Multiple perspectives on self-regulation in alcohol use disorder: executive functioning, neuroimaging and psychophysiology

Reduced ability to regulate deleterious behaviours can lead to negative social, health, and financial outcomes. Individuals with alcohol use disorder that continue to drink despite adverse consequences from their drinking demonstrate dysregulated drinking behaviour, potentially due to difficulty in appropriate self-regulation. Identifying the factors that may be integral in appropriate regulation of responses to alcohol cues may help us better understand the underlying mechanisms involved in self-regulation in these dysregulated individuals. Elucidating the factors involved in the regulation of impulsive, motivational drives inherent in alcohol use disorder is important to inform and augment current frameworks, which do not yet adequately explain dysregulated behaviour within this complex and multifaceted disorder. Thus, the aim of thesis was to empirically examine the regulation of responses to alcohol cues and influencing factors in alcohol use disorder. A diverse methodology of neuropsychological, psychophysiological and neuroimaging techniques was applied to comprehensively evaluate regulation across various time periods surrounding cue presentation, to assess the influence of components, such as executive functioning, in appropriate regulation, and to identify overlapping evidence of underlying regulatory processes and influencing factors in a range of dysregulated alcohol use disorder samples. Four separate studies were conducted. The first applied an influential theoretical framework of executive functioning to demonstrate discrete executive functioning domains were uniquely associated with the regulation of alcohol cue-elicited responses as indicated by physiological indices in non-treatment-seeking drinkers. The second further investigated these associations using the same methodology in more severely dysregulated alcohol use disorder samples—individuals with alcoholic liver disease and alcohol dependence—and showed overall difficulties in regulation of responses in these samples that were not related to executive functioning ability. The third used the same dysregulated samples to examine whether reduced capacity for incorporating previous negative feedback leads to impaired decision-making processes regarding drinking, and found reduced physiological responses to risky choices with negative outcomes and decision-making deficits in these samples. The final study used functional neuroimaging techniques to find converging reduced neural activation in prefrontal regions related to regulation of alcohol cue responses, and worse executive functioning and dysregulated drinking measures in an alcohol dependent sample. Taken together, this thesis advances our understanding of the integral components that may underlie the progression and maintenance of alcohol use disorder. This body of work contributes to the literature involved in elucidating the role of self-regulation and influencing factors in alcohol use disorder, through a convergence of neurocircuitry and underlying neurocognitive mechanisms that is essential to advance our understanding of key processes of regulation in alcohol use disorder and better inform treatment approaches.