Influence of real-world cue exposure and mood states on drinking: testing neurobiological models of alcohol use disorder.

Rationale: Two prominent neurobiological models of addiction, the allostatic and incentive-sensitization models, have guided clinical research on alcohol use disorder (AUD). While these models are often viewed in isolation, it is plausible these theories are complimentary.

Objectives: Use naturalistic, daily diary reports to determine whether positive and negative mood states influence alcohol cue sensitivity in a clinical sample with AUD.

Methods: This is an exploratory analysis of daily diary data collected from a non-treatment seeking sample with current AUD over two weeks. Eligible adult participants (N = 50) were enrolled in a medication trial for AUD. Each morning, participants retrospectively reported on pre-drinking mood states, alcohol cue exposure, and craving levels, and subsequent alcohol intake occurring the previous day. Multilevel models tested the singular and interactive relationships between cue exposure and mood states with craving and drinking. Within-person and between-person outcomes were assessed. Exploratory analyses examined whether individuals with withdrawal-related dysphoria were more vulnerable to mood states and cue-reactivity.

Results: Greater cue exposure was associated with higher daily drinking levels (p = .001), but not daily alcohol craving. Higher negative mood (p < .0001) and lower positive mood (p = .012) were associated with higher daily alcohol craving, but not same-day drinking. As negative mood levels increased (p < .01) and positive mood levels decreased (p = .010), the relationship between cue exposure and same-day drinking became stronger. These findings were most pronounced among those with withdrawal-related dysphoria.

Conclusions: Findings provided concomitant support for the allostatic model and incentive-sensitization model as determinants of alcohol craving and drinking among individuals with AUD.