How adolescents' working memory abilities relate to their alcohol craving in real-life contexts depends on biological sex

Abstract

Aim: We sought to elucidate whether stress, peers, and in vivo (i.e., direct) alcohol cues elicit alcohol craving in daily life among adolescents and to test whether individual variation in working memory function and biological sex alters these associations.

Methods: We leveraged ecological momentary assessment (EMA) to examine momentary associations between stress, peers, and direct alcohol cues with craving, assessed as "urge to drink alcohol," among 86 male (51.2 %) and female (48.8 %) frequent drinkers (i.e., two or more drinking days per week). Participants were ages 14-24 years (M = 20.7 years, SD = 2.1). Participants completed EMA throughout the day for about one week prior to randomization to a treatment condition for an AUD clinical trial. Pre-registered, secondary analyses focused on craving for assessments when adolescents were not drinking, and assessments occurring after drinking on drinking days were removed. Working memory performance was assessed in the laboratory via the Memory for Words subtest of the Woodcock-Johnson III Tests of Cognitive Abilities.

Results: Craving was heightened at more stressful moments and when adolescents were with their peers and in the presence of direct alcohol cues. Working memory function was not related to craving but altered the relation of momentary stress, peers, and cues with craving once biological sex-related differences were considered. Females generally had lower craving than males, but working memory function served to buffer against stress-induced craving for males.

Conclusions: Higher working memory function buffered the in-the-moment relation of stress with alcohol craving for males but not females.

Keywords: Adolescents; Alcohol; Craving; Ecological momentary assessment; Stress.

Figure 1.

Simple slopes of craving (y axis) from times of low momentary stress to high momentary stress (x axis), plotted separately by biological sex and at high and low levels of working memory (WM). Black lines correspond to males, and gray lines correspond to females. Dashed lines correspond to +1 standard deviation working memory, and solid lines correspond to −1 standard deviation working memory. Momentary stress is a repeated measure over time and was person-mean centered to reflect a participant’s fluctuations in stress relative to their own average. Low and high values on the x axis correspond to +/−1 standard deviation for person-mean centered momentary stress.