Craving: Approaching Avoidance : Part 4

by National Institute of Health

(Page 4 of 7)

However, in investigations focusing on negative expectancies, the findings suggest a more dynamic relationship between negative expectancies and alcohol consumption. For example, negative expectancies in both light and moderate drinkers seem to be associated with less alcohol use, perhaps indicating that negative expectancies promote avoidance and restraint. Because negative expectancies among lighter drinkers may be relatively mild ("I would expect my handwriting to be affected" or "I would expect to feel fuzzy"), positive expectancies may remain dominant. However, people are more likely to experience weightier negative consequences as their drinking escalates or persists ("I would expect to get into a fight" or "I would expect to lose my job"). This finding suggests that negative expectancies might ultimately challenge initially dominant positive expectancies and subsequently promote ambivalence toward drinking. However, until the point is reached where negative expectancies begin to affect drinking behavior, a person may experience a period during which negative expectancies and alcohol use increase simultaneously.

In their review of studies investigating the concurrent operation of both positive and negative alcohol expectancies, Jones and McMahon make a compelling case for precisely this point. They present evidence for the pivotal role that negative beliefs about alcohol effects and outcomes play in determining decisions about drinking. Their conclusion is consistent with the proposal that much may be gained from considering the avoidance inclinations that compete with craving and other approach inclinations to influence the choice to drink or not drink.

Holding particular beliefs about alcohol's effects is not in and of itself a condition sufficient to cause drinking to occur. People must also value the consequences they expect. In this regard, strong empirical evidence indicates that subjective evaluations of the desirability of expected outcomes linked to alcohol use moderate the relationship between expectancies and drinking decisions. According to motivational models of alcohol use, subjective evaluations of expected consequences of indulgence provide motives for drinking that are the more proximal determinants of choices about alcohol use.

The Role of Motives

The evaluative space of the model depicted in the figure on page 198 is useful when considering a patient's motives or reasons for drinking or not drinking alcohol. Research in the area of motivation to drink has not ordinarily been designed to analyze competing inclinations to either approach or avoid alcoholic beverages, nor has it considered changes in motives across time and context. However, research has revealed that different global motives for drinking are associated with fairly distinct patterns of alcohol use and abuse. For instance, efforts to enhance pleasure and to cope with negative emotions have both been identified as potentially important motives for alcohol use. Drinking to cope with negative emotions, however, is primarily predictive of alcohol problems in adolescents and alcohol dependence in adults. Unfortunately, distinct biases analogous to those observed in alcoholexpectancy research are also evident in the extant literature on alcohol-related motives. Clearly, the focus has been primarily on the reasons why people say they want to drink, rather than on the potentially important reasons why people might want to avoid alcohol and choose to not drink.

As a first step toward redefining the focus of alcohol research, we developed a questionnaire to assess motives for not drinking alcohol. This questionnaire was based on the general principles of an expanded version of Cox and Klinger's motivational model of alcohol use and applied a measurement approach similar to that used by Cooper and colleagues to study motives for drinking.

Preliminary results indicate that at least among adolescents, different motives for not drinking are strongly linked to different aspects of alcohol use. For example, the frequency of alcohol use and the category of drinker (drinker versus abstainer) are predicted by constraints associated with religion and family and by motivational indifference. In contrast, the quantity of alcohol consumed on a typical drinking occasion is predicted only by fear of negative consequences.

These findings emphasize the importance of studying people's motives for avoiding alcohol and suggest that both alcohol education and prevention programs for teenagers should be tailored accordingly. If a program's objective is to prevent or forestall young people's initiation to drinking, an effective strategy might be to emphasize traditional relationships and encourage involvement in rewarding activities that are alternatives to drinking and thereby increase indifference toward alcohol. However, if the objective is to reduce alcohol consumption among drinkers, the most effective approach might be to focus on the adverse consequences of indulgence, perhaps even threatening or enforcing stronger negative sanctions.

Each of the steps and diverse categories of variables reviewed thus far involves competing forces. These forces, in turn, must be weighed and combined to determine whether the decisional balance will tip toward drinking or not drinking for any one person in any situation. In other words, a full understanding of the impact of craving on alcohol use requires consideration of the relative impact of the inclination to avoid alcohol use as well.

The Concept of Ambivalence and the Mapping of an Evaluative Space

In his treatise on why "excessive appetites" for alcohol consumption and other addictive behaviors revolve around conflict or ambivalence as the central, defining construct, Orford cited the work of two independent researchers who had applied classic conflict theory to the phenomenon of excessive alcohol use. Both Astin and Heilizer suggested that for problem drinkers, alcohol-associated cues induce an approach-avoidance conflict. According to both Astin's and Heilizer's models, conflict arises in alcoholics because previous alcohol use has been both reinforced and punished. Both authors noted that rather than sustaining an ambivalent state, alcoholics exposed to alcohol cues tend repeatedly to resolve the conflict in the approach direction (they choose to drink). In other words, their desire to drink appears to increase as they near the goal (alcohol), whereas their avoidance inclination appears to remain constant or even decline along the way.

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.