Real-Time Assessment of Alcohol Reward, Stimulation, and Negative Affect in Individuals With and Without Alcohol Use Disorder and Depressive Disorders.

Abstract

Objective: The allostasis theory states that, as addiction develops, alcohol is consumed to relieve negative affect rather than to produce positive effects. This study aimed to investigate the real-time subjective effects of alcohol in individuals with alcohol use disorder (AUD) and those prone to negative affect by virtue of having comorbid depressive disorder (DEP).

Methods: Participants (N=221) completed high-resolution ecological momentary assessments during 3-hour monitoring of one alcohol drinking episode and one non-alcohol drinking episode in their natural environment. Participants also completed daily mood surveys and next-day surveys. Linear mixed-effect models were used to compare drinking behavior and subjective responses (stimulation, sedation, liking, wanting, negative affect) among 120 participants with AUD (AUD+; with depression [DEP+]: N=64, without depression [DEP-]: N=56) and 101 participants without AUD (AUD-; DEP+: N=45, DEP-: N=56).

Results: During the monitoring period, participants with AUD consumed an average of 8.5 standard alcohol drinks (estimated blood alcohol concentration [eBAC]=0.115 g/dl) versus 3.7 drinks (eBAC=0.040 g/dl) for non-AUD participants. The AUD group, regardless of comorbid DEP, reported increases in stimulation and rewarding effects that persisted throughout most of the alcohol episode relative to the non-alcohol episode. To a lesser extent, alcohol relieved negative affect but this was not specific to AUD or DEP groups.

Conclusions: Contrary to the allostasis model of addiction's emphasis on negative reinforcement drinking, findings demonstrated that people with AUD prone to negative affect displayed positive alcohol reinforcement with pronounced and prolonged sensitivity to alcohol's pleasurable effects, akin to their noncomorbid counterparts. The findings provided critical testing of addiction theories in the natural environment to enhance external validity.