# Working memory in context: The role of alcohol distractors in working memory performance in low to heavy alcohol drinkers

## TL;DR

Alcohol-related distractions hurt working memory performance, especially under high mental effort and in people with moderate alcohol use.

## Contribution

The study reveals that alcohol-related cues impair working memory more in mid-risk drinkers during high cognitive load.

## Key findings

- Alcohol-related flankers reduced accuracy and increased reaction times under high working memory load.
- Mid-risk drinkers showed a greater decline in accuracy with alcohol cues compared to low-risk drinkers.
- Alcohol-related cognitive interference is more pronounced during early stages of problematic alcohol use.

## Abstract

Motivational and cognitive control‐related processes both play a role in addiction but are often studied independently. Alcohol‐related cues may impair performance in cognitively demanding tasks, particularly in individuals with alcohol use‐related problems, where working memory (WM) may be especially affected. This study investigated whether distracting alcohol‐related flankers impact WM performance across varying levels of alcohol use severity.

A total of 310 participants were classified into risk groups based on Alcohol Use Disorder Identification Test (AUDIT) scores: low (≤7), mid (8–14), and high (≥15). We developed an online N‐back flanker task where letters were flanked by alcohol‐related or neutral words. Four WM‐loads (0‐, 1‐, 2‐, 3‐back) were included, with higher loads requiring participants to hold and update more information in WM. Linear mixed effects models assessed the effects of WM‐load, flanker type, group, or their interaction on accuracy (% correct) and reaction time.

An interaction was found between WM‐load and flanker type; reduced accuracy (B = −2.47; p
Holm = 0.002) and longer reaction times (B = 58.46; p
Holm < 0.001) were found when participants were presented with alcohol flankers and a higher WM‐load relative to neutral flankers and a lower WM‐load. Difference scores (3‐back minus 1‐back) showed that individuals in the mid‐risk group had a larger reduction in accuracy (B = −4.12; p
Holm = 0.021) when presented with alcohol versus neutral flankers, relative to the low‐risk group. For reaction time, only an effect of flanker type was found, with shorter reaction times (B = −29.93; p
Holm = 0.012) for alcohol flankers versus neutral flankers.

Our findings suggest that a distracting alcohol‐related context negatively impacts WM performance, particularly under high cognitive demand. This effect is particularly pronounced in mid‐risk alcohol users. This suggests that alcohol‐related cognitive interference may be more significant during the early stages of problematic alcohol use.

Alcohol‐related distracting cues were found to impair working memory (WM) performance under high cognitive demand. Across the sample, alcohol flankers were associated with reduced accuracy and slower responses as WM load increased. Examining load‐dependent change, individuals in the mid‐risk (AUDIT 8–14) group showed a greater decline in accuracy from low to high WM load when alcohol cues were present, relative to the low‐risk (AUDIT≤7) group. This suggests that alcohol‐related cognitive interference may be more significant during early stages of problematic alcohol use.