Alcohol dependence is a chronic disorder with frequent relapses during recovery. Most studies have pointed out that craving is the main process involved in relapse, but recently other factors have been implicated in it, such as attentional bias and impulsivity. Some authors consider that different stages could be involved in the relapse process, and each may be governed by different mechanisms: Attentional bias; motivational response to alcohol cues and inhibitory control.

Motivationally salient cues attract and hold selective attention, and this “attentional bias, (AB)” is related to individual differences in appetitive and aversive motivation. In a recent review, attentional bias has been shown to be significantly present in alcohol-dependent and is associated with craving and risk to a relapse in alcohol consumption.

In alcohol-dependent subjects, alcohol-related cues reach a very high motivational valence (Motivational response, MR), which, in effect, increases craving for alcohol and activates behavioral strategies towards alcohol intake. One method used to assess motivational valence of alcohol is the craving self-assessment. In addition, in recent years, the affective modulation of the startle reflex has been used as an objective measure of craving. It has been shown that subjects with a low baseline startle response when viewing alcohol-associated pictures are at major risk of relapse compared to those with increased reactions.

Once alcohol craving has appeared, the subject will either drink or not, depending on his ability to resist his behavior towards alcohol consumption (impulsivity or inhibitory control, IC). Moreover, subjects that exhibit greater impulsivity are those more likely to relapse.

Our group has recently conducted a study on a sample of 172 alcohol-dependent patients seen in outpatient therapeutic program during 12 weeks. All of them were assessed with the following measures: Attentional bias was assessed using the dot task, motivational response was evaluated using the affective modulation of the startle reflex paradigm, inhibitory control was assessed by the stop-signal reaction time task. Alcohol relapse variables were: relapse, days to the first relapse and days of accumulated abstinence.

One of the most relevant results was that processes related to inhibitory control (Stop-signal reaction time and attentional bias) were the most relevant measures to explain variables related to relapse in alcohol consumption during the treatment period.

Our results support the use of assessment strategies, therapeutic and pharmacological inhibtoria aimed at improving the ability of serious alcohol-dependent patients.