"Killing Two Birds with One Stone": Alcohol Use Reduction Interventions with Potential Efficacy in Enhancing Self-Control

Abstract

We review interventions with empirical support for reducing alcohol use and enhancing self-control. While any intervention that decreases drinking could improve self-control, we focus here on interventions with evidence of direct benefit for both indications. Although no intervention yet shows strong evidence for dual efficacy, multiple interventions have strong evidence for one indication and solid or suggestive evidence for the other. Among pharmacotherapies, opioid antagonists currently have the best evidence for reducing alcohol use and enhancing self-control. Nicotinic partial agonist varenicline also appears to be efficacious for alcohol use and self-control. Many psychosocial and behavioral interventions (e.g., cognitive behavioral therapy, contingency management, mindfulness training) may have efficacy for both indications based on purported mechanisms of action and empirical evidence. Cognitive bias modification and neurophysiological interventions have promise for alcohol use and self-control as well and warrant further research. We offer several other suggestions for future research directions.

Keywords: GABA; alcohol use disorders; animal model; approach bias; attentional bias; cognitive behavioral therapy; cognitive bias modification; contingency management; deep brain stimulation; delay discounting; dopamine; executive function; glutamate; impulsivity; memantine; mindfulness; nalmefene; naloxone; naltrexone; neurophysiological interventions; opioid antagonist; repetitive transcranial magnetic stimulation; response inhibition; transcranial direct current stimulation; varenicline.