Findings in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging could pave the way for targeted and personalized interventions for people with alcohol use disorder

October 19, 2026 – 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 study, appearing in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 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.