Although preliminary, the present findings suggest that compared to non-drinking peers, adolescents with recent heavy episodic drinking display greater negative affect responses and poorer distress tolerance in cognitively challenging situations during early abstinence and become less emotionally reactive as abstinence continues. Recent heavy episodic drinking of these adolescents was associated with greater emotional reactivity to an externally produced stressful situation. Specifically, heavy episodic drinkers’ affective responses to a cognitive stressor, with respect to frustration, irritability, and happiness, were initially more pronounced than those of peers with limited alcohol exposure, but the emotional reactivity of heavy drinkers diminished with continued abstinence. These findings suggest that heavy episodic drinking adolescents experience more emotional reactivity during early abstinence and appear to become less reactive within 4-6 weeks of abstinence. These findings could reflect a return to functioning that existed prior to onset of heavy drinking, an experience of short-term positive responses to encouraging life events , or other factors related to recent abstinence. Heavy episodic drinking teens with greater lifetime and recent alcohol consumption as well as a greater frequency of recent alcohol-induced blackouts and withdrawal symptoms showed greater increases in frustration, irritability, and anxiety from the task compared to youth without drinking experiences. Even when the groups reacted with similar levels of frustration following one month of abstinence, teens with greater lifetime exposure to alcohol and with more recent withdrawal symptoms still showed a greater induction of frustration to the task. Thus, among adolescents, trimming trays for weed recentheavy drinking may be related to negative affect, and greater lifetime severity of alcohol involvement and withdrawal symptoms may relate to persistence of negative emotional states.
Contrary to our hypothesis, youth with and without histories of heavy episodic drinking did not differ significantly in their performance on the PASAT-C task at the initial session or across testing sessions, although drinkers consistently performed slightly worse than non-drinkers across time points. While the groups did not differ statistically in performance, teens who initiated regular alcohol use at an earlier age continued to show worse task performance even with sustained abstinence. Lower distress tolerance was most evident during early abstinence for youth with a heavy drinking history. In the first week of abstinence, heavy episodic drinking adolescents quit the distress tolerance stage of the task an average of approximately 90 seconds earlier than non-drinking peers. The drinkers’ behavioral response of quitting the task more quickly is consistent with prior adult and adolescent research showing that duration of recent abstinence is related to the ability to persist when facing a psychological stressor . These results suggest that youth with less than two weeks of abstinence may experience stronger emotional responses in challenging situations and that youth with low distress tolerance may have difficulty persisting in productive behavior when experiencing negative emotions and may rely on negative reinforcement to provide relief . It is possible that heavy episodic drinking adolescents may focus on immediate gains and attend less to the potential negative consequences of their behavior, which may be an important vulnerability factor in progression to or persistence of alcohol involvement .
Interestingly, at the initial testing session, heavy episodic drinking teens with recent alcohol exposure showed poorer tolerance of distress, but they showed a different pattern than predicted at subsequent assessments. Contrary to the hypothesis, both groups of participants, regardless of drinking history, quit the task sooner with subsequent administration, and in fact may be learning that quitting earlier is more adaptive in this stage. The difficulty level of the distress tolerance stage, with one second inter-stimulus intervals, is very high and with repeated exposure youth may learn that this stage is unlikely to result in significant point increases. Thus, while the initial administration of the PASAT-C may indicate poorer distress tolerance among recent heavy episodic drinkers, repeated administration of the PASAT-C may reflect youth expectations of the quit option, rather than distress tolerance alone. This study is the first to examine changes in emotional reactivity and distress tolerance in relation to length of abstinence among heavy episodic drinking youth. The groups were comparable on demographic and family history of alcoholism dimensions, and the heavy drinking teens were studied prior to onset of alcohol dependence. Nevertheless, these findings should be considered tentative as the sample size was modest, limiting generalizability and resulting in lower power to examine gender or ethnic differences. Replication of these findings with a larger sample would substantiate and strengthen these preliminary findings. The PASAT-C was designed to measure performance, change in affect, and distress tolerance in specific stages of the task , but participants may not have responded to the task as designed over repeated testings.
There is a need for further research to distinguish the contributing factors in adolescent responses to the PASAT-C over repeated administration. Future studies might also consider including youth who continue to engage in heavy drinking but follow the same testing schedule, allowing a more direct test of the effects of abstinence on youth functioning and enabling a better understanding of the practice effects with this task. The existing literature examining substance use and dependence suggests that intolerance of emotional and somatic sensations is a key mechanism driving continued use . While the effects are modest, this study is the first to illustrate heightened emotional reactivity and poorer distress tolerance to a cognitively challenging task in heavy drinking adolescents in early periods of abstinence. It is possible that the combination of elevated negative affect and low distress tolerance during early abstinence may be a mechanism whereby heavy episodic drinking heightens risk for progression to an alcohol use disorder or results in a return to use following periods of abstinence. This information may also be relevant for teachers, parents, and counselors to understand that youth with recent heavy alcohol exposure may show heightened emotional reactivity and poorer tolerance of distress. Students and young adults frequently encounter academically challenging or socially demanding situations, and those with recent heavy drinking may have more difficulty due to their reduced ability to manage their emotional reactivity and tolerate negative affect, which can also lead to disrupted interpersonal relations or heightened risk for impulsive decision making . Reductions in emotional reactivity with abstinence may contribute to improvements in academic and social functioning among nonclinical, heavy drinking youth. The capacity to withstand aversive internal states, including negative emotions, is integral to daily functioning. Importantly, the emotional reactivity of heavy episodic drinking adolescents appears to reduce with continued abstinence. Additional research is needed to understand factors underlying and facilitating this improvement and whether interventions can further improve emotional reactivity and distress tolerance among youth during early periods of abstention. It may also be helpful for youth to know that it is typical to experience heightened emotional reactivity and poorer distress tolerance during early periods of abstinence. This knowledge may encourage maintenance of abstention or a lower compulsion to consume alcohol if they feel confident that their emotional lability will reduce relatively quickly.Alcohol is the most commonly used intoxicant during adolescence. By their senior year of high school, 71% of students have consumed alcohol and 54% have been drunk . According to national data, 41% of high school seniors drank alcohol in the past month, and 23% of seniors reported heavy episodic drinking in the prior two weeks . Compared to adults, adolescents drink alcohol less frequently but in higher doses, and such heavy episodic drinking among adolescents may be more harmful than consuming alcohol in moderation every day . Consuming greater quantities of alcohol in one sitting is concerning because heavy alcohol consumption associates with high risk, life-threatening outcomes including motor vehicle accidents, alcohol poisoning, illegal activities, school failure, and risky sexual behavior . A growing number of animal and human studies also suggests that heavy episodic drinking appears to alter developmental trajectories and to interfere with normal neuroanatomical and neurocognitive development .
