Decreasing the Temporal Window in Individuals With Alcohol Use Disorder

Participants will be randomly assigned to experimental or control groups, balanced by discounting rates and sex. We plan to have 112 participants complete the study, based on our power analysis. Participants will complete two online sessions. During the first session, they will complete the baseline assessments. During the second session, they will complete the same assessments after being exposed to the scarcity or control narratives (both in audio format).

The assessment will include delay discounting and demand tasks, and measures of alcohol craving. Participants will also complete assessments of their stress and mood response to the narrative intervention, using the Stress Appraisal Measure (SAM) for two purposes. That is, 1) to monitor participant safety, 2) to measure the mediating ability of affect on changes in the temporal window.

• Scarcity Narrative (Behavioral): Participants are presented with a hypothetical scarcity narrative and asked to listen and consider the scenario.
• Neutral Narrative (Behavioral): Participants are presented with a hypothetical neutral narrative and asked to listen and consider the scenario.

Primary outcomes

• Delay Discounting (DD) Rates [At the first session (S1; baseline measures) and Session 2 (S2; occurs approximately 2-3 days after S1)]: DD rates were measured using an adjusting amount task where participants were presented with hypothetical choices between smaller immediate or larger later amounts of money after a range of delays (1 day-25 years). Individual indifference points were calculated for each delay and then used to estimate DD rates for each participant using Mazur's (1987) equation: V = A/(1+kD), where V is the value of the indifference point, A is the amount of the larger delayed reward, k is the discounting rate, and D is the delay. Discounting rates (k) were then natural-logarithmically transformed (ln(k)). Higher ln(k) indicates steeper discounting and greater reward devaluation with increases in delay, while a lower ln(k) reflects shallower discounting and less reward devaluation with increases in delay. Changes in ln(k) were compared within-subjects between S1 and S2. Average ln(k) was calculated for each session (S1 and S2) in each condition (scarcity or neutral).
• Intensity of Alcohol Demand [At the first session (S1; baseline measures) and Session 2 (S2; occurs approximately 2-3 days after S1)]: Participants completed a hypothetical Alcohol Purchase Task where they had to indicate how many drinks they would purchase at different prices ($0 to $80 per drink). The number of drinks purchased at $0 was used to calculate the intensity of demand. Changes in intensity of alcohol demand were compared within-subjects between Session 1 and Session 2, and between narrative type (scarcity or neutral).
• Change in Alcohol Craving [At the first session (S1; baseline measures) and Session 2 (S2; occurs approximately 2-3 days after S1)]: A brief questionnaire (the Alcohol Urges Questionnaire) will be used to assess alcohol craving. The Alcohol Urges Questionnaire is an 8-item survey that produces scores between 8-56, where higher scores indicate greater craving. Change in alcohol craving will be compared within-subjects between Session 1 and Session 2. The scores will be compared between groups (arms) across sessions.

Secondary outcomes

• Change in Stress Appraisal Measure [Session 2 (occurs approximately 2-3 days after baseline [S1])]: The Stress Appraisal Measure will be used to measure acute stress induced by the intervention. This measure is a 28-item survey that produces scores between 28-140, where higher scores indicate greater stress. Change scores were compared between groups during Session 2, to assess differences in stress level as a function of the narrative presented.

Sex: All, ages: 21 Years to any

Inclusion Criteria:

* High-risk or harmful drinking (AUDIT>15)
* 21 years of age or older
* Desire to quit or cut down on their drinking, but do not have proximate plans to enroll in treatment for AUD during the study period

Exclusion Criteria:

* having a current unmanaged psychotic disorder
* reporting current pregnancy or lactation
* having dementia

Participant flow

Outcome results

• Delay Discounting (DD) Rates (Primary), Mean, ln(K-value): Scarcity Narrative -4.69 +/- 0.38; Neutral Narrative -5.15 +/- 0.38 (p .60)
• Intensity of Alcohol Demand (Primary), Mean, Drinks: Scarcity Narrative 14.17 +/- 1.53; Neutral Narrative 16.22 +/- 2.55 (p .54)
• Change in Alcohol Craving (Primary), Mean, score on a scale: Scarcity Narrative 34.4 +/- 1.98; Neutral Narrative 33.11 +/- 1.87 (p .88)
• Change in Stress Appraisal Measure (Secondary), Mean, score on a scale: Scarcity Narrative 88.52 +/- 2.14; Neutral Narrative 73.49 +/- 2.02 (p <.001)

Adverse events

Time frame: During study participation (approximately 1 week)

• Study Protocol and Statistical Analysis Plan (PDF, 2024-02-27)

• Stephen M LaConte, PhD, Principal investigator, Fralin Biomedical Research Institute at VTC

NIH grants: R01AA027381