Counterconditioning Alcohol Cues: Neural and Behavioral Modulation of Automatic Tendencies and Pavlovian-to-Instrumental Transfer in Male Alcohol Users

Alcohol cues can influence ongoing instrumental behavior through Pavlovian-to-instrumental transfer (PIT), possibly promoting problematic alcohol consumption. This influence can be explained by automatic approach tendencies towards alcohol, which play a role in understanding alcohol abuse and relapse. However, individuals differ in these tendencies; some exhibit a strong approach, while others exhibit avoidance; yet, how such profiles shape PIT and intervention outcomes remains unclear. Existing interventions predominantly target approach tendencies, often overlooking avoidance profiles that may represent distinct motivational control. Building on evidence that cue-evoked responding reflects learned expectancies about response effectiveness, we investigated whether counterconditioning (CC), i.e., reversing alcohol cue valence by pairing it with an aversive outcome, could reduce approach tendencies and attenuate alcohol-related PIT effects across both approach and avoidance groups. To enhance interventional effect transfer, we integrated retrieval cues to facilitate memory reactivation in non-treatment contexts. Thirty-nine alcohol users completed the Alcohol Approach-Avoidance Task (A-AAT) and PIT task before and after CC, with participants categorized by their baseline Alcohol Approach Index. EEG recorded neural responses, focusing on N2 and P3 ERPs as indices of conflict monitoring and cognitive control. Individuals with approach tendencies showed stronger PIT interference during avoidance-related actions in the presence of alcohol cues. CC attenuated these tendencies and restored instrumental responding, with retrieval cues supporting transfer effects. Post-intervention, enhanced frontal N2 and centro-parietal P3 amplitudes reflected improved conflict monitoring and top-down control. These findings demonstrate that retrieval cue-integrated CC can recalibrate automatic approach tendencies and restore adaptive instrumental behavior, with corresponding neural enhancements, offering a practical intervention to reduce cue-driven drinking.