Risk-taking propensity has been crucial to the investigation of alcohol use and consequences. One measure, the balloon analogue risk task (BART), has been used consistently over the past two decades. However, it is unclear how this measure is related to alcohol outcomes. This paper systematically reviews the literature on the BART and alcohol outcomes. First, direct associations between the BART and alcohol use are reviewed including correlations, group comparisons, the BART’s prediction of alcohol outcomes and BART performance after consuming alcohol. Then, potential moderators that explain when and for whom the BART is related to alcohol outcomes are reviewed. Finally, potential mechanisms that explain how the BART and alcohol outcomes are related are reviewed. This review reveals patterns in the BART suggesting risk-taking propensity may be related to changes in alcohol use over time; however, there is little evidence to suggest BART scores increase after consuming alcohol. Yet, additional research suggests adjusted average pump scores may be too simplistic for the amount of information the BART captures and understanding individual’s patterns of responses on the BART is important for investigating its relation to alcohol outcomes. Finally, this review opens up several future directions for research to understand how risk-taking propensity is related to alcohol outcomes.

Introduction: The Self-Medication Hypothesis suggests that individuals drink to alleviate undesirable affective states. Behavioral Economics Theory states that individuals deprived of resources (i.e., physically neglected) consume more reinforcing substances when they are available than others. Childhood trauma may indirectly increase impaired control over alcohol (IC; drinking beyond one’s own intentions) and thereby increase alcohol use and problems through the employment of coping-motives. Method: A structural equation model that included sex as a covariate examined mediated paths with 612 university students. Results: Men were less likely to be emotionally abused and were more likely to use greater amounts of alcohol than women did. Physical neglect was directly linked to both more IC and alcohol use. Emotional and sexual abuse were directly linked to more coping motives. Both emotional and sexual abuse were indirectly linked to more alcohol use and its related problems through increased coping motives and IC. Conclusions: Consistent with Behavioral Economics Theory, there was a direct link between physical neglect and IC. We also found partial support for the Self-Medication Hypothesis regarding the emotional and sexual abuse trauma dimensions; they indirectly contributed to alcohol use and its related problems via the mediating mechanisms of more coping motives and IC. Our findings suggest coping motives could be a therapeutic target for intervention among those sexually or emotionally abused.

The Self-Medication Model predicts that individuals exposed to chronic stressful life histories (life experiences and physical neglect) will exhibit exaggerated behavioral impaired control over alcohol (i.e., IC; drinking beyond intended and/or recommended limits during ad libitum drinking) after experiencing acute stress. The Behavioral Economics Model predicts those with physical neglect histories (denied necessities) will be more likely to exhibit behavioral IC regardless of the presence or absence of acute and/or other chronic stress. Neither of these competing theories of alcohol addiction makes precise or distinct predictions concerning sex differences. We randomized groups of 2–3 drinkers (N = 210, 105 women, 105 men) to stress or no stress and alcohol or expectancy placebo conditions followed by a 90 min ad libitum social drinking session. We used the GLIMMIX procedure in SAS 9.4 to conduct a multilevel model for the number of standardized drinks ordered and Peak Blood Alcohol Concentration (BAC). We found significant three-way interactions of physical neglect level by stress condition by sex assigned at birth. Consistent with the Self-Medication Model, women with mean + 1 unit greater physical neglect histories showed higher behavioral IC only when the acute stress was present. In accordance with the Behavioral Economics Model, men with mean + 1 unit greater physical neglect histories showed higher behavioral IC when the acute stress was absent. Our competing theory test highlights the importance of physical neglect in alcohol misuse as well as the need to update etiological theories of addiction by accounting for sex differences.