WEBVTT - Is alcohol dependence about more than willpower? 0:00:00.129 --> 0:00:02.989 This podcast was made on the lands of the Wurundjeri people, 0:00:03.250 --> 0:00:06.050 the Woi Wurrung and the Bunurong. We pay our respects 0:00:06.050 --> 0:00:09.109 to their elders, past and present, and to emerging leaders. 0:00:15.140 --> 0:00:18.860 From the University of Melbourne's School of Psychological Sciences, this 0:00:18.860 --> 0:00:20.079 is Psych Talks. 0:00:20.510 --> 0:00:24.219 Welcome back. Today we're talking about alcohol use, impulsivity, and 0:00:24.219 --> 0:00:27.290 why some people move from casual drinking to dependence while 0:00:27.290 --> 0:00:30.379 others don't. We sometimes think of addiction as a matter 0:00:30.379 --> 0:00:33.380 of self-control or willpower, but what if the story is 0:00:33.380 --> 0:00:37.040 more about how we respond to reward, learn from consequences, 0:00:37.049 --> 0:00:38.360 and think about the future? 0:00:38.900 --> 0:00:41.900 We're joined by Dr Antoinette Poulton to talk about her 0:00:41.900 --> 0:00:45.619 research on impulsivity, feedback, and how simple insights into their 0:00:45.619 --> 0:00:48.900 behaviour might help people change their relationship with alcohol. 0:00:49.180 --> 0:00:51.729 Antoinette is a researcher at the University of Melbourne whose 0:00:51.729 --> 0:00:54.500 work focuses on the brain's executive functions and how they 0:00:54.500 --> 0:00:56.259 relate to substance use and addiction. 0:00:56.790 --> 0:00:59.189 Her research explores why some people are more vulnerable to 0:00:59.189 --> 0:01:03.310 developing problematic alcohol use and how real-time feedback and digital 0:01:03.310 --> 0:01:07.539 tools can support behaviour change. Her work spans experiments, digital 0:01:07.540 --> 0:01:11.569 and pharmacological interventions, and app-based studies that track people's cognition 0:01:11.569 --> 0:01:13.330 and behaviour in everyday life. 0:01:13.839 --> 0:01:16.790 Antoinette, welcome to PsychTalks. So let's start with how you 0:01:16.790 --> 0:01:19.410 got into research in this area. Was it a straight 0:01:19.410 --> 0:01:20.789 path or a winding one? 0:01:21.169 --> 0:01:24.410 Well, thanks so much for having me on PsychTalks. Um, 0:01:24.650 --> 0:01:27.789 my research journey has been, uh, an incredibly winding path, 0:01:27.870 --> 0:01:31.849 in fact, I started my professional career in teaching. Um, 0:01:31.959 --> 0:01:34.690 when I first started teaching in Australia, I was teaching 0:01:34.690 --> 0:01:37.809 English language to new arrivals, to migrants, to refugees, and 0:01:37.809 --> 0:01:40.970 also to international students. And then I spent some time 0:01:40.970 --> 0:01:44.610 teaching abroad. I worked in mainstream secondary schools supporting young 0:01:44.610 --> 0:01:47.970 people with learning difficulties. Uh, basically I was helping them 0:01:47.970 --> 0:01:50.050 access the mainstream curriculum and respond to it. 0:01:50.550 --> 0:01:53.949 Um, then I had this extraordinary teaching experience in Spain. 0:01:54.269 --> 0:01:58.019 I was employed by a research institute attached to the, um, 0:01:58.029 --> 0:02:00.589 Polytechnic University of Valencia. 0:02:00.980 --> 0:02:05.419 And their research focused on thermodynamics, thermofluids, and they had 0:02:05.419 --> 0:02:10.800 these very lucrative contracts with um European automotive companies, um, 0:02:10.809 --> 0:02:14.179 and my students essentially were working on those contracts, and 0:02:14.179 --> 0:02:17.059 they needed help to um express their results more fluently 0:02:17.059 --> 0:02:19.419 in English, so I was employed, um, to work with 0:02:19.419 --> 0:02:21.899 them so that they could speak more clearly and, and 0:02:21.899 --> 0:02:23.080 more quickly and fluently. 0:02:23.380 --> 0:02:27.869 Um, but they were all PhD students, um, in engineering, physics, 0:02:27.910 --> 0:02:30.389 and maths, and during this time I witnessed a very 0:02:30.389 --> 0:02:32.820 different attitude to drugs than I had seen as a 0:02:32.820 --> 0:02:35.889 young person in Australia. My students were very high achieving, 0:02:36.029 --> 0:02:37.690 high performing individuals. 