ABSTRACT
Young adults’ heavy drinking represents a substantial public health problem, in part because alcohol use is
associated with risk behaviors that can have both short- and long-term consequences for individuals and
society as a whole. Alcohol myopia theory (AMT) has emerged as a prominent framework to understand why
acute alcohol intoxication is associated with increased likelihood of risk behaviors, such as aggression,
unprotected sex, and unsafe driving. AMT asserts that alcohol narrows one’s attention, reducing the range of
external and internal cues that one can process, increasing the focus on “here-and-now” central information at
the cost of longer-term, peripheral information. This attentional narrowing is theorized to limit the processing of
cues that may otherwise inhibit risk behaviors, as costs and consequences tend to be more peripheral or
temporally distant than immediate rewards. Although AMT is supported by laboratory research, the connection
between AMT and real-world risk-taking remains unclear. Clarifying whether myopia is indeed a mechanism
will be an important step toward dynamic theory-based interventions targeting alcohol-related risk behaviors.
To advance theory and inform intervention development, the current study will (1) adapt laboratory-based
cognitive tasks to assess spatial and temporal alcohol myopia for smartphone-based ecological momentary
assessments (EMA), (2) evaluate feasibility, acceptability, reliability, and validity of the adapted smartphone
tasks in laboratory and EMA settings, and (3) explore AMT within EMA by testing myopia as a mediator of the
intoxication-risk behavior association. To achieve these aims, interviews will be conducted with up to 30 young
adults to inform iterative improvements that maximize usability of myopia tasks on smartphones. Then, 100
heavy drinking young adults will complete a laboratory session involving alcohol administration to test the
adapted myopia tasks within a controlled setting. These participants will also complete eight consecutive
weekends of EMA to assess spatial and temporal myopia and risk behaviors in their natural environments,
while wearing a wrist-based transdermal alcohol biosensor to objectively and unobtrusively assess intoxication
levels. By integrating laboratory and EMA findings, this study will yield tasks that allow for a comprehensive
understanding of alcohol myopia, including within- and between-person variability in myopia, dose-dependent
effects of AMT within natural drinking episodes, and associations with real-world risk behaviors. The rigorous
development and testing of cognitive EMA for myopia will pave the way for new just-in-time adaptive
interventions targeting myopia to reduce risk behaviors when drinking. By using innovative tools and
methodologies to advance behavioral research and interventions, this proposal is consistent with the NIAAA
mission and strategic goals to identify patterns and strategies to prevent alcohol-related consequences.
