Cognitive Mechanisms of Heavy Drinking

UoM administered thesis: Phd

  • Authors:
  • Elly Mcgrath


Background: In order to develop reliable preventive measures for heavy drinking, investigating the cognitive differences present in heavy drinkers may be crucial. The focus of this thesis is on impulsivity, executive function and attentional bias for alcohol. The thesis is formed by three parts; the first (Study 1) investigates how these mechanisms could be trained using neuropsychological tasks in order to reduce alcohol consumption. The second (Studies 2 and 3), focuses on applying those findings to the understanding and use of implementation intentions to reduce alcohol consumption. The third (Studies 4 and 5), focusses on the impact of impaired cognition in heavy drinkers in terms of violent offending. Study 1: A systematic review and meta-analysis to establish whether training heavy drinkers in cognitive tasks designed to improve impulsivity, executive control and biased attention for alcohol reduces subsequent alcohol consumption. Nine studies reported in eight papers met the inclusion criteria. There was a small effect of completion of cognitive tasks on reducing alcohol consumption. Study 2: An fMRI investigation conducted on 32 heavy drinkers using neuroimaging paradigms to assess the impact on alcohol consumption of including an implementation intention into the instructions of two cognitive training tasks. Results show a marked reduction in alcohol consumption. Study 3: Applying implementation intentions directly targeting alcohol behaviour to a heavy drinking population and investigating how facets of executive function, impulsivity and attentional bias mediate the effect of this intervention on alcohol consumption. Results show a significant reduction in alcohol consumption by implementation intentions proving their effectiveness for heavy drinkers. Study 4: A multi-dimensional investigation of impulsivity, executive function and attentional bias applying findings from the heavy drinking literature to a violent heavy drinking population using a combination of self-report measures and neuropsychological tasks. Results suggest that violent heavy drinkers show greater deficits in impulsivity than non-violent heavy drinkers and have approach and avoidance conflict tendencies similar to that of dependant alcohol users. Study 5: A large-scale study employing longitudinal data of sanctioned offenders, their criminogenic needs assessments and contact with criminal justice agencies to assess whether alcohol-using offenders have higher rates of prior violent offending than abstinent offenders. Results indicated higher rates of violent offending in alcohol using offenders. The difference was particularly pronounced in women, who had prior violent offending rates at three times higher than their gender-matched counterparts. Conclusions: This thesis has generated some important findings. Firstly, current neuropsychological measures of impulsivity, executive function and attentional bias are not specific enough to detect change brought about by brief alcohol interventions. Secondly, implementation intention formations are highly effective at reducing alcohol consumption in heavy drinkers. Thirdly, violent offending is likely influenced by the same cognitive deficits as heavy drinking. This has implications for future research that should enable better understanding, inform more effective neuropsychological identification measures of these cognitive facets and attempt to replicate the alcohol consumption reduction reported.


Original languageEnglish
Awarding Institution
Award date1 Aug 2019