Cognitive Bias Modification Training During Inpatient Alcohol Detoxification Reduces Early Relapse: A Randomized Controlled Trial.

BACKGROUND Relapse is common in alcohol-dependent individuals and can be triggered by alcohol-related cues in the environment. It has been suggested that these individuals develop cognitive biases, in which cues automatically capture attention and elicit an approach action tendency that promotes alcohol seeking. The study aim was to examine whether cognitive bias modification (CBM) training targeting approach bias could be delivered during residential alcohol detoxification and improve treatment outcomes. METHODS Using a 2-group parallel-block (ratio 1:1) randomized controlled trial with allocation concealed to the outcome assessor, 83 alcohol-dependent inpatients received either 4 sessions of CBM training where participants were implicitly trained to make avoidance movements in response to pictures of alcoholic beverages and approach movements in response to pictures of nonalcoholic beverages, or 4 sessions of sham training (controls) delivered over 4 consecutive days during the 7-day detoxification program. The primary outcome measure was continuous abstinence at 2 weeks postdischarge. Secondary outcomes included time to relapse, frequency and quantity of alcohol consumption, and craving. Outcomes were assessed in a telephonic follow-up interview. RESULTS Seventy-one (85%) participants were successfully followed up, of whom 61 completed all 4 training sessions. With an intention-to-treat approach, there was a trend for higher abstinence rates in the CBM group relative to controls (69 vs. 47%, p = 0.07); however, a per-protocol analysis revealed significantly higher abstinence rates among participants completing 4 sessions of CBM relative to controls (75 vs. 45%, p = 0.02). Craving score, time to relapse, mean drinking days, and mean standard drinks per drinking day did not differ significantly between the groups. CONCLUSIONS This is the first trial demonstrating the feasibility of CBM delivered during alcohol detoxification and supports earlier research suggesting it may be a useful, low-cost adjunctive treatment to improve treatment outcomes for alcohol-dependent patients.

[1]  Linda C. Sobell,et al.  Timeline Follow-Back A Technique for Assessing Self-Reported Alcohol Consumption , 1992 .

[2]  R. Remien,et al.  PrEP in substance abuse treatment: a qualitative study of treatment provider perspectives , 2015, Substance Abuse Treatment, Prevention, and Policy.

[3]  R. Wiers,et al.  Retraining Automatic Action Tendencies Changes Alcoholic Patients’ Approach Bias for Alcohol and Improves Treatment Outcome , 2011, Psychological science.

[4]  Antoine Bechara,et al.  A somatic marker theory of addiction , 2009, Neuropharmacology.

[5]  Mark Jenkinson,et al.  Manifestations of early brain recovery associated with abstinence from alcoholism. , 2006, Brain : a journal of neurology.

[6]  A. Greenwald,et al.  Measuring individual differences in implicit cognition: the implicit association test. , 1998, Journal of personality and social psychology.

[7]  W. Hulstijn,et al.  Affective Decision-Making Is Predictive of Three-Month Relapse in Polysubstance-Dependent Alcoholics , 2012, European Addiction Research.

[8]  Ruchi M. Sanghani,et al.  Assessing success—a commentary on the necessity of outcomes measures , 2015, Substance Abuse Treatment, Prevention, and Policy.

[9]  R. Wiers,et al.  Implementation of approach bias re-training in alcoholism-how many sessions are needed? , 2014, Alcoholism, clinical and experimental research.

[10]  Henrik Walter,et al.  Effects of cognitive bias modification training on neural alcohol cue reactivity in alcohol dependence. , 2015, The American journal of psychiatry.

[11]  S. Herpertz,et al.  The impact of cognitive impairment and impulsivity on relapse of alcohol‐dependent patients: implications for psychotherapeutic treatment , 2016, Addiction biology.

[12]  Paul F. Hill,et al.  Remember the Future: Working Memory Training Decreases Delay Discounting Among Stimulant Addicts , 2011, Biological Psychiatry.

[13]  M. Field,et al.  Experimental manipulation of attentional bias increases the motivation to drink alcohol , 2005, Psychopharmacology.

[14]  T. Palfai,et al.  Compelled to consume: the Implicit Association Test and automatic alcohol motivation. , 2006, Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors.

[15]  Soyoung Q. Park,et al.  Neural Correlates of Alcohol-Approach Bias in Alcohol Addiction: the Spirit is Willing but the Flesh is Weak for Spirits , 2014, Neuropsychopharmacology.

[16]  A. Sartorius,et al.  Translational Magnetic Resonance Spectroscopy Reveals Excessive Central Glutamate Levels During Alcohol Withdrawal in Humans and Rats , 2012, Biological Psychiatry.

[17]  Mark E. Johnson,et al.  The reliability and validity of drug users' self reports of amphetamine use among primarily heroin and cocaine users. , 2010, Addictive behaviors.

[18]  Mijke Rhemtulla,et al.  Alcohol cognitive bias modification training for problem drinkers over the web. , 2015, Addictive behaviors.

[19]  A. Bechara.  Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive perspective , 2005, Nature Neuroscience.

[20]  T. Stockwell,et al.  The measurement of alcohol dependence and impaired control in community samples. , 1994, Addiction.

[21]  Jerry L. Grenard,et al.  Automatic and controlled processes and the development of addictive behaviors in adolescents: A review and a model , 2007, Pharmacology Biochemistry and Behavior.

[22]  Reinout W. Wiers,et al.  Cognitive Bias Modification and Cognitive Control Training in Addiction and Related Psychopathology , 2013 .

[23]  Miriam Sebold,et al.  Too Difficult to Stop: Mechanisms Facilitating Relapse in Alcohol Dependence , 2014, Neuropsychobiology.

[24]  M. Field,et al.  Attentional bias in addictive behaviors: a review of its development, causes, and consequences. , 2008, Drug and alcohol dependence.

[25]  Ann-Christine Ehlis,et al.  Prefrontal correlates of approach preferences for alcohol stimuli in alcohol dependence , 2014, Addiction biology.

[26]  K. Berridge,et al.  The Mind of an Addicted Brain: Neural Sensitization of Wanting Versus Liking , 1995 .

[27]  S. Potvin,et al.  Widespread and sustained cognitive deficits in alcoholism: a meta‐analysis , 2013, Addiction biology.

[28]  F. Strack,et al.  Reflective and Impulsive Determinants of Social Behavior , 2004, Personality and social psychology review : an official journal of the Society for Personality and Social Psychology, Inc.

[29]  Soyoung Q. Park,et al.  Effects of cognitive bias modification training on neural signatures of alcohol approach tendencies in male alcohol‐dependent patients , 2015, Addiction biology.

[30]  R. Wiers,et al.  Retraining automatic action-tendencies to approach alcohol in hazardous drinkers. , 2010, Addiction.

[31]  K. Mann,et al.  Rapid partial regeneration of brain volume during the first 14 days of abstinence from alcohol. , 2013, Alcoholism, clinical and experimental research.

[32]  Reinout W. Wiers,et al.  Approach bias modification in alcohol dependence: Do clinical effects replicate and for whom does it work best? , 2013, Developmental Cognitive Neuroscience.

[33]  Reinout W Wiers,et al.  Implicit cognition and addiction: a tool for explaining paradoxical behavior. , 2010, Annual review of clinical psychology.

[34]  Reinout W. Wiers,et al.  Getting a Grip on Drinking Behavior , 2011, Psychological science.