Constantine J. Trela, Thomas M. Piasecki, Bruce D. Bartholow, Andrew C. Heath, Kenneth J. Sher

Low sensitivity to alcohol is a well-established risk factor for alcohol use disorder (AUD). However, little is known about how the low sensitivity phenotype is expressed on a fine-grained, momentary level in drinkers' daily experience. The objective of the study is to evaluate individual differences in subjective states and appraisals of alcoholic beverages during the ascending limb of real-world drinking episodes. Social drinkers (N = 398) with varying degrees of alcohol sensitivity as indexed by the Self-Rating of the Effects of Alcohol form (SRE; Schuckit et al. in Addiction 92:979-988, 1997a) recorded diary entries over a 3-week monitoring period (2576 drinking episodes containing 6546 moments). Hierarchical linear modeling was used to evaluate whether individual differences in alcohol sensitivity predicted differing intra-episode estimated blood alcohol concentration (eBAC) trajectories, ratings of subjective states, and drink appraisals. Lower self-reported alcohol sensitivity was associated with consuming "too much, too fast," as indicated by a steeper slope of ascending eBAC. In models adjusted for momentary eBAC level, participants reporting lower alcohol sensitivity at baseline showed blunted subjective intoxication and drink-contingent punishment. The results suggest that low sensitivity to alcohol is associated with a blunting of some forms of subjective feedback (i.e., perceptions of intoxication and punishment) that might typically encourage drinking restraint. This may 'tip the scales' toward excess consumption and could help to explain why a low alcohol sensitivity forecasts AUD.