Graduate Studies, UNL

 

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

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First Advisor

Dennis McChargue

Degree Name

Doctor of Philosophy (Ph.D.)

Committee Members

Kathy Chiou, Ken Wakabayashi, Lisa Kort-Butler

Department

Psychology

Date of this Version

3-30-2026

Document Type

Dissertation

Citation

A dissertation presented to the faculty of the Graduate College at the University of Nebraska in partial fulfillment of requirements for the degree Doctor of Philosophy

Major: Psychology

Under the supervision of Professor Dennis McChargue

Lincoln, Nebraska, May 2026

Comments

Copyright 2026, Alexi Cranford. Used by permission

Abstract

Traumatic brain injury (TBI) and alcohol use are common and pervasive issues in society today. Alcohol use is frequently linked with brain injury even in its mildest form, concussion, also known as mild traumatic brain injury (mTBI). The brain’s reward system has been shown to be involved in alcohol and substance use behaviors, and a neural basis has been demonstrated to underlie reactivity to alcohol cues. Learning theories such as classical and operant conditioning can also help conceptualize how these relationships develop. Reward sensitivity and executive functioning (particularly decision-making skills) are cognitive processes that may moderate the relationship between brain injury and alcohol use. The current study aimed to investigate relationships between mTBI, alcohol use, and intervening cognitive factors such as reward sensitivity and decision-making in response to rewarding stimuli. Further, college traditionally arrives at a developmental stage in which individuals are particularly susceptible to the rewarding properties of alcohol. Thus, 160 college student participants were included in the current study, which involved exposure to a cue reactivity paradigm (viewing of alcohol-related vs. neutral images) and investigation of its effect on reward processing. The study additionally investigated the impact of mTBI history on these relationships. Following cue exposure, participants completed the Alcohol Purchase Task (a measure of reward sensitivity) and the Monetary Choice Questionnaire (a measure of delay discounting and decision-making). Analyses revealed that participants with a history of mTBI who were exposed to alcohol cues reported the highest breakpoint on the Alcohol Purchase Task, indicating that their hypothetical expenditure on alcohol on the task exceeded that of all other study groups. However, mTBI history did not moderate the effect of cue condition on delay discounting task performance. Relationships between additional psychosocial outcome variables and mTBI history were explored, including academic performance, mood, and problematic alcohol use. While the current study offers a contribution to extant literature on mTBI and alcohol use, future research should further investigate these relationships with other methodologies and more diverse samples.

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