Fluctuations in Real-Life Drinking in Alcohol Use Disorder: A 1-Year Longitudinal Study Using Gamified Tasks of Decision Making and Cognitive Control
Year: 2026
Type: article
Study design: Observational Study
Abstract: 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 1-year longitudinal ecological momentary assessment study of 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 2 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. Furthermore, 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 to subsequent drinking. Fluctuations in cognitive control and risk-taking in a win context were not associated with fluctuations in drinking. CONCLUSIONS: Our findings offer novel insights into the cognitive-behavioral forces driving changes in alcohol consumption in AUD: specific alterations in decision making precede changes in consumption. These findings suggest that smartphone-based gamified tasks show promise in identifying periods of heightened risk, paving the way for mechanism-based, real-time interventions in AUD.
Authors: Hilmar Zech, Maria Waltmann, Dominic Reichert, Fabian Arntz, Ying Lee, Markus Reichert, Rachel L. Bedder, Robb B. Rutledge, Thomas Goschke, Bernd Lenz, Patrick Bach, Falk Kiefer, Michael Marxen, Rainer Spanagel, Heike Tost, Ulrich Ebner-Priemer, Michael A. Rapp, Andreas Heinz, Ray Dolan, Michael N. Smolka, Lorenz Deserno, Lorenz Deserno
Institutions: University of Würzburg, Technische Universität Dresden, Max Planck Institute for Human Cognitive and Brain Sciences, Heidelberg University, University Hospital Heidelberg, Central Institute of Mental Health, University of Applied Sciences Potsdam, University College London, Yale University, Medizinische Fakultät Mannheim, University of Tübingen
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,050
Funder: Deutsche Forschungsgemeinschaft
Awards: SFB 940: Volition und kognitive Kontrolle: Mechanismen, Modulatoren, Dysfunktionen, G3434867832, G3986097662, G4094304398, TRR 265: Verlust und Wiedererlangung der Kontrolle über den Drogenkonsum: Von Trajektorien über Mechanismen bis hin zu Interventionen, GRK 2773: Risikofaktoren und Pathomechanismen von Affektiven Störungen, G88412094
OpenAlex ID: W7203829437