0:02:38.369 --> 0:02:42.039 Many had already won very prestigious national awards in their field, 0:02:42.580 --> 0:02:46.410 but they were nonetheless engaging in, at least by Australian standards, 0:02:46.419 --> 0:02:50.339 a fairly serious recreational drug use. Um, it wasn't uncommon 0:02:50.339 --> 0:02:51.899 for them to turn up on a Monday morning and 0:02:51.899 --> 0:02:53.429 to tell me about how they'd been high on this 0:02:53.429 --> 0:02:56.460 or that across the weekend, um, but they'd front up 0:02:56.460 --> 0:03:00.089 to work on Monday, perfectly functional, they'd engage in highly 0:03:00.089 --> 0:03:01.839 technical work successfully. 0:03:02.179 --> 0:03:04.940 And yeah, it was a little bit unusual. I'd not 0:03:04.940 --> 0:03:08.020 witnessed that before in Australia, um, and, and in general 0:03:08.020 --> 0:03:10.169 really in Spain, the people I interacted with had a 0:03:10.169 --> 0:03:13.139 very relaxed relaxed attitude to drug taking, there was less 0:03:13.139 --> 0:03:17.649 stigma and certainly around recreational drug use anyway. So early 0:03:17.649 --> 0:03:19.740 on when I was still thinking my career would be 0:03:19.740 --> 0:03:22.940 in teaching, um, I was developing this curiosity around different 0:03:22.940 --> 0:03:25.520 attitudes to drugs and what constituted addiction. 0:03:26.130 --> 0:03:28.039 When I returned to Australia after about 5 years, I 0:03:28.038 --> 0:03:30.809 actually continued teaching, and again I was supporting young people 0:03:30.809 --> 0:03:34.269 in mainstream schools with learning issues, but after a while 0:03:34.270 --> 0:03:37.669 I started to get very bored, very restless, and I thought, well, 0:03:37.800 --> 0:03:39.529 a way to combat that would be to do some 0:03:39.529 --> 0:03:41.570 psychology subjects. I thought maybe I could look at the 0:03:41.570 --> 0:03:45.669 neurobiology underpinning some of the disorders I saw in my students. 0:03:46.009 --> 0:03:50.210 Um, so I started taking some undergraduate psychology subjects, and 0:03:50.210 --> 0:03:53.449 basically I got hooked very quickly. Within 6 months, I'd 0:03:53.449 --> 0:03:56.089 quit school or quit work as a teacher, and I'd 0:03:56.089 --> 0:03:58.649 come to the University of Melbourne. I was doing the 0:03:58.649 --> 0:04:02.250 graduate diploma in psychology. And during that time, it was 0:04:02.250 --> 0:04:04.490 sort of during the 3rd year subjects that I counted 0:04:04.490 --> 0:04:06.889 Professor Rob Hester, and he was doing a series of 0:04:06.889 --> 0:04:10.970 lectures on addiction and what constituted addiction, and I got very, 0:04:11.050 --> 0:04:13.770 very interested. It recalled my experiences in Spain. 0:04:14.080 --> 0:04:16.869 Um, and so really from that point on, one thing 0:04:16.869 --> 0:04:19.029 led to another very quickly. I did my 4th year 0:04:19.029 --> 0:04:21.519 with Rob as supervisor and then undertook a PhD a 0:04:21.519 --> 0:04:24.260 couple of years later, also with Rob as supervisor. 0:04:24.720 --> 0:04:27.519 So a lot of your recent research is about drinking 0:04:27.519 --> 0:04:30.618 and especially what you call hazardous alcohol use. 0:04:31.220 --> 0:04:33.459 So it'd be interesting just to talk about what you 0:04:33.459 --> 0:04:37.760 define hazardous use. Is it a binge on the weekend? 0:04:37.899 --> 0:04:40.299 Is it a clinical addiction? Is it something else? Is 0:04:40.299 --> 0:04:41.799 it different here than in Spain? 0:04:42.339 --> 0:04:45.579 Yeah, well, hazardous alcohol use actually is defined by the 0:04:45.579 --> 0:04:46.558 World Health Organization. 0:04:47.089 --> 0:04:50.420 And it involves three core components or core elements. It, 0:04:50.640 --> 0:04:55.299 it refers to consumption, so basic quantity, frequency questions around 0:04:55.299 --> 0:04:57.980 how much we're drinking, and that can include binge drinking questions. 0:04:58.380 --> 0:05:02.019 It also includes symptoms of dependence, so for instance, struggling 0:05:02.019 --> 0:05:05.260 to stop drinking once you've started, functional difficulties that we 0:05:05.260 --> 0:05:07.980 might experience that I didn't see in Spain, um, and 0:05:07.980 --> 0:05:12.410 alcohol related problems like guilt, blackout, if someone's perhaps alerted 0:05:12.410 --> 0:05:15.178 you to, um, their concerns about your drinking. 