APA Citation
Lindgren, K., Neighbors, C., Gasser, M., Ramirez, J., & Cvencek, D. (2017). A review of implicit and explicit attitudes toward alcohol and drinking behavior. *Annual Review of Clinical Psychology*, 13, 397-419.
Summary
This comprehensive review examines how both conscious attitudes (explicit) and unconscious associations (implicit) influence alcohol use and drinking behaviors. The research demonstrates that while people may consciously express negative attitudes about excessive drinking, their unconscious associations with alcohol may be positive, leading to complex decision-making patterns. The study reveals how implicit attitudes, formed through repeated experiences and conditioning, can override conscious intentions and contribute to problematic drinking patterns even when individuals explicitly recognize the harmful consequences.
Why This Matters for Survivors
For narcissistic abuse survivors, this research illuminates how trauma can create unconscious coping mechanisms around substances, even when survivors consciously know these behaviors aren't helpful. Understanding the gap between what we think we want and what our traumatized nervous system seeks helps explain the complexity of healing and reduces self-blame for relapse or continued harmful patterns during recovery.
What This Research Establishes
Implicit attitudes toward alcohol operate independently of conscious beliefs and can predict drinking behavior more accurately than explicit attitudes, explaining why people may drink despite consciously wanting to abstain.
The gap between implicit and explicit attitudes is particularly pronounced in problematic drinking, suggesting that unconscious associations play a crucial role in maintaining addictive behaviors even when conscious motivation for change exists.
Implicit attitudes are formed through repeated experiences and conditioning, meaning that trauma survivors who used alcohol to cope may have deeply ingrained unconscious associations between substances and emotional relief.
Traditional interventions focusing solely on conscious decision-making miss a critical component of addiction recovery, as they fail to address the powerful unconscious processes that drive substance use behaviors.
Why This Matters for Survivors
If you’ve struggled with alcohol or substances during or after narcissistic abuse, this research offers profound validation. Your conscious desire to heal and your unconscious pull toward substances aren’t contradictory—they’re operating on different levels of your mind. The abuse you experienced may have created implicit associations between alcohol and safety, numbing, or relief that your conscious mind didn’t choose.
Understanding this dual-process helps explain why willpower alone often isn’t enough. Your brain learned to associate substances with survival during traumatic experiences, creating automatic responses that bypass conscious thought. This isn’t a failure of character or strength—it’s how the human mind adapts to overwhelming circumstances.
Recovery becomes more compassionate when you recognize that healing must address both levels. Your unconscious mind needs retraining through trauma-informed approaches, not just conscious education about the dangers of substances. This research validates that your recovery journey is complex and that setbacks don’t mean you’re weak.
The gap between what you know is good for you and what your nervous system seeks makes perfect sense in light of this research. Your healing process can honor both your conscious commitment to recovery and the deep work needed to retrain unconscious patterns formed during abuse.
Clinical Implications
This research fundamentally challenges traditional addiction treatment approaches that rely primarily on education, conscious motivation, and willpower. For narcissistic abuse survivors, clinicians must recognize that implicit attitudes toward substances may have been shaped by trauma responses and require specialized intervention strategies that address unconscious associations.
Effective treatment needs to incorporate trauma-informed approaches that work with both explicit and implicit systems. This might include EMDR, somatic therapies, or mindfulness-based interventions that help clients become aware of and gradually shift unconscious patterns while building new associations with safety and regulation.
Assessment protocols should evaluate both conscious attitudes toward substances and the underlying implicit associations that may be driving behavior. Traditional screening tools that rely on self-report may miss the crucial unconscious components that predict relapse or continued problematic use.
The research suggests that sustainable recovery requires patience and recognition that changing implicit attitudes takes time and specialized approaches. Clinicians should normalize the complexity of recovery for trauma survivors and avoid interventions that may inadvertently increase shame when conscious intentions don’t immediately translate to behavioral change.
How This Research Is Used in the Book
This research provides crucial insight into why recovery from narcissistic abuse often involves complex relationships with substances and why traditional approaches to addressing these patterns may fall short. The findings help explain the neurobiological basis for the internal conflicts many survivors experience.
“Sarah couldn’t understand why she kept reaching for wine each evening, even though she desperately wanted to process her divorce from her narcissistic ex-husband with clarity. The research on implicit attitudes revealed what her conscious mind couldn’t see: years of using alcohol to survive emotional attacks had trained her nervous system to associate wine with safety and relief. Her conscious desire for sobriety and her unconscious pull toward alcohol weren’t contradictory—they were operating on different levels that required different healing approaches.”
Historical Context
This 2017 review was published during a pivotal time when the addiction treatment field was increasingly recognizing the limitations of purely cognitive-behavioral approaches. The integration of implicit cognition research with clinical practice reflected a broader shift toward understanding addiction as involving unconscious, automatic processes shaped by experience and trauma, rather than simply conscious choice and moral failing.
Further Reading
• Stacy, A. W., & Wiers, R. W. (2010). Implicit cognition and addiction: A tool for explaining paradoxical behavior. Annual Review of Clinical Psychology, 6, 551-575.
• Wiers, R. W., Bartholow, B. D., van den Wildenberg, E., Thush, C., Engels, R. C., Sher, K. J., … & Stacy, A. W. (2007). Automatic and controlled processes and the development of addictive behaviors in adolescents. Pharmacology Biochemistry and Behavior, 86(2), 263-283.
• Reich, R. R., Below, M. C., & Goldman, M. S. (2010). Explicit and implicit measures of expectancy and related alcohol cognitions. Psychology of Addictive Behaviors, 24(1), 13-25.
About the Author
Kristen P. Lindgren is a clinical psychologist and researcher at the University of Washington specializing in addiction, implicit cognition, and behavioral interventions. Her work focuses on understanding the unconscious processes that drive addictive behaviors.
Clayton Neighbors is a professor at the University of Houston whose research examines social influences on drinking behavior and the development of brief interventions for substance use disorders.
Historical Context
Published during a period of increased recognition of trauma-informed addiction treatment, this review helped bridge cognitive psychology and clinical practice by demonstrating how unconscious processes influence recovery outcomes in ways that traditional conscious-focused interventions might miss.
Frequently Asked Questions
Research shows that unconscious attitudes toward alcohol can override conscious knowledge. For trauma survivors, alcohol may be unconsciously associated with relief or safety, even when they explicitly understand its dangers.
Implicit attitudes are unconscious, automatic associations we form about alcohol through experience. Unlike explicit attitudes (our conscious thoughts), these operate below awareness and can influence behavior without our realizing it.
Narcissistic abuse can create implicit associations between substances and emotional regulation or escape, making recovery more complex because the unconscious mind may seek substances even when the conscious mind wants sobriety.
Yes, research suggests implicit attitudes can be modified through targeted interventions, mindfulness practices, and trauma-informed therapy that addresses both conscious and unconscious patterns.
This research explains that implicit attitudes often override conscious intentions. Healing requires addressing unconscious associations, not just conscious decision-making.
Through repeated experiences of using substances to cope with abuse, the brain forms unconscious associations between substances and relief, safety, or emotional regulation.
Trauma can create powerful implicit associations where substances become unconsciously linked to survival, comfort, or emotional numbing, even when survivors consciously want to avoid them.
Recognizing that unconscious patterns influence behavior helps reduce shame and guides treatment toward addressing deeper, automatic responses rather than just conscious choices.