Research Shows Risk-Taking Behavior Precedes Increased Alcohol Consumption, Not Vice Versa

A novel study has found that increases in risk-taking behavior in people with mild to moderate alcohol use disorder (AUD) precede increases in alcohol consumption, not vice versa. This research is the first to predict changes in real-life drinking longitudinally using gamified smartphone-based decision-making tasks. The findings from the new studyopens in new tab/window, appearing in Biological Psychiatry: Cognitive Neuroscience and Neuroimagingopens in new tab/window, published by Elsevier, open up the possibility of future targeted and timely interventions for people with AUD.

AUD is a major contributor to global disability and mortality. Cross-sectional studies have linked AUD to reduced cognitive control and heightened risky decision making. However, whether these cognitive-behavioral alterations are a consequence or a precursor of changes in drinking was previously unknown. This study clarifies the temporal direction of these effects.

The investigators conducted a unique one-year longitudinal study in individuals with mostly mild to moderate AUD who may fluctuate substantially in their drinking over time. Using smartphone-based assessments and gamified experiments, the researchers tracked participants’ drinking behavior, cognitive control, and decision making.

“We found that monthly fluctuations in aspects of decision making predicted subsequent alcohol consumption,” explains co-lead investigator Dr. Hilmar Zech, postdoctoral research fellow at the University Hospital Würzburg and Technische Universität Dresden, Germany. “Specifically, participants shifted to higher monthly alcohol consumption when their risk-taking was higher in a mixed gambling context and lower in a loss context in the preceding month. Further, when information sampling biases decreased, participants consumed more alcohol in the subsequent month.”

Co-lead investigator Prof. Dr. Lorenz Deserno, Associate Professor for Neuroscience in Developmental Psychiatry and Principal Investigator of the Computational and Developmental Psychiatry Lab at the University Hospital Würzburg, Germany, adds, “This temporal direction was specific and was not observed vice versa, even after accounting for the amount of previous drinking. The findings also showed that fluctuations in self-control (i.e., response inhibition and working memory) and reward-driven behavior (i.e., risk-taking for rewards) were not associated with fluctuations in drinking.”

Editor-in-Chief of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging Cameron S. Carter, MD, University of California Irvine School of Medicine, comments, “Decision making and cognitive control cannot be accurately examined through interviews or self-reports and instead require experimental tasks. To address real-life fluctuations, the researchers of this study developed smartphone-based versions of experimental tasks. The findings of this longitudinal assessment suggest that smartphone-based gamified tasks show promise in identifying periods of heightened risk in people with AUD, paving the way for mechanism-based, real-time interventions.”

While there are no immediate treatment implications, these findings using smartphone-based and gamified measurement methods to link certain key aspects of risky decision making to subsequent increases in real-life drinking could guide the development of early detection and preventive interventions such as warning signals for high-risk periods to deliver targeted and personalized support at just the right time.

Notes for editors

The article is "Fluctuations in Real-Life Drinking in Alcohol Use Disorder: A 1-Year Longitudinal Study Using Gamified Tasks of Decision Making and Cognitive Control," by Hilmar Zech, Maria Waltmann, Dominic Reichert, Fabian Arntz, Ying Lee, Markus Reichert, Rachel L. Bedder, Robb B. Rutledge, Thomas Goschke, Bernd Lenz, Patrick Bach, Falk Kiefer, Michael Marxen, Rainer Spanagel, Heike Tost, Ulrich Ebner-Priemer, Michael A. Rapp, Andreas Heinz, Ray Dolan, Michael N. Smolka, and Lorenz Deserno (https://doi.org/10.1016/j.bpsc.2026.07.019opens in new tab/window). It appears online in Biological Psychiatry: Cognitive Neuroscience and Neuroimagingopens in new tab/window, published by Elsevier.

The article is openly available at https://www.biologicalpsychiatrycnni.org/article/S2451-9022(26)00248-X/fulltextopens in new tab/window.

Copies of this paper are also available to credentialed journalists upon request; please contact Rhiannon Bugno at [email protected]opens in new tab/window. Journalists wishing to interview the study’s authors should contact Prof. Dr. Lorenz Deserno at [email protected]opens in new tab/window or Dr. Hilmar Zech at [email protected]opens in new tab/window.

Prof. Michael Smolka and Prof. Thomas Goschke, both from the Technische Universität Dresden, Germany, were key collaborators on this study. Prof. Raymond J. Dolan, University College London, UK, collaborated on the development of gamified smartphone-based tasks.

This research was part of the German collaborative research center on Losing and Regaining Control over Drug Intake (ReCoDe) https://www.trr265.org/enopens in new tab/window at three German sites (Berlin, Dresden, and Mannheim). Research reported in this publication was supported by grants from the German Research Foundation/Deutsche Forschungsgemeinschaft (DFG project numbers 402170461 [TRR 265 “Losing and Regaining Control over Drug intake”], 178833530 [SFB 940], 454245598 [IRTG 2773], and 521379614 [TRR 393]).

The authors’ affiliations and disclosures of financial relationships and conflicts of interest are available in the article.

Cameron S. Carter, MD, is Chair of the Department of Psychiatry & Human Behavior at the University of California Irvine School of Medicine. His disclosures of financial relationships and conflicts of interest are available hereopens in new tab/window.

About Biological Psychiatry: Cognitive Neuroscience and Neuroimaging

Biological Psychiatry: Cognitive Neuroscience and Neuroimagingopens in new tab/window is an official journal of the Society of Biological Psychiatryopens in new tab/window, whose purpose is to promote excellence in scientific research and education in fields that investigate the nature, causes, mechanisms and treatments of disorders of thought, emotion, or behavior. In accord with this mission, this peer-reviewed, rapid-publication, international journal focuses on studies using the tools and constructs of cognitive neuroscience, including the full range of non-invasive neuroimaging and human extra- and intracranial physiological recording methodologies. It publishes both basic and clinical studies, including those that incorporate genetic data, pharmacological challenges, and computational modeling approaches. The 2025 Journal Impact Factor^TM score, from Clarivate, for Biological Psychiatry: Cognitive Neuroscience and Neuroimaging is 4.9. www.sobp.org/bpcnniopens in new tab/window

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