Motor inhibition and impulsivity in alcohol use disorder and at‐risk drinking: A systematic review and meta‐analysis

Abstract Background and aims Harmful alcohol use is a global health problem, with deficits in impulse control, encompassing motor inhibition and motor impulsivity, associated with its development and persistence. We aimed to synthesise performance‐based motor inhibition and self‐reported impulsivity in individuals with alcohol use disorder (AUD) and at‐risk drinkers, relative to controls, and to compare the two alcohol‐use groups. Methods Pre‐registered systematic review and subgroup meta‐analysis. PubMed, PsycINFO, EMBASE, MEDLINE and CINAHL were searched to 31 December 2024, supplemented by reference‐list searching and snowballing. Adults with diagnosed AUD or at‐risk drinking were compared with healthy or low‐severity drinking controls across 110 independent datasets. Impulse control was measured using performance‐based motor inhibition tasks (go/no‐go and stop‐signal tasks) and self‐report motor impulsivity questionnaires (Barratt Impulsiveness Scale; BIS). Primary outcomes were go/no‐go commission errors, stop‐signal reaction time and BIS total and motor scores. Results The combined alcohol‐use group exhibited poorer motor inhibition than controls on go/no‐go commission errors [g = −0.27, 95% confidence interval (CI) = −0.43 to −0.11] and stop‐signal reaction time (g = −0.20, 95% CI = −0.36 to −0.05); and higher self‐reported Barratt total (g = −0.77, 95% CI = −0.97 to −0.58) and motor impulsivity scores (g = −0.68, 95% CI = −0.80 to −0.55). Individuals with AUD reported higher impulsivity than at‐risk drinkers on Barratt total and motor scores ( P < 0.001 and P = 0.022, respectively). The AUD and at‐risk groups did not differ significantly in stop‐signal reaction time ( P = 0.247), whereas the commission‐error effect was larger among at‐risk drinkers ( P = 0.033). Summary Alcohol use disorder and at‐risk drinking appear to be associated with poorer performance‐based inhibition and higher self‐reported impulsivity compared with healthy or low‐severity drinking, with consistently larger effects on self‐reported impulsivity. Unexpectedly, the two alcohol groups (alcohol use disorder and at‐risk drinking) in this study were better differentiated by self‐reported motor impulsivity than by performance‐based motor‐inhibition measures.