Biological psychiatry. Cognitive neuroscience and neuroimaging · 2026
Fluctuations in real-life drinking in alcohol use disorder: A one-year longitudinal study using gamified tasks of decision making and cognitive control.
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Zech Hilmar, Waltmann Maria, Reichert Dominic, Arntz Fabian, Lee Ying, Reichert Markus, Bedder Rachel L, Rutledge Robb B, Goschke Thomas, Lenz Bernd, Bach Patrick, Kiefer Falk, Marxen Michael, Spanagel Rainer, Tost Heike, Ebner-Priemer Ulrich, Rapp Michael A, Heinz Andreas, Dolan Ray, Smolka Michael N, Deserno Lorenz
Аннотация
BACKGROUND: Alcohol use disorder (AUD) is a major contributor to global disability and mortality. Cross-sectional studies have linked AUD to reduced cognitive control and heightened risky decision-making. However, the temporal direction of these effects remains unknown: are cognitive-behavioral alterations a consequence or a precursor of changes in drinking?
METHODS: We deployed a battery of smartphone-based, gamified tasks in a one-year longitudinal ecological momentary assessment study of N=603 participants diagnosed with mostly mild to moderate AUD. Tasks measured cognitive control (working memory, response inhibition) and decision-making (risk-taking, information sampling). Participants completed tasks monthly and reported alcohol consumption every two days.
RESULTS: We found that monthly fluctuations in aspects of decision-making predicted subsequent consumption. Specifically, participants shifted to higher monthly alcohol consumption when their risk-taking was higher in a mixed gambling context and lower in a loss context in the preceding month. Further, when information sampling biases decreased, participants consumed more alcohol in the subsequent month. This temporal direction-that within-subject fluctuations in task outcomes preceded changes in monthly drinking-was specific, was not observed vice versa and survived correction for autocorrelation in drinking, indicating risky decision-making as a precursor of subsequent drinking. Fluctuations in cognitive control and risk-taking in a win context were not associated with fluctuations in drinking.
DISCUSSION: Our findings offer novel insights into the cognitive-behavioral forces driving changes in alcohol consumption in AUD: specific decision-making alterations precede changes in consumption. These findings suggest that smartphone-based gamified tasks show promise to identify periods of heightened risk paving the way for mechanism-based, real-time interventions in AUD.
METHODS: We deployed a battery of smartphone-based, gamified tasks in a one-year longitudinal ecological momentary assessment study of N=603 participants diagnosed with mostly mild to moderate AUD. Tasks measured cognitive control (working memory, response inhibition) and decision-making (risk-taking, information sampling). Participants completed tasks monthly and reported alcohol consumption every two days.
RESULTS: We found that monthly fluctuations in aspects of decision-making predicted subsequent consumption. Specifically, participants shifted to higher monthly alcohol consumption when their risk-taking was higher in a mixed gambling context and lower in a loss context in the preceding month. Further, when information sampling biases decreased, participants consumed more alcohol in the subsequent month. This temporal direction-that within-subject fluctuations in task outcomes preceded changes in monthly drinking-was specific, was not observed vice versa and survived correction for autocorrelation in drinking, indicating risky decision-making as a precursor of subsequent drinking. Fluctuations in cognitive control and risk-taking in a win context were not associated with fluctuations in drinking.
DISCUSSION: Our findings offer novel insights into the cognitive-behavioral forces driving changes in alcohol consumption in AUD: specific decision-making alterations precede changes in consumption. These findings suggest that smartphone-based gamified tasks show promise to identify periods of heightened risk paving the way for mechanism-based, real-time interventions in AUD.