Alcohol Dual Training Programme
A contemporary model of addiction considers addiction to result from alterations in two brain systems involved in motivation and decision-making. The first is an overactive impulsive, sensory-driven system where reward-seeking reactions become “sensitised” to drug-related cues, such as sights, sounds, or smells associated with drugs. This means attention, memories, and behavioural impulses are more easily and quickly focused on these cues. The second is an underactive reflective decision-making system that enables us to consider information, goals and values, weigh up options and consider long-term consequences of behaviours. These two systems are altered as a result of the effects of long-term, heavy drug use on the brain.
Several types of “brain-training” programmes have been developed to reduce over-active “impulsive” processes, and other programmes have also been developed to try to strengthen “reflective” processes. Some of these programmes have been shown to help reduce alcohol use in recent clinical trials, but prior to our study, no-one had tried combining training programmes targeting both “impulsive” and “reflective” processes in the same study. We thought that targeting both types of thought processes at the same time might have an even better effect than just doing one type of training on its own, and we conducted this small study to see whether it was feasible for people undergoing residential alcohol withdrawal (i.e. “detox”) to complete a combined programme (“dual-training”) and whether they found it acceptable. Our “dual-training” programme involved a type of training called “approach bias modification”, which aims to reduce impulses to approach alcohol, and a type of training called “working memory training”, which aims to increase people’s ability to hold and use information in their mind. We aimed to get patients to complete 4 sessions of each type of training before they left detox.
37 patients being treated for alcohol withdrawal at Wellington House took part in this study. 26 of them (70%) managed to complete all 4 sessions of training, suggesting that this training approach was reasonably feasible during withdrawal. 30 of the participants completed a questionnaire providing their feedback on the task, and their responses suggested the training was acceptable: 28 of the 30 participants (93%) felt the training was interesting and 26 (87%) felt it improved their attention, although most (53%) indicated they were “unsure” if it reduced their alcohol craving.
We also phoned participants 2 weeks after they left detox to ask about their alcohol use. Of the 30 participants we managed to contact, 16 (53%) had remained abstinent from alcohol. However, this was slightly less than the proportion who were abstinent for 2 weeks (69%) in a previous study we ran where we gave approach bias modification training only (without working memory training), and was not much different than the rate of abstinence we found in people who received no training in that previous study (47%). Therefore, while “dual-training” seemed to be feasible and acceptable, it did not appear to be as effective as we hoped. This may be because working memory training requires more than 4 sessions to be effective, or it may be that other types of training aiming to strengthen reflective processes are more effective, which we hope to explore in future research.