DESCRIPTION (provided by applicant): This competing continuation application follows-up on the major findings from our last five years of funding that showed that alcohol dependence (AD) with high levels of co-occurring antisocial psychopathology (AP) was consistently associated with higher levels of disinhibited impulsive decision making, risky decisions to drink, and reduced executive working memory capacity (eWMC) compared with those with alcohol use disorders (AUDs) with low levels of AP and co-occurring externalizing psychopathology (EXT). Furthermore, our results showed that reduced eWMC played a key role in the disinhibited, impulsive decision making in those with AD and high AP, and compromising eWMC via a cognitive load significantly increased impulsive decision making and risky decisions to drink to extreme levels in those with AD and high AP. This application proposes to further investigate the role / mechanisms of eWMC in impulsive decision-making in AD with high AP by systematically studying the effects (on impulsive decision making and risky drinking decisions) of manipulations designed (i) to deplete eWMC (via WM - cognitive load), (ii) offset the effects of
WM load depletion (via an attentional shifting - refocus technique), and (iii) augment aspects of eWMC (via adaptive eWMC training). Although not a clinical trial, this study lays the foundation for the development of cognitive interventions designed to reduce impulsive decision making and behavioral disinhibition in AD with high AP. The first specific aim is to systematically study the effect of an attentional shifting - refocusing technique to offset the impact of a WM load on impulsive decision making and risky drinking decision making in those with AD and high AP compared with those with AUDs and low AP, and controls without any EXT. The second specific aim is to investigate the effects of an adaptive eWMC training program on 1. impulsive decision making/risky drinking decisions and alcohol consumption, 2. measures of eWMC, 3.other measures of executive function associated with attention (flanker/stroop) and motor inhibition, and 4. the effects of negative and positive affect/urgency on decision making. Computational models are used to identify key cognitive processes associated with disinhibited, impulsive decision making and eWMC that may be affected by cognitive load and the two training manipulations. The third specific aim is to investigate the personality, cognitive, subjective, and
symptom-level predictors of the effectiveness of the attentional shifting - refocusing technique and eWMC training on decision making. This study has high clinical relevance and potential for clinical impact. The results of the study will have direct implications for the development and refinement of cognitive interventions to modify impulsive, risky decision making (a core vulnerability) in those with AD and EXT in general, and for understanding the factors that may predict the positive impact of these two interventions on impulsivity in those with AD and EXT in general.