0:05:15.589 --> 0:05:18.869 So it's essentially hazardous alcohol use is essentially a pattern 0:05:18.869 --> 0:05:22.618 of behaviour that increases an individual's risk for physical or 0:05:22.619 --> 0:05:26.790 psychological harm, even if you don't actually yet see those consequences. 0:05:26.829 --> 0:05:30.070 They may emerge later, and it's linked to an increased 0:05:30.070 --> 0:05:33.950 risk of acute injuries like falls or car accidents or 0:05:33.950 --> 0:05:37.709 being the perpetrator or victim of violence, greater likelihood of 0:05:37.709 --> 0:05:40.850 developing chronic illness like liver disease or other cancers related 0:05:40.850 --> 0:05:42.328 to alcohol. 0:05:42.670 --> 0:05:46.220 And critically, this type of alcohol use renders people much 0:05:46.220 --> 0:05:50.738 more vulnerable for developing alcohol use disorders or dependence. So 0:05:50.738 --> 0:05:53.729 hazardous use is different to addiction, but it can be considered, 0:05:53.940 --> 0:05:56.320 at least for some people, a bit of a precursor 0:05:56.320 --> 0:05:59.730 to the development of alcohol use disorder. Now, in Australia, 0:05:59.738 --> 0:06:03.700 we actually use, we assess consumption using national drinking guidelines 0:06:03.700 --> 0:06:07.660 which currently state that um anyone who drinks more than 0:06:07.660 --> 0:06:12.730 10 standard drinks a week or 4 drinks in one day, is, um, 0:06:12.850 --> 0:06:14.419 at greater risk of harm. 0:06:14.829 --> 0:06:17.440 Uh, but the guidelines do emphasise that actually there's no 0:06:17.440 --> 0:06:21.320 level of drinking that's completely safe. Recent national surveys in Australia, 0:06:21.399 --> 0:06:24.760 so these are surveys conducted by the Australian Institute of 0:06:24.760 --> 0:06:27.880 Health and Welfare, and we've got a big national survey 0:06:27.880 --> 0:06:29.760 that comes out every 2 to 3 years, the National 0:06:29.760 --> 0:06:32.600 Drug Strategy Household Survey, that shows that about 1 in 0:06:32.600 --> 0:06:36.040 3 Australians are drinking above those Australian guidelines, and if 0:06:36.040 --> 0:06:37.839 we look at the group of people under the age 0:06:37.839 --> 0:06:41.118 of 25, it's about 40% exceed those guidelines. 0:06:42.178 --> 0:06:45.660 And there's been some recent news about kids or young 0:06:45.660 --> 0:06:49.850 people these days drinking less, so is, is hazardous drinking 0:06:49.850 --> 0:06:54.700 in Australia a bigger problem for younger people than perhaps 0:06:54.700 --> 0:06:55.769 we're seeing in the news? 0:06:55.899 --> 0:06:58.899 It's true that younger people on average are drinking less, 0:06:59.059 --> 0:07:01.880 but it's the same amount of alcohol, so there are still, 0:07:01.940 --> 0:07:04.700 there are still this group, this sub-cohort of young people 0:07:04.700 --> 0:07:07.179 who are drink that are keeping the level, the amount 0:07:07.178 --> 0:07:10.660 of drinking elevated. Um, I think just recently, yesterday or 0:07:10.660 --> 0:07:11.690 the day before actually, 0:07:12.049 --> 0:07:14.260 Um, some results came out about the biggest group of 0:07:14.260 --> 0:07:16.929 drinkers are now men in their middle age. Um, it's 0:07:16.929 --> 0:07:19.579 definitely true that we see that group at the moment 0:07:19.579 --> 0:07:22.940 engaging in greater frequency and quantity of drinking. 0:07:23.410 --> 0:07:26.160 But yeah, generally drinking is done by the sort of 0:07:26.160 --> 0:07:29.130 hazardous drinking or drinking above guidelines is done by a 0:07:29.130 --> 0:07:31.559 relatively small number of people, but they're drinking a lot, 0:07:31.730 --> 0:07:34.010 and that's certainly the case for younger people, and, and 0:07:34.010 --> 0:07:36.390 causing some harmful consequences, 0:07:36.510 --> 0:07:38.489 I, yeah, yep. I'll have to look out for that 0:07:38.489 --> 0:07:42.049 when I enter middle age. Um, so one idea that's 0:07:42.049 --> 0:07:45.089 really front and centre in your scientific work, Antoinette, is 0:07:45.089 --> 0:07:48.010 this idea of impulsivity, so what do you mean by that? 0:07:48.690 --> 0:07:53.339 Um, so broadly we're, we can think about impulsivity as 0:07:53.339 --> 0:07:55.529 acting on the spur of the moment or acting quickly, 0:07:55.700 --> 0:08:00.140 perhaps too quickly without thinking things through or thinking about consequences. 