Relationships Between Alcohol-Related Memory Association and Changes in Mood: Systematic Differences Between High- and Low-Risk Drinkers

Alcohol & Alcoholism Vol. 43, No. 5, pp. 551–558, 2008 Advance Access publication 9 May 2008 doi: 10.1093/alcalc/agm174 COGNITIVE AND BEHAVIOURAL EFFECTS Relationships Between Alcohol-Related Memory Association and Changes in Mood: Systematic Differences Between High- and Low-Risk Drinkers Adrian B. Kelly1,∗ and Paul W. Masterman2 1 2 School of Social Science, The University of Queensland, Australia School of Rural Health, Monash University, Victoria, Australia ∗ Author to whom correspondence should be addressed: Michie Building, School of Social Science, The University of Queensland, St Lucia, 4072, Australia. Tel.: +61 07 33656663; Fax: +61 07 33651544; E-mail (Received 21 September 2007; first review notified 5 November 2007; in revised form 16 November 2007; accepted 23 November 2007; advance access publication 9 May 2008) Abstract — Heavy alcohol use is common in undergraduates and is associated with health-risk behaviors, negative consequences, and increased risk for future alcohol dependence. Alcohol-related memory associations (AMAs) and mood changes are independently related to student drinking, but more research on how these variables interact is needed. Aims: To examine (i) how AMAs predict drinking behavior after accounting for depression, and (ii) how changes in negative and positive mood predict AMAs among low- and high-risk drinkers. Methods: Positive and negative moods were manipulated using a musical mood induction procedure immediately prior to completion of memory association measures. A bootstrapped structural equation model was tested, permitting a sampling distribution free of the requirement of normality. Results: Negative mood changes predicted AMAs in high-risk drinkers but not in low-risk drinkers, and the opposite was found for positive mood changes. Conclusion: The negative mood–AMA association appeared related to risky drinking, and these subtle implicit cognitive processes may warrant a special focus in intervention programs for high-risk drinkers. INTRODUCTION In Western societies, alcohol consumption is a common feature of university undergraduate experience (e.g., Pihl et al., 1993; Maio et al., 1994; Roche and Watt, 1999; O’Malley and Johnston, 2002; Jones, 2003). Heavy episodic consumption (i.e., drinking five or more standard drinks per occasion; NHMRC, 1992) is also widespread among college students and is associated with a range of health-risk behaviors and negative consequences (Pihl et al., 1993; Maio et al., 1994; O’Malley and Johnston, 2002). In young people, heavy drinking is associated with injuries and motor vehicle accidents (McGinnis and Foege, 1993), unsafe sex (Weschler et al., 1994; Cooper, 2002), sexual and physical assault (Engs and Hanson, 1985), ethanol poisoning (Greenfield, 2001), smoking (Kelly and Jackson-Carroll, 2007; Kelly et al., 2006), and increased risk of developing alcohol dependence (Baer, 2002; Schulenburg and Maggs, 2002; Dawson et al., 2004). Social-cognitive models of alcohol use have long emphasized the importance of explicit (conscious and considered) cognition in accounting for heavy drinking. A large body of literature supports the utility of alcohol expectancy and refusal self-efficacy models in explanations of drinking, though overall affects are modest (Leigh and Stacy, 1991). In more recent years, there have been challenges to the notion that explicit cognitive processes are the primary driver of drinking-related decisions (e.g., Stacy, 1995, 1997; Goldman, 1999; Kelly and Witkiewitz, 2003). Contemporary cognitive explanations of alcohol use emphasize the role of automatic information processing that may be more implicit (occurring outside awareness) than explicit in determining drinking outcomes (Tiffany, 1990; Greenwald and Banaji, 1995; Stacy, 1997; Tiffany and Conklin, 2000). Associative memory network theorists propose that alcohol-related information is interlinked in memory and that accessibility of these informational nodes is variable. A central assumption is that these alcohol-related networks contain representations of cues depending on the alcohol-related learning history of the individual (e.g., Stacy, 1995, 1997; Tiffany and Conklin, 2000). The informational nodes that increase the likelihood of drinking may vary from apparently irrelevant, or ambiguous, associations with alcohol (e.g., being tired, hot, or stressed) to strong associations with drinking (e.g., bars/pubs). People who drink heavily are proposed to be more likely to experience alcohol-related activation in response to ambiguous cues, compared to others. To investigate the role of accessibility of alcohol-related memory associations (AMAs) in the prediction of drinking, researchers have previously used a cue-association paradigm (e.g., Stacy, 1995). In this paradigm, free associations are made to ambiguous alcohol-related homographs (e.g., pitcher, tap) embedded in a list of homographs not related to drinking (e.g., stair, field). Responses are then coded for alcohol-related references (see Stacy, 1997). This task is held to reflect implicit memory processes because respondents are not asked to introspect about outcomes and are not aware of the alcohol focus of the research. Studies utilizing cue-association measures have shown that AMAs cross-sectionally and longitudinally predict drinking in young adults (Stacy, 1995; Weingardt et al., 1996; Stacy, 1997; Palfai and Wood, 2001; Kelly et al., 2005). AMAs are associated with problem drinking among drug offenders (Ames and Stacy, 1998; Ames et al., 2002), and predict alcohol and marijuana use in high-risk adolescents (Ames et al., 2005). Although research indicates a univariate association between AMAs and alcohol consumption, there is limited research exploring the potential role of affect in moderating/mediating the AMA–drinking behavior relationship. The basis for incorporation of affect into AMA models is strong given that negative and positive affect have long been implicated in drinking behavior. For example, depressed affect increases self-reported craving and motivation to drink among recreational drinkers (Willner et al., 1998). Nervous mood predicts increased drinking among social drinkers (Swendsen et al., 2000), and negative affect is a frequently endorsed antecedent to relapse in treated drinkers (Strowig, 2000). Drinking to enhance positive mood  C The Author 2008. Published by Oxford University Press on behalf of the Medical Council on Alcohol. All rights reserved 552 A. B. Kelly and P. W. Masterman is a commonly endorsed motive for drinking among university undergraduates (e.g., Stewart et al., 1996). Positive mood enhancement motives have also predicted alcohol-related problems in college students (Carey and Correia, 1997) and are a frequent motivator for drinking in social situations (Kilty, 1990; Fromme and Dunn, 1992). In experimental research (involving the systematic manipulation of mood) there is good evidence of a main affect (...truncated)