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Alcohol approach-avoidance task behavior and brain potentials differentially predict ecologically assessed alcohol craving and consumption in early emerging adulthood
Journal article   Open access   Peer reviewed

Alcohol approach-avoidance task behavior and brain potentials differentially predict ecologically assessed alcohol craving and consumption in early emerging adulthood

Roberto U Cofresí, Sandie Keerstock, Casey B Kohen, Thomas M Piasecki and Bruce D Bartholow
Addiction (Abingdon, England), Vol.121(4), pp.804-824
04/2026
DOI: 10.1111/add.70247
PMCID: PMC12980300
PMID: 41292122
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC12980300/View
Open Access

Abstract

The current study measured the extent to which different neurobehavioral indices of incentive-motivational salience attribution to alcohol cues predict alcohol craving and consumption in the natural environment. Laboratory study at a university in Missouri, USA, followed by a smartphone-based 21-day ecological momentary assessment (EMA) protocol. Participants were emerging adults (N = 218-268 [52-56% female], age 18-20). Participants completed an alcohol cue approach-avoidance task while their electroencephalogram (EEG) was recorded. Behavioral measures (response time) indexed the strength of cue-activated approach vs. avoidance tendency. Cue-locked event-related potentials provided EEG-based neural measures of motivated attention (P3 amplitude) and approach-avoidance conflict (N450 amplitude). From EMA, measures of alcohol consumption dynamics (as indexed by estimated blood alcohol concentration [eBAC], g/dL) during real-world drinking episodes were obtained, as were measures of alcohol craving (7-point visual analogue scale) dynamics during and outside these episodes. Different approach-avoidance task-derived behavioral and neural measures rank-ordered participants differently. Participants who approached alcohol cues more rapidly in lab subsequently showed steeper increases in craving (∆B ± standard error [SE] = 1.042 ± 0.499 point/hr), and eBAC (∆B ± SE = 0.046 ± 0.017 g/dl/hr), during real-world drinking episodes. Participants who avoided alcohol cues more slowly in lab also showed steeper increases in eBAC (∆B ± SE = 0.056 ± 0.017 g/dl/hr). Participants with larger P3 during alcohol cue approach in lab subsequently showed steeper increases in eBAC (∆B ± SE = 0.048 ± 0.017 g/dl/hr), as did those with smaller P3 during alcohol cue avoidance (∆B ± SE = 0.025 ± 0.017 g/dl/hr). Participants with smaller N450 during alcohol cue approach in lab subsequently showed steeper increases in craving during drinking episodes (∆B ± SE = 1.465 ± 0.607 point/hr). Tests examining lab-based neurobehavioral measures as predictors of craving dynamics during nondrinking moments, such as following incidental cue exposure, generally were inconclusive. Incentive salience toward alcohol may influence alcohol seeking (including craving) and alcohol consumption through distinct behavioral risk pathways in different people.
 Neuroscience approach bias craving ERP positive affect incentive salience appetitive motivation attention bias cue reactivity

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