A new study overturns a long-held assumption about alcohol use disorder (AUD), showing that risk-taking behavior actually drives increases in drinking—not the other way around. The research, published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, tracked monthly drinking patterns alongside cognitive tasks over a year, revealing a clear cause-and-effect relationship.
The findings challenge prior theories that linked AUD primarily to reduced cognitive control. While earlier studies noted correlations between risky decision-making and heavy drinking, they couldn’t determine which came first. This study’s longitudinal design, using smartphone-based gamified tasks, filled that gap. Participants with mild to moderate AUD showed higher alcohol consumption in months following increased risk-taking, particularly in mixed gambling scenarios or when they reduced information-gathering before decisions. The study also found that risk-taking in loss contexts (where participants avoided potential losses) did not predict subsequent drinking increases, suggesting the effect is specific to reward-driven risk-taking rather than general impulsivity.
Dr. Hilmar Zech, co-lead investigator at the University Hospital Würzburg, explained that the pattern held even after accounting for prior drinking levels. “Participants shifted to higher monthly alcohol consumption when their risk-taking was higher,” he said. The research further clarified that fluctuations in self-control (such as response inhibition and working memory) and reward-driven behavior were not associated with changes in drinking, reinforcing the specificity of the risk-taking effect.
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The study’s approach stands out for its monthly monitoring. Traditional methods like interviews or self-reports can’t capture fluctuations in decision-making as they happen. Instead, researchers adapted cognitive tasks into smartphone games, allowing regular assessment. This method also identified a specific bias: when participants stopped thoroughly evaluating options before deciding, their subsequent alcohol use rose. The investigators developed these gamified tasks specifically to address real-life fluctuations, making them more ecologically valid than lab-based assessments.
Alcohol use disorder remains a leading cause of global disability and mortality, yet most interventions focus on reducing consumption after the fact. This study’s focus on predicting risky behavior could guide the development of early detection and preventive interventions. The research was conducted by a team at the University Hospital Würzburg and Technische Universität Dresden, using data from individuals with fluctuating drinking patterns over 12 months. The investigators noted that the effect was specific and was not observed vice versa, even after accounting for the amount of previous drinking.
This study is the first to predict changes in real-life drinking longitudinally using gamified decision-making tasks, advancing understanding of the temporal trends of AUD.