Abstract/Project Summary
Heavy drinking in young adults (YA) is prevalent, and associated with serious negative consequences
including mortality and risk for alcohol use disorders (AUD) 1-7. However, existing interventions have shown
modest efficacy 8-14, and innovative interventions are needed. YA interventions have potential for broad
impact if they are brief, computerized (especially web-based), and target core neurocognitive
mechanisms underlying heavy drinking 14,15. Two such mechanisms are craving and regulation of craving.
Defined in DSM-5 as “a strong desire” 16, craving is prospectively associated with and predicts drinking (e.g.,17-
25, including in YAs (e.g., 26-29). Importantly, alcohol-associated cues increase craving 30; such cue-induced
craving is also prospectively associated with and predicts drinking(e.g.,31-35), including in YA 32,33,36,37. These
data implicate cue-induced craving as a core mechanism underlying drinking 38. Consistently, skills
training in regulation of craving is an important feature of many interventions 39-44, including cognitive-behavioral
therapy (CBT) 45 and mindfulness-based treatments (MBT) 46,47. Further, regulation of craving directly relates to
reductions in craving and drinking, and better treatment outcomes(e.g., 34,41,42,48-52), including in YA 53. These
data implicate regulation of craving as a core mechanism underlying change in drinking/abstinence 54.
We developed the Regulation of Craving (ROC) task to investigate cognitive, affective, and neural mechanisms
associated with craving and its regulation across substances 55-61. In one study, alcohol drinkers were exposed
to alcohol images60. On craving trials, they experienced cue-induced craving and exhibited neural activity in
regions including ventral striatum and ventromedial prefrontal cortex 62-64. On regulation trials they used a
treatment-based strategy to modulate their craving. We found that self-reported craving and craving-related
neural activity were significantly reduced during regulation 60. However, across studies we found that the
neural mechanisms by which regulation operates depend on the strategy used. Specifically, regulation
with CBT strategies (e.g., ‘think of the negative consequences of drinking’) depends on the PFC 56,60,65 while
regulation with MBT strategies (e.g., ‘notice and accept craving without judgment’) does not 57,66,67.
Based on this, we developed two brief, web-based, mechanism-focused interventions: CBT-based and
MBT-based Regulation of Craving Training (ROC-T) 58,68,69, in which participants repeatedly practice
regulating craving in the presence of alcohol images. We propose to evaluate the efficacy of ROC-T and its
mechanisms by randomizing 177 YA heavy drinkers to 4x45 minute sessions of (1) CBT-ROC-T, (2) MBT-
ROC-T, or (3) CONTROL (no strategy). Alcohol use will be measured via Timeline Followback 70 for 10 weeks
as well as a wearable transdermal sensor 71,72. Pre- and post-training, we will evaluate cognitive, affective, and
neural mechanisms underlying ROC-T using the ROC task and fMRI. The current project has the potential to
significantly advance mechanism-targeted interventions for heavy drinking, AUD, and other addictive disorders.