Alcohol-related cues acquire incentive salience through Pavlovian conditioning
and then can markedly affect instrumental behavior of alcohol-dependent
patients to promote relapse. However, it is unclear whether similar effects
occur with alcohol-unrelated cues. We tested 116 early-abstinent alcohol-
dependent patients and 91 healthy controls who completed a delay discounting
task to assess choice impulsivity, and a Pavlovian-to-instrumental transfer
(PIT) paradigm employing both alcohol-unrelated and alcohol-related stimuli.
To modify instrumental choice behavior, we tiled the background of the
computer screen either with conditioned stimuli (CS) previously generated by
pairing abstract pictures with pictures indicating monetary gains or losses,
or with pictures displaying alcohol or water beverages. CS paired to money
gains and losses affected instrumental choices differently. This PIT effect
was significantly more pronounced in patients compared to controls, and the
group difference was mainly driven by highly impulsive patients. The PIT
effect was particularly strong in trials in which the instrumental stimulus
required inhibition of instrumental response behavior and the background CS
was associated to monetary gains. Under that condition, patients performed
inappropriate approach behavior, contrary to their previously formed
behavioral intention. Surprisingly, the effect of alcohol and water pictures
as background stimuli resembled that of aversive and appetitive CS,
respectively. These findings suggest that positively valenced background CS
can provoke dysfunctional instrumental approach behavior in impulsive alcohol-
dependent patients. Consequently, in real life they might be easily seduced by
environmental cues to engage in actions thwarting their long-term goals. Such
behaviors may include, but are not limited to, approaching alcohol