Animal research suggests that adolescents are more vulnerable than adults to ethanol-induced decrements in functioning, weed trimming tray especially following chronic, intermittent exposure to high levels of ethanol, which is considered the analog of ‘heavy episodic drinking’ in humans . Adolescent rats show more susceptibility to hippocampal injury and to frontal-anterior cortical damage , and adolescent rats exposed to ethanol continue to show structural and functional abnormalities into adulthood . In particular, adolescent rats seem to experience lower initial brain sensitivity to ethanol , abnormal development of sensitivity to alcohol-induced motor impairments , and slower onset and magnitude of sedation following alcohol exposure . That adolescents have reduced sensitivity to ethanol-induced motor impairing and sedative effects may theoretically allow youth to drink greater quantities of alcohol and attain higher blood alcohol concentrations with less sedation than would be expected in adulthood. The concurrence of reduced susceptibility to the sedating and motor impairing effects of alcohol with an enhanced vulnerability to alcohol-induced neuroanatomical and neurocognitive deficits presents a concerning effect during adolescence. The extant human literature is consistent with animal research and suggests that heavy and recent alcohol exposure in adolescence is associated with poorer neuropsychological outcomes relative to those of non-drinkers. Studies of adolescents with alcohol use disorders and of nonclinical populations of heavy episodic drinkers have consistently found deficits on executive function measures of planning, decision-making, verbal working memory, and inhibition . Adolescents with AUDs also demonstrate deficits in verbal learning and recognition discriminability , and they have shown mild decrements in visuospatial memory such as delayed recall of a complex figure . Adolescent and young adult heavy drinkers commonly show decrements in aspects of visuospatial function including block constructions, spatial working memory, and pattern recognition . Studies also suggest higher error rates among AUD youth and deficits in processing speed, motor speed, and attention . Finally, alcohol abusing adolescents have been shown to have significantly lower verbal and full scale IQ scores and lower academic achievement in math, reading, and spelling than their non-drinking peers. While many of these studies report deficits across several neurocognitive domains, to date no study has investigated the rate and pattern of neuropsychological recovery in heavy episodic drinking teens throughout the initial days to weeks of abstinence from alcohol . Further, to the best of our knowledge, no existing study has ensured groups’ comparable academic functioning that predates initiation of substance use , which limits the ability to make generalizations about the impact of alcohol as compared to preexisting differences. By ensuring comparable, premorbid academic functioning and by following adolescents over several weeks of abstinence, this study aimed to elucidate the pattern of neurocognitive recovery during early abstinence from heavy alcohol use. Such knowledge may have important implications for clinical intervention and for strategies to improve academic functioning and reduce relapse risk. The present study examined cognitive performance of youth engaged in heavy episodic drinking during adolescence, a critical time of brain development. Drinking and non-drinking participants completed a neuropsychological battery three times at 2-week intervals over four weeks of monitored abstinence. We aimed to identify neuropsychological deficits associated with recent heavy episodic drinking during adolescence, and determine whether alcohol-induced neurocognitive deficits improve with abstinence. Based on prior research, we hypothesized that recent heavy episodic drinking youth would display neuropsychological deficits during early abstinence relative to similar non-drinking peers in the domains of executive functioning, learning and memory, visuospatial construction, working memory, attention, processing speed, and learning and achievement, and abstaining heavy episodic drinkers would demonstrate improvements in these cognitive domains over a four week abstinence period when compared to non-drinking teens studied at comparable time points. In other words, we expected that prolonged abstinence would be linked to normalization of functions previously shown to be affected by alcohol.After providing their assent/consent, adolescent participants and their parents were separately administered confidential structured clinical interviews assessing demographics, social and academic functioning , family history of psychiatric disorders using the structured clinical interview of Family History Assessment Module Screener , and personal history of Axis I psychiatric disorders using the Computerized Diagnostic Interview Schedule for Children . Parents completed the Child Behavior Checklist and teens completed the Youth Self Report to assess levels of internalizing and externalizing psychopathology. Teen substance use history was documented using the Customary Drinking and Drug Use Record , which assessed lifetime and recent tobacco, alcohol, and drug use , withdrawal symptoms, DSM-IV abuse and dependence criteria, and other negative consequences associated with heavy drinking. Good inter-rater reliability, internal consistency, and test-retest ability have been demonstrated with the CDDR among adolescent participants .