0:08:00.540 --> 0:08:04.809 In the research arena, impulsivity is understood to be multi-dimensional, 0:08:05.059 --> 0:08:07.619 and there are two aspects that are particularly relevant in 0:08:07.619 --> 0:08:12.079 the area of addiction or addiction research, that's impulsive decision-making 0:08:12.079 --> 0:08:13.500 and response inhibition. 0:08:13.880 --> 0:08:17.029 Impulsive decision making refers to that tendency some of us 0:08:17.029 --> 0:08:20.160 have to favour immediate rewards regardless of whats the outcome, 0:08:20.239 --> 0:08:23.040 and if we put that another way, that's sensitivity to 0:08:23.040 --> 0:08:29.040 proximate or close reward and insensitive, insensitivity to the delayed consequences. 0:08:29.429 --> 0:08:32.429 And we're exhibiting this type of impulsivity when we choose 0:08:32.429 --> 0:08:35.270 to keep drinking because it feels good, rather than to 0:08:35.270 --> 0:08:38.070 consider how it might impact our ability to perform it 0:08:38.070 --> 0:08:40.209 at our job tomorrow or how it might affect our 0:08:40.210 --> 0:08:45.169 long-term health. Response inhibition by contrast is thought of as self-control. 0:08:45.419 --> 0:08:48.109 It's our ability to think through the consequences and to 0:08:48.109 --> 0:08:50.750 inhibit or stop ourselves from drinking in the moment. 0:08:51.760 --> 0:08:54.369 Got it, so a combination of sort of rushing into 0:08:54.369 --> 0:08:57.919 things too quickly without thinking about long-term consequences and not 0:08:57.919 --> 0:08:59.830 resisting or delaying gratification? 0:09:00.250 --> 0:09:02.900 Exactly, that's exactly right, and the theory suggests that impulsivity 0:09:02.900 --> 0:09:06.580 will emerge when there's an imbalance between those two aspects 0:09:06.580 --> 0:09:10.159 of impulsive, you know, impulsive decision making versus the um 0:09:10.159 --> 0:09:11.679 inhibitory control processes. 0:09:12.280 --> 0:09:14.659 It reminds me of another episode we've got this season 0:09:14.960 --> 0:09:18.400 with Daniel Bennett around gambling, and I guess gambling goes 0:09:18.400 --> 0:09:21.549 hand in hand with alcohol use both in kind of 0:09:21.549 --> 0:09:25.200 behaviours but also this impulsivity. Can you tell us a 0:09:25.200 --> 0:09:28.625 little bit about the brain processes or the mental functions 0:09:28.625 --> 0:09:30.635 that are responsible for impulsivity? 0:09:30.784 --> 0:09:34.184 Yeah, sure, so impulsive decision making is thought to be 0:09:34.184 --> 0:09:38.065 mediated by reward sensitive, dopamine rich mid-brain areas, and we're 0:09:38.065 --> 0:09:40.905 talking about several areas here. People have probably heard of 0:09:40.905 --> 0:09:42.944 the amygdala, which processes emotion. 0:09:43.219 --> 0:09:47.599 And biases decision making toward emotionally charged immediate responses, um, 0:09:47.659 --> 0:09:49.939 we're talking about the insular as well, which is linked 0:09:49.940 --> 0:09:52.780 to craving, that sort of feeling we must have it now. Um, 0:09:52.900 --> 0:09:55.218 the ventral striatum is also involved, which is a key 0:09:55.219 --> 0:10:00.059 area for reward-processing and risk-taking. Um, response inhibition by contrast 0:10:00.059 --> 0:10:05.289 is underpinned by more top-down processes, so it falls under the, um, 0:10:05.299 --> 0:10:07.500 overarching umbrella of executive function. 0:10:07.940 --> 0:10:11.510 And inhibition in fact is a core element of executive function. 0:10:11.820 --> 0:10:14.820 Our executive functions are those higher order skills that enable 0:10:14.820 --> 0:10:19.250 us to plan, to organise, um, to enact self-control, to remember, 0:10:19.340 --> 0:10:21.880 keep things in mind, our working memory, to shift attention, 0:10:21.979 --> 0:10:26.130 to adjust, um, our behaviour in response to changing circumstances, 0:10:26.460 --> 0:10:29.179 and these functions are mediated by the prefrontal cortex. 