Implicit alcohol cognitions in risky drinking nicotine users with and without co-morbid major depressive disorder

• Risky drinking nicotine users with MDD had strongest implicit drinking motivations.
• Risky drinkers without comorbid nicotine and MDD had weakest implicit cognitions.
• There was a main effect of nicotine use on alcohol–approach cognitions.
• Risky drinking nicotine users with MDD were most likely to report drinking to cope.
• Results are consistent with negative reinforcement models of addiction.

ObjectiveAlcohol consumption, nicotine use, and major depressive disorder (MDD) are highly co-morbid. The negative reinforcement model of addiction would suggest that smokers may consume alcohol to relieve negative affective symptoms, such as those associated with MDD and withdrawal from nicotine. Over time, these behaviors may become so strongly paired together that they automatically activate a desire to use alcohol, even in the absence of conscious or deliberate intention. This study examined implicit alcohol cognitions in 146 risky drinking nicotine users (n = 83) and non-users (n = 63), to help uncover cognitive mechanisms that link drinking, nicotine use, and depression together. We proposed that nicotine users with a history of MDD would have stronger implicit motivations to drink than non-nicotine users without MDD.MethodParticipants were assessed on lifetime MDD (n = 84) or no MDD (n = 62), and then completed an Implicit Association Task designed to test the strength of associations between alcohol pictures and “approach” words.ResultsRegression analyses showed that implicit alcohol–approach attitudes were stronger among risky drinking nicotine users than non-users. Alcohol–approach motivations were also stronger among risky drinking nicotine users compared to non-users with a history of MDD; nicotine use was unrelated to implicit alcohol cognitions for risky drinkers without MDD.ConclusionsImplicit cognitive processes may be targeted in behavioral and pharmacological treatments in risky drinking nicotine users, particularly those with depression comorbidity.