Development and Validation of a Culturally Adapted, Event-related Potential Paradigm for Assessing Alcohol Cue Reactivity and Error Processing in Alcohol Dependence

Background: Research on event-related potentials (ERP) in addiction highlights the importance of cognitive ERP markers, such as P300 and error-related negativity (ERN), in distinguishing between alcohol-dependent patients and healthy controls. We aimed to develop and validate ERP paradigms utilizing culturally validated stimuli to evoke P300 and ERN for the Indian population. Methods: In a cross-sectional study, 16 alcohol-dependent patients and age-matched healthy controls were recruited. For P300, we designed a visual oddball (Go/No-Go) task using culturally appropriate alcohol and non-alcohol-related images. To study ERN, we used the Assessing Neurocognition via Gamified Experimental Logic (ANGEL) task, developed in India, integrating its “game” levels to capture error monitoring with fewer trials. A 32-channel EEG-ERP system was used for data acquisition. Results: Participants showed high engagement in the visual Go/No-Go task, with 94.4% accuracy. The P300 difference wave showed significantly higher amplitudes (p =.01, Cohen’s d = 0.97) and latencies (p <.001, Cohen’s d = 1.62) in patients compared to controls at the Pz electrode. No significant group differences were found in accuracy or reaction times for frequent and rare stimuli. In the ANGEL task, patients had a significantly lower ERN difference wave amplitude at the Pz electrode than controls (p <.001, Cohen’s d = 1.47), with no latency differences. Task accuracy was lower, and reaction time was longer in patients. Conclusions: The visual Go/No-Go task and the ANGEL task are promising tools for understanding the neurocognitive mechanisms underlying alcohol dependence in the Indian context.