0:10:29.460 --> 0:10:34.349 Response inhibition in particular is supported by the dorsolateral prefrontal cortex, 0:10:34.429 --> 0:10:37.140 and that's an area where we hold long-term goals in mind, 0:10:37.270 --> 0:10:39.109 such as, I need to stay sober. 0:10:39.590 --> 0:10:43.169 So, does being more impulsive make you more likely to 0:10:43.169 --> 0:10:46.750 start using alcohol in hazardous ways, or more likely for 0:10:46.750 --> 0:10:50.000 your hazardous use to progress further, or what? 0:10:50.229 --> 0:10:53.309 Yeah, well this is really interesting because there is quite 0:10:53.309 --> 0:10:57.940 a raft of evidence that suggests pre-existing impulsivity renders individuals more 0:10:57.940 --> 0:11:01.940 vulnerable for problems with alcohol and or drugs, so impulsive 0:11:01.940 --> 0:11:04.960 decision making and or response, poor response inhibition in children 0:11:04.960 --> 0:11:09.090 and young adults predicts an earlier onset of first alcohol 0:11:09.090 --> 0:11:13.830 or drug use. It also predicts a rapid escalation of use, um, 0:11:13.859 --> 0:11:15.940 so for instance, from occasional use to heavy. 0:11:16.169 --> 0:11:20.250 Use, but we also know though that alcohol and drug 0:11:20.250 --> 0:11:23.650 use can exacerbate impulsivity, and there's sort of two arms 0:11:23.650 --> 0:11:26.369 to this type of research. There are acute effects, so 0:11:26.369 --> 0:11:28.809 when under the influence, people tend to be more impulsive, 0:11:29.090 --> 0:11:33.359 and people who had pre-existing higher levels of impulsivity will 0:11:33.359 --> 0:11:37.049 be even more impulsive in the moment once they've taken 0:11:37.049 --> 0:11:38.390 some alcohol or drugs on board. 0:11:38.799 --> 0:11:42.000 But there's also with chronic use, we see structural and 0:11:42.000 --> 0:11:45.069 functional changes in the brain, and it's, it's, it's those 0:11:45.070 --> 0:11:48.309 brain regions I mentioned involved in decision making and self-control, 0:11:48.650 --> 0:11:52.280 which can produce then even greater heightened impulsive behaviour, so 0:11:52.280 --> 0:11:54.440 it's sort of a feedback loop starts to develop. 0:11:54.950 --> 0:11:57.669 It's worth mentioning that there's evidence that the changes we 0:11:57.669 --> 0:12:01.549 see in the brains um related to decision making and 0:12:01.549 --> 0:12:04.989 response inhibition are especially prominent in young people who commence 0:12:04.989 --> 0:12:07.950 alcohol and drug use quite early. So there's a bit 0:12:07.950 --> 0:12:10.140 of research around young people who commence drinking sort of 0:12:10.140 --> 0:12:13.608 at around 15, and we see long-term changes in their brain. 0:12:14.070 --> 0:12:18.349 So you're talking about people having differences in impulsivity from 0:12:18.349 --> 0:12:21.630 a starting point. So if we know impulsivity is a 0:12:21.630 --> 0:12:27.020 risk factor for problematic alcohol use, how do we change that? 0:12:27.299 --> 0:12:30.619 Yeah, um, so there's a bit of research going on, uh, 0:12:30.820 --> 0:12:33.140 in this area at the moment and different research groups 0:12:33.140 --> 0:12:38.728 are taking different approaches. Impulsivity does appear to have biological underpinnings, um. 0:12:39.020 --> 0:12:41.690 Nonetheless, it's important to remember, that being impulsive doesn't mean 0:12:41.690 --> 0:12:45.098 someone will definitely develop problems with drug or alcohol, um, 0:12:45.219 --> 0:12:47.039 it's just that they appear to be more vulnerable. 0:12:47.289 --> 0:12:49.929 So it might be of benefit to intervene in these cases, 0:12:50.049 --> 0:12:52.969 to be able to target these people with early interventions, 0:12:53.359 --> 0:12:57.039 early education, maybe some skill building, and I guess it's 0:12:57.039 --> 0:13:00.130 probably beneficial to think in terms of managing and reducing 0:13:00.130 --> 0:13:03.289 the impact of impulsivity rather than categorically being able to 0:13:03.289 --> 0:13:03.728 change it. 0:13:03.890 --> 0:13:07.510 Would someone know if they're high on impulsivity? 