表明，当人们处于高度去抑制状态时，大量饮酒的可能性更大。我们建议全面研究重度饮酒者去抑制状态波动的意义，以期开发新的临床干预措施，帮助重度饮酒者控制他们的饮酒行为。我们提出了几项研究。首先，从当地社区招募的酗酒者将携带手持电子设备（类似于IPhone），这些设备将在他们的自然环境中（例如在工作和家中）每天多次测量他们的抑制解除情况。我们还将测量他们每天的饮酒量，这将使我们能够检查人们是否倾向于在他们更放松的日子里喝得更多。研究二和研究三将在大学校园的“酒吧实验室”进行；这些研究的目的是调查急性压力（研究2）和酒精“线索”（研究3）是否会导致暂时的去抑制作用增加，以及这些去抑制作用的增加是否与压力和线索导致的饮酒行为增加有关。在研究4中，我们将尝试在重度社交饮酒者中加强抑制控制过程（即减少抑制解除）。在几周的时间里，参与者将在互联网上完成多个电脑化培训课程，其目标是加强他们的抑制控制的一般水平（在一组参与者中），或者加强他们的抑制控制，但只有在酒精相关线索存在时（在另一组中）。对照组的参与者将接受安慰剂训练，他们反复接触与酒精有关的线索，但他们不会接受任何抑制训练。我们预测，抑制控制的反复训练（无论是一般训练还是特定线索训练）将导致酒精消耗量的显著减少。这些研究将促进我们对酒精问题（以及更普遍的成瘾问题）中去抑制的临床意义的理解，并可能为未来酒精问题的行为治疗提供信息。

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.