Alcohol Craving in the Natural Environment: Moderating Roles of Cue Exposure, Drinking, and Alcohol Sensitivity

Public Health Significance This study provides evidence that, in natural settings, craving for alcohol is especially high when drinkers are exposed to alcohol cues during a drinking episode. The study also suggests that individuals lower in sensitivity to alcohol's acute effects may be especially vulnerable to the craving-provoking effects of alcohol cues during drinking episodes. These findings are the first to demonstrate a combined effect of cue exposure and postdrinking status on craving for alcohol in the natural environment. Effects of cue exposure and alcohol consumption (e.g., priming doses) on craving for alcohol have been examined in largely separate literature, limiting what is known about their potential interaction. Individuals with low alcohol sensitivity, a known risk factor for alcohol use disorder (AUD), exhibit stronger cue-elicited craving than their higher-sensitivity (HS) peers in both laboratory and real-world contexts. Here, underage drinkers (N = 155) completed a 21-day ecological momentary assessment (EMA) protocol in which they recorded exposure to alcohol cues and levels of craving during both nondrinking and postdrinking moments. Multilevel modeling detected a significant interaction of cue exposure and postdrinking status on craving. Cue-induced craving was increased in postdrinking moments compared to nondrinking moments. Contrary to prediction, cue-elicited increase in craving during nondrinking moments was stronger in participants reporting higher sensitivity to alcohol. In the presence of cues, lower sensitivity was robustly related to craving intensity in the postdrinking state but unrelated to craving during nondrinking moments. Craving during drinking episodes in the natural environment is magnified by the presence of alcohol cues, potentially contributing to the maintenance or acceleration of drinking episodes. Moreover, lower-sensitivity drinkers may be particularly susceptible to the combined effects of cue exposure and postdrinking status on alcohol craving.