0:13:08.320 --> 0:13:12.520 Well, they may do, um, one arm of research just 0:13:12.520 --> 0:13:16.280 asks self-report questions about impulsivity, so it's possible to, you know, 0:13:16.400 --> 0:13:18.719 go online and have a look, but you, I mean 0:13:18.719 --> 0:13:21.280 in testing people, certainly a number of people will indicate 0:13:21.280 --> 0:13:22.909 to me prior to testing, oh I think I'm more 0:13:22.909 --> 0:13:24.989 impulsive than most people, yeah. 0:13:25.479 --> 0:13:27.520 Yeah, it's so interesting cos when you think about impulsiveness 0:13:27.520 --> 0:13:30.359 from a personality perspective, it just suggests this is something 0:13:30.359 --> 0:13:32.199 that you have or something that you are and you're 0:13:32.200 --> 0:13:34.679 not really gonna change it very much, so, what do 0:13:34.679 --> 0:13:35.309 you do about it? 0:13:35.359 --> 0:13:37.159 But I think what's interesting about your work is you're 0:13:37.159 --> 0:13:41.099 thinking about impulsiveness as something that you can not necessarily overcome, but, 0:13:41.159 --> 0:13:44.049 but there are clever tricks that you can get around 0:13:44.049 --> 0:13:46.640 it if you like, or, or uh uh offer a 0:13:46.640 --> 0:13:49.840 more optimistic, if you like, stance towards recovery. 0:13:49.919 --> 0:13:51.549 So one thing that you've done in your work which 0:13:51.549 --> 0:13:54.440 I think is fascinating, is this idea that simply giving 0:13:54.440 --> 0:13:57.880 people feedback about their drinking can result in reductions in 0:13:57.880 --> 0:14:00.799 hazardous alcohol use. So can you explain what you've done 0:14:00.799 --> 0:14:02.099 on this topic? Yeah, absolutely. 0:14:02.280 --> 0:14:05.659 So we've conducted two studies now with two different samples, 0:14:05.880 --> 0:14:08.559 and um the results have shown that if we provide 0:14:08.559 --> 0:14:12.319 people with personalised information about their drinking, about their level 0:14:12.320 --> 0:14:16.640 of impulsivity, and how impulsivity is implicated in hazardous alcohol use, 0:14:17.119 --> 0:14:19.559 they appear to reduce their drinking. 0:14:19.859 --> 0:14:22.849 So in one study we found that young hazardous drinkers 0:14:23.440 --> 0:14:25.780 had reduced their total intake at follow-up, which was at 0:14:25.780 --> 0:14:29.429 about 60 days, by 32 to 35%, which is equivalent 0:14:29.429 --> 0:14:32.109 to 4 standard drinks per week. And so this was 0:14:32.109 --> 0:14:34.390 in response to this feedback, that group of young people, 0:14:34.469 --> 0:14:37.590 there was 250 of them, and they're 21, 22 years 0:14:37.590 --> 0:14:38.210 of age. 0:14:38.770 --> 0:14:41.739 Um, the impact on their drinking was so substantial that 0:14:41.739 --> 0:14:45.900 these hazardous drinkers couldn't be distinguished from non-harmful drinkers at follow-up, 0:14:46.179 --> 0:14:48.780 and this was on measures of total intake, on binge drinking, 0:14:48.890 --> 0:14:50.739 on how much people would drink in any one day. 0:14:51.020 --> 0:14:54.250 We could no longer define them as, um, hazardous drinkers. 0:14:54.659 --> 0:14:57.859 We've recently replicated this study in a larger multi-part study 0:14:57.859 --> 0:15:00.700 which is about to come out in JMIR, and in 0:15:00.700 --> 0:15:02.979 this study we follow people at 3 months, and again 0:15:02.979 --> 0:15:05.460 we see a 33% reduction in drinking. 0:15:05.849 --> 0:15:10.070 Does that feedback only reduce the drinking for those who 0:15:10.250 --> 0:15:12.719 feel they have a problem or who want to reduce it, 0:15:12.809 --> 0:15:15.729 that have some motivation to drink less when they find 0:15:15.729 --> 0:15:19.940 out how much they're drinking, or, can anyone kind of 0:15:19.940 --> 0:15:21.820 see a reduction in their drinking even if they don't 0:15:21.820 --> 0:15:24.539 have that kind of desire or motivation to drink less? 0:15:24.729 --> 0:15:27.140 Well, you would think that motivation might be a key factor, 0:15:27.219 --> 0:15:29.469 but that's not actually what we saw in our results. 