There is a revised version at: https://osf.io/nxe9a Cue exposure treatment for alcohol dependence is based on extinction of conditioned responses to alcohol related cues but despite a sound rationale and clear evidence of effectiveness in other conditions, cue exposure has had only limited effectiveness for alcohol dependence. Here we examined two explanations for this observation, namely, that alcohol dependent individuals have either slower extinction or greater contextual specificity of extinction than non-dependent individuals. Two experiments were carried out. Seventy-four (54 female, age M=20.4 years) participants took part in Experiment 1 and 102 (40 female, age M=41.3 years) participants took part in Experiment 2. In both experiments participants completed the Alcohol Use Disorders Identification Test, answered one-week time-line follow-back alcohol consumption questions, filled in the Barratt Impulsiveness Scale (11 th Ed), and participated in a computerised learning task. In Experiment 2 participants additionally completed the 44-item Big Five Inventory, a drug use history checklist, and the Hospital Anxiety and Depression Scale. In Experiment 1 we found no difference in learning task performance on any of Pavlovian acquisition, extinction, response recovery, and context inhibition between light and heavy drinkers. However, in Experiment 2, there was slower extinction in abstinent alcohol dependent participants compared to light drinkers and some evidence that participants with alcohol dependence acquired knowledge of the CS-US pairings more slowly than light drinkers. An exploratory follow-up analysis showed that the observed relationship between learning and dependence was not mediated by group differences on personality nor due to group differences on drug use other than alcohol. We conclude that slow associative learning, especially in extinction, may be a characteristic of alcohol dependence and this finding may provide an explanation for the relatively poor outcomes that have been obtained for alcohol cue-exposure treatment.
Slow associative learning in alcohol dependence and the alcohol cue exposure treatment paradox
