The central executive model: An examination of its utility to predict changes in drinking behavior among people abusing alcohol

Prochaska and DiClemente's Transtheoretical Stages of Change Model (1982) postulates that cognitive processes, including executive cognitive functions such as memory, planning, organizing, impulse control, and problem-solving abilities, are critical skills for drinking behavior change. Heavy drinking has been associated with executive cognitive dysfunction that has been linked to poor drinking outcomes over time. Alan Baddeley's Central Executive Model (1986; 1992), may provide a useful cognitive model for understanding complex drinking behavior as described in the Transtheoretical Model, such as motivation to change, skills utilization, self-efficacy, and self-regulation of behavior. A meta-memory attention-concentration system (central executive) may integrate factual knowledge about recent drinking episodes, increasing concern about drinking and enhancing motivation to change, with visual-spatial cues associated with recognizing high risk drinking situations and how to negotiate such situations successfully in order to maintain behavior change.; One hundred twenty participants who met criteria for alcohol abuse or dependence, without other neurocognitive risk factors, were administered neuropsychological tests assessing executive cognitive function. It was hypothesized that better executive cognitive function would predict greater motivation to change drinking, lower response time for coping, and higher self-efficacy (confidence) to negotiate high-risk drinking situations, and lower consumption rates of alcohol at three-month follow-up. Results modestly supported the efficacy of the Central Executive Model to predict motivation to change and self-regulation of drinking behavior. Attention-concentration abilities predicted changes in drinking rates over a three month period; greater verbal memory abilities predicted greater awareness of drinking problems, but not lower total alcohol expectancies; visuospatial deficits predicted longer response times to solving problems; and better visual memory function and fewer visuospatial deficits significantly predicted drinking reduction over a three month period after baseline among people motivated to change their drinking behavior. Depressive symptoms, but none of the variables of interest, predicted self-efficacy in high risk drinking situations. Finally, significant reduction of drinking in the sample was noted between baseline and follow-up, suggesting an inadvertent assessment-related intervention effect. These findings suggest that the Central Executive may have utility for predicting difficulties with behavior change among people abusing alcohol.