0:15:29.580 --> 0:15:32.219 We were looking in this second study to see if 0:15:32.219 --> 0:15:34.739 we could see what was underpinning this reduction in drinking, 0:15:34.780 --> 0:15:37.580 and motivation was one of the variables that we included, 0:15:37.859 --> 0:15:39.770 but this didn't seem to have any impact on the 0:15:39.770 --> 0:15:43.539 actual change, which was actually a surprising finding. There are 0:15:43.539 --> 0:15:45.659 some large meta-analysis studies that have come out of the 0:15:45.659 --> 0:15:46.960 United States recently. 0:15:47.669 --> 0:15:50.669 That that do question whether motivation's an essential element for 0:15:50.669 --> 0:15:53.460 this kind of change, but nonetheless I did expect to 0:15:53.460 --> 0:15:55.750 see that it might, you know, mediate the results in 0:15:55.750 --> 0:15:58.330 some way, but no, we didn't see that this time. 0:15:58.830 --> 0:16:01.549 It's sort of astonishing that just giving feedback even without 0:16:01.549 --> 0:16:05.590 motivation could make such an impact on behaviour change and 0:16:05.590 --> 0:16:08.710 without wanting to get too controversial, you know, this idea 0:16:08.710 --> 0:16:11.349 that you don't have to delve into people's childhoods or 0:16:11.349 --> 0:16:17.007 make them commit to something or appeal to a higher power, uh, 0:16:17.007 --> 0:16:19.960 they're simply giving some accurate knowledge about what people are 0:16:19.960 --> 0:16:20.989 doing could have an effect. 0:16:21.159 --> 0:16:24.000 It also presumably goes against a lot of what some 0:16:24.000 --> 0:16:27.059 people believe about a sort of a brain disease model 0:16:27.059 --> 0:16:29.429 of alcohol. Again, I don't want to be too controversial here, 0:16:29.489 --> 0:16:32.200 but if this was something that you couldn't change, and 0:16:32.200 --> 0:16:35.059 yet your research is showing that a bit of factual 0:16:35.059 --> 0:16:39.200 information can lead to significant change, that's, uh, astonishing. 0:16:39.510 --> 0:16:42.280 Well, I mean, it is, it is really astonishing, um, 0:16:42.590 --> 0:16:45.229 at least it's the case for young hazardous drinking. We 0:16:45.229 --> 0:16:47.900 have to be a little bit circumspect, I suppose. Um, 0:16:47.989 --> 0:16:50.349 we need to build on these findings to see if 0:16:50.349 --> 0:16:52.830 this type of personalised feedback has the same impact in 0:16:52.830 --> 0:16:56.270 the wider community or other cohorts, whether, for example, our, 0:16:56.429 --> 0:16:57.390 you know, our, our, our, 0:16:57.489 --> 0:16:59.650 men in middle age will react in the same way 0:16:59.650 --> 0:17:01.369 to this type of feedback is yet to be seen, 0:17:01.489 --> 0:17:03.669 but yeah, that, that's, that's coming work. 0:17:03.809 --> 0:17:06.649 But it's also fascinating, a lot of the, the models 0:17:06.650 --> 0:17:10.170 of behaviour change have motivation as a core kind of 0:17:10.170 --> 0:17:12.890 feature to to dial up or dial down in terms 0:17:12.890 --> 0:17:14.889 of encouraging a behaviour change. 0:17:15.910 --> 0:17:18.959 Um, a fascinating part of your research is how you 0:17:18.959 --> 0:17:23.040 get accurate feedback to these drinkers, and we probably can 0:17:23.040 --> 0:17:26.599 all reflect on having less than ideal self-reports when we 0:17:26.599 --> 0:17:29.119 ask someone, you know, how much did you drink in 0:17:29.119 --> 0:17:31.359 this session or whatever the behaviour is. 0:17:31.819 --> 0:17:35.458 So how did you develop ways to assess drinking in 0:17:35.459 --> 0:17:38.660 a real-time, more accurate way than just asking someone on 0:17:38.660 --> 0:17:40.599 Monday how much they drank on the weekend? 0:17:41.140 --> 0:17:44.489 So um during my PhD I designed an app, um, 0:17:44.500 --> 0:17:47.660 which it was designed to help researchers capture real-time information 0:17:47.660 --> 0:17:48.380 about drinking. 0:17:48.760 --> 0:17:50.930 At the time, I was hoping to develop a tool 0:17:50.930 --> 0:17:53.770 that would overcome some of the limitations around accurately assessing 0:17:53.770 --> 0:17:56.688 alcohol use. At that point we were relying on sort 0:17:56.689 --> 0:18:00.140 of summary retrospective measures of alcohol intake, and this is, 0:18:00.329 --> 0:18:02.889 as you say, there are disadvantages to that type of assessment. 