Cognitive Bias Modification - Alcohol Pilot Study
Many people relapse to alcohol use after treatment for alcohol dependence. There are likely to be many reasons for this, but one factor that is believed to cause relapse is a mental process called “approach bias”. “Approach bias” refers to the way we’re drawn to approach or seek things we find rewarding when we encounter signals (like sights, sounds, smells, or places) that remind us of those things. When people drink alcohol frequently, they often develop an approach bias for alcohol, so that sights (like alcohol advertisements), places (like pubs), smells (like the smell of their favourite drink), or other signals automatically spur their desire to approach or seek alcohol … and then of course consume it!
Approach bias can be triggered very quickly, and may function at a somewhat subconscious level, so people aren’t even fully aware they’re being influenced by it. This can make it difficult to control. However, in recent years, researchers have developed computerised training programs called “approach bias modification” (ABM), where people repeatedly practice responding to pictures of alcohol in a way that can reduce their approach bias. Some research has found that doing repeated sessions of ABM can also reduce the likelihood of relapsing after being treated for alcohol dependence.
The earliest studies that found that ABM could help with alcohol dependence were run in residential rehabilitation centres, where people receive several months of residential treatment. However, only a small fraction of people who get treated for alcohol dependence receive residential rehabilitation, and it is important to test whether ABM works in other treatment settings. People with very severe alcohol dependence often need to undergo short-term (i.e. 5-10 days) treatment in a withdrawal unit (i.e. a “detox”) before proceeding to other forms of treatment such as medication, rehabilitation, or counselling. Since there is a particularly high rate of relapse after withdrawal treatment, we decided to test whether giving 4 sessions of ABM to people while they were in the withdrawal unit would help reduce likelihood of relapse.
This study was run at Wellington House and Windana Drug and Alcohol Recovery by researchers from Turning Point, Monash University, and Deakin University. 83 patients participated. We gave ABM training to half the participants, and the other half received a “sham” version where they were trained to respond to pictures that were not designed to change approach bias. In the “sham training” group, 47% of participants managed to abstain from alcohol for at least 2 weeks after leaving treatment, but in the ABM group, this was increased to 69%. When we just looked at the participants who finished all 4 sessions of training (i.e. ignoring those who left after only finishing 1, 2, or 3 sessions), the difference was even bigger (45% vs. 75%), and was statistically significant.
This suggests that ABM is a useful intervention during withdrawal treatment, at least for preventing early relapse in the first few weeks after treatment. It’s not clear if the effect of such a short course of ABM lasts for the longer term, though. When we followed up participants 3 months after treatment, the difference between groups was smaller (30% abstinence in the “sham group” and 38% in the ABM group), and the number of participants was too small to tell whether this was still a significant difference. We are now following this research up with a larger trial to test whether ABM during withdrawal treatment has longer-lasting effects.
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- Manning, V., Staiger, P. K., Hall, K., Garfield, J. B. B., Flaks, G., Leung, D., Hughes, L., Lum, J. A. G., Lubman, D. I., & Verdejo-Garcia, A. (2016). Cognitive bias modification training during inpatient alcohol detoxification reduces early relapse: A randomised controlled trial. Alcoholism: Clinical and Experimental Research, 40, 2011-2019. DOI: 10.1111/acer.13163