Sensory and Physical Reactions to Beverage Cues

Cue reactivity paradigms are widely used in alcohol use disorder (AUD) research. Utilizing matched alternative beverages offers a unique methodological tool to evaluate these cue-driven responses. This randomized, double-blind, within-subjects crossover study will evaluate craving and beverage liking to distinct beverage stimuli in adults with AUD.

The study will enroll approximately 20 adults aged 21 to 70 years with DSM-5 diagnoses of AUD (mild or greater severity). Following screening and baseline characterization, eligible participants will complete two identical cue reactivity testing sessions spaced approximately 7 days apart. Participants will be randomized (1:1 ratio) to one of two session-order sequences (Sequence AB or Sequence BA). In one session, participants will be exposed to cues corresponding to a target test beverage (prepared to match their typical brand, mixer, and glassware); in the other session, participants will be exposed to a visually and odor-matched similar beverage condition. Participants and study staff will remain fully blinded to condition assignments across both visits.

Each testing visit consists of standardized pre-session clinical evaluations (including breathalyzer testing, vital signs, withdrawal monitoring, and baseline craving questionnaires) followed by a 2-trial cue reactivity protocol conducted in a controlled environment. During each session, participants are exposed to a neutral water cue trial followed by a test-beverage cue trial, using pre-recorded audio instructions that guide participants through holding and smelling each beverage without consumption.

The primary objective is to determine whether exposure to different test-beverage cue conditions produces changes in subjective craving, measured via visual analog scales (VAS). Secondary objectives include evaluating condition differences in beverage liking, peak craving levels, and the trajectory of craving return to baseline post-exposure.

Inclusion criteria

• Age 21-70 years.
• Current AUD (mild or greater severity on the SCID-5).
• Regular drinkers (at least one drink in past week as identified in TLFB) able to identify a preferred alcoholic beverage (e.g., beer, wine, spirits, or mixed) for which a visually matched non-alcoholic alternative exists and can be sourced .
• Willing to abstain from alcohol for ≥12 hours prior to each session and arrive with BrAC = 0.000% at visit 1 and ≤ 0.020% at visit 2. BrAC will be collected immediately after the participant signs the consent form at visit 1.

Exclusion criteria

• CIWA-Ar ≥10 which suggests clinically meaningful withdrawal.
• Pregnancy, nursing, or planning pregnancy.
• Medical contraindications to any alcohol exposure (e.g., liver disease, unstable cardiovascular condition).
• Current use of medications that strongly affect craving or alcohol consumption (e.g., naltrexone, acamprosate, disulfiram).
• Severe psychiatric illness or symptoms (e.g., bipolar disorder, schizophrenia, active suicidal ideation) that would interfere with procedures.