0:18:03.209 --> 0:18:06.770 People find it difficult to conceptualise their intake. They're often 0:18:06.770 --> 0:18:09.399 overlooking high intake sessions, so they're sort of applying an 0:18:09.400 --> 0:18:11.229 average already to their own drinking. 0:18:11.540 --> 0:18:15.160 Um, and obviously there's difficulties with recall, so the information's 0:18:15.500 --> 0:18:19.250 not particularly accurate and it's certainly not very nuanced. So 0:18:19.250 --> 0:18:20.939 we reasoned that if we had an app, we could 0:18:20.939 --> 0:18:23.939 have people recording their drinking as it happened, and we 0:18:23.939 --> 0:18:26.939 were hoping that it would provide very, um, accurate and 0:18:26.939 --> 0:18:28.060 detailed information. 0:18:28.849 --> 0:18:32.099 Um, the app's called Alcohol Capture, and it enables people 0:18:32.099 --> 0:18:34.979 to track consumption for a period of days. We typically 0:18:34.979 --> 0:18:38.179 use 14 days, but it's variable. They get notifications to 0:18:38.180 --> 0:18:39.899 input data a couple of times a day, but they 0:18:39.900 --> 0:18:42.159 can also open the app at any time and put 0:18:42.160 --> 0:18:44.899 information in. And all Australian drink sizes have been programmed 0:18:44.900 --> 0:18:46.459 into the app, so people are not having to make 0:18:46.459 --> 0:18:49.659 complicated calculations in their head about standard drink sizes. And 0:18:49.660 --> 0:18:50.260 an early paper, 0:18:50.364 --> 0:18:53.564 From my PhD showed that participants were recording greater frequency 0:18:53.564 --> 0:18:56.525 of drinking on the app and higher intake, as opposed 0:18:56.525 --> 0:18:59.484 to when completing the retrospective measures. So that's the app 0:18:59.484 --> 0:19:02.574 we've been using in our feedback studies. We're providing people 0:19:02.574 --> 0:19:06.494 with this personalised feedback based on data coming from the app, um, 0:19:06.645 --> 0:19:09.034 in the hope that it's, it's very accurate and, um, 0:19:09.045 --> 0:19:12.645 it's linked quite clearly to actual drinking episodes. We have 0:19:12.645 --> 0:19:15.925 simultaneously developed an app to assess cognition in real time, 0:19:15.964 --> 0:19:17.505 and this is called CheckCog. 0:19:17.979 --> 0:19:21.229 Um, it allows us to assess both inhibit- response inhibition 0:19:21.229 --> 0:19:24.500 and working memory several times a day again for 14 days, 0:19:24.869 --> 0:19:27.069 and so, um, if you think about what I said before, 0:19:27.189 --> 0:19:30.689 we're assessing elements of executive function with this app, and 0:19:30.869 --> 0:19:33.170 just this week, in fact, a, a colleague of mine, 0:19:33.270 --> 0:19:36.409 Dr Gezelle Dali, has found that day to day fluctuations 0:19:36.989 --> 0:19:40.170 in cognition assessed via this app predicts drinking that day. 0:19:40.839 --> 0:19:42.880 So, this is great because this is opening up the 0:19:42.880 --> 0:19:45.199 door for us to give just in time feedback where 0:19:45.199 --> 0:19:47.939 we can potentially tell people about their impulsivity in real 0:19:47.939 --> 0:19:50.800 time on the day, in the hope that it influences 0:19:50.800 --> 0:19:52.020 drinking later that day. 0:19:52.239 --> 0:19:55.280 And just on that, I think people wouldn't necessarily be 0:19:55.280 --> 0:19:59.520 surprised to think that drinking might impact cognition or performance 0:19:59.520 --> 0:20:02.280 on cognitive tasks, but what you're saying is that it 0:20:02.280 --> 0:20:03.198 is the other way as well? 0:20:03.290 --> 0:20:06.369 So if your cognition is declining, you are then more 0:20:06.369 --> 0:20:08.329 likely to, engage in drinking 0:20:08.489 --> 0:20:11.609 Yeah, yeah, so she's found differences in cognition sort of 0:20:11.609 --> 0:20:14.089 measured across the two time points in the day, are 0:20:14.089 --> 0:20:15.839 predicting that drinking on the day, yeah. 0:20:15.890 --> 0:20:18.619 And what sort of cognitive tasks are these just so 0:20:18.619 --> 0:20:19.689 people can imagine? 0:20:19.770 --> 0:20:22.410 Yeah, so the response inhibition task is a task called 0:20:22.410 --> 0:20:26.949