Craving: Approaching Avoidance : Part 3

by National Institute of Health

(Page 3 of 7)

Despite these insights, the theory of neuroadaptation in craving, like the earlier conditioning models of reactivity to alcohol cues, can be faulted for its exclusive focus on the development and elicitation of approach inclinations. Given the high likelihood that excessive drinkers will have histories that include punishment as well as reinforcement from their extensive alcohol use, they should harbor both negative and positive associations with alcohol cues. Not only should this dual association lead to a certain amount of ambivalence in their response to alcohol cues, but it should also raise questions about what neural substrates might underlie the development and elicitation of avoidance inclinations or motives to not drink.

One solution to this dilemma is to consider the possibility that in addition to mediation by appetitive brain systems such as those referred to in connection with neurobiological models of craving, response to alcohol cues and decisions to not drink may involve a parallel, aversive brain system that governs response to threats and other negative stimuli. Indeed, substantial evidence indicates that such a system exists and certainly its activation by alcohol-related cues is plausible. Moreover, much recent research indicates that although both the appetitive and aversive systems are subcortically based,1 they can interact with more complex cognitive processes,2 including attention, perception, imagery, and certain types of memory. Not only do these relatively independent systems provide a neural basis for ambivalence, but their interactions with the cortex also point to the complementary roles of both simple conditioning and higher level cognitive processes in reactions to alcohol cues and in inclinations to drink or not drink. However, before elaborating on how competing associations and cognitions might influence the approach or avoidance of alcohol, this article briefly examines what Cox and Klinger called "current factors" and the role they might play in shaping subsequent decisions to drink or not drink.

The Role of Current Factors

Current factors are variables in the immediate situation that influence whether a person is inclined to approach or avoid drinking. For example, to the extent that alcohol is available, the context can be seen as conducive to drinking. Similarly, if other people around the target person encourage drinking, he or she is more likely to follow the path of approach than the path of avoidance. Conversely, to the extent that alcohol is unavailable, the immediate context is not appropriate for drinking, and/or those around the target person discourage drinking, the person is more likely to avoid, than approach, alcohol. These immediate circumstances are considered when people assess whether the consequences of drinking or not drinking will likely be positive or negative. In addition to situational factors such as these, the availability of alternative behavioral options with predictable outcomes can mediate the impact of the current situation on decisions to drink or not drink.

According to behavioral theories of choice, preference for alcohol consumption varies depending on access to other valued and enjoyable activities. The availability of alternative rewarding activities promotes an indifferent "take it or leave it" attitude toward alcohol and predicts that people with such options will more likely follow the path of avoidance than that of approach. However, if alternative sources of reward are unavailable or limited, or if access to them is delayed or requires more effort, then a person is more likely to choose to drink rather than not drink.

In this context, many of the potential benefits associated with not drinking (avoiding a hangover) seem particularly distant when choices are made, thereby diminishing their impact on the decisionmaking process. This fact enhances the relative impact of the more immediate rewards associated with indulgence.

The Role of Expectancies

Alcohol outcome expectancies (beliefs that people hold regarding the behavioral, cognitive, and emotional effects of alcohol consumption) represent a third category of variables that influence the likelihood that a person will be inclined to either approach or avoid alcoholic beverages. Such expectancies are shaped by the positive and negative consequences that a person has experienced as a result of drinking. However, the fact that beliefs about alcohol effects develop in children and adolescents well before they engage in any drinking attests to the strong impact of social and observational learning on them.

Regardless of the origin of alcohol expectancies, and the recognition that expectancies can change across time and context, certain obvious predictions can be made based on aggregated expectations. To the extent that alcohol effects are believed to be mainly positive, and potential negative outcomes are viewed as relatively modest, people should be more likely to follow the path of approach than avoidance. Furthermore, this finding should be particularly true when anticipated reinforcements are immediate and punishments delayed. Conversely, to the extent that the effects of drinking are expected to be predominantly negative, even when some expectation of modest positive effects exists, people should ordinarily be motivated to avoid, rather than approach, alcohol. However, such applications of global expectancies may overlook the relevance of alcohol beliefs specific to particular situations and often fail to fully consider the independent roles of divergent expectancies.

A critical question emerging from alcohol expectancy research as it pertains to predictions about people's choice to drink or not drink concerns the relative contribution of positive versus negative expectancies. As was the case with craving research, most of the early studies of alcohol expectancies focused on beliefs that would attract one to drinking (foster approach inclinations). In other words, the research highlighted the importance of positive expectancies to understanding alcohol use and its problems. Pertinent evidence suggests that the more positive expectancies people hold regarding alcohol, the more likely they are to use alcohol and, if they already drink, the more likely they are to report higher levels of alcohol consumption.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.