Working memory in context: The role of alcohol distractors in working memory performance in low to heavy alcohol drinkers

Background: Motivational and cognitive control-related processes both play a role in addiction but are often studied independently. Alcohol-related cues may impair performance in cognitively demanding tasks, particularly in individuals with alcohol use-related problems, where working memory (WM) may be especially affected. This study investigated whether distracting alcohol-related flankers impact WM performance across varying levels of alcohol use severity. Methods: A total of 310 participants were classified into risk groups based on Alcohol Use Disorder Identification Test (AUDIT) scores: low (≤7), mid (8–14), and high (≥15). We developed an online N-back flanker task where letters were flanked by alcohol-related or neutral words. Four WM-loads (0-, 1-, 2-, 3-back) were included, with higher loads requiring participants to hold and update more information in WM. Linear mixed effects models assessed the effects of WM-load, flanker type, group, or their interaction on accuracy (% correct) and reaction time. Results: An interaction was found between WM-load and flanker type; reduced accuracy (B = −2.47; p_Holm = 0.002) and longer reaction times (B = 58.46; p_Holm < 0.001) were found when participants were presented with alcohol flankers and a higher WM-load relative to neutral flankers and a lower WM-load. Difference scores (3-back minus 1-back) showed that individuals in the mid-risk group had a larger reduction in accuracy (B = −4.12; p_Holm = 0.021) when presented with alcohol versus neutral flankers, relative to the low-risk group. For reaction time, only an effect of flanker type was found, with shorter reaction times (B = −29.93; p_Holm = 0.012) for alcohol flankers versus neutral flankers. Conclusions: Our findings suggest that a distracting alcohol-related context negatively impacts WM performance, particularly under high cognitive demand. This effect is particularly pronounced in mid-risk alcohol users. This suggests that alcohol-related cognitive interference may be more significant during the early stages of problematic alcohol use.