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Addict Behav. 2014 Apr;39(4):797-802. doi: 10.1016/j.addbeh.2013.12.012. Epub 2013 Dec 19.

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

Author information

  • 1Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA. Electronic address:
  • 2Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA. Electronic address:
  • 3National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA. Electronic address:
  • 4Department of Psychology, Clark University, Worcester, MA, USA. Electronic address:
  • 5Department of Psychology, University of North Carolina at Wilmington, Wilmington, NC, USA. Electronic address:
  • 6Department of Criminology, University of South Florida, Tampa, FL, USA. Electronic address:



Alcohol 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.


Participants 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.


Regression 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.


Implicit cognitive processes may be targeted in behavioral and pharmacological treatments in risky drinking nicotine users, particularly those with depression comorbidity.


Alcohol use; Comorbidity; Depression; Drinking; Implicit attitudes; Nicotine use

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