Abstract
BackgroundRecent theoretical models emphasize the role of impulsive processes in alcohol addiction, which can be retrained with computerized Cognitive Bias Modification (CBM) training. In this study, the focus is on action tendencies that are activated relatively automatically.ObjectiveThe aim of the study is to examine the effectiveness of online CBM Alcohol Avoidance Training using an adapted Approach-Avoidance Task as a supplement to treatment as usual (TAU) in an outpatient treatment setting.MethodsThe effectiveness of 8 online sessions of CBM Alcohol Avoidance Training added to TAU is tested in a double-blind, randomized controlled trial with pre- and postassessments, plus follow-up assessments after 3 and 6 months. Participants are adult patients (age 18 years or over) currently following Web-based or face-to-face TAU to reduce or stop drinking. These patients are randomly assigned to a CBM Alcohol Avoidance or a placebo training. The primary outcome measure is a reduction in alcohol consumption. We hypothesize that TAU + CBM will result in up to a 13-percentage point incremental effect in the number of patients reaching the safe drinking guidelines compared to TAU + placebo CBM. Secondary outcome measures include an improvement in health status and a decrease in depression, anxiety, stress, and possible mediation by the change in approach bias. Finally, patients’ adherence, acceptability, and credibility will be examined.ResultsThe trial was funded in 2014 and is currently in the active participant recruitment phase (since May 2015). Enrolment will be completed in 2019. First results are expected to be submitted for publication in 2020.ConclusionsThe main purpose of this study is to increase our knowledge about the added value of online Alcohol Avoidance Training as a supplement to TAU in an outpatient treatment setting. If the added effectiveness of the training is proven, the next step could be to incorporate the intervention into current treatment.Trial RegistrationNetherlands Trial Register NTR5087; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5087 (Archived at WebCite http://www.webcitation.org/6wuS4i1tH)
Highlights
BackgroundAlcohol misuse is a key public health concern and is associated with a high burden of disease, which in turn contributes to considerable economic costs for both individuals and society [1]
Alcohol-related Cognitive Bias Modification (CBM) programs have been shown to be effective in changing attentional bias [16,17,18], memory bias [19,20], and approach bias [21,22,23], which in turn is often associated with reductions in drinking behavior or reduced relapse into drinking behavior
The current study focuses on retraining the automatically triggered behavioral tendency to approach alcohol, by using online Alcohol Avoidance Training
Summary
Alcohol misuse is a key public health concern and is associated with a high burden of disease, which in turn contributes to considerable economic costs for both individuals and society [1]. CBT programs primarily target the reflective, voluntary system and leave the automatic, impulsive system mostly unaffected [10,11] This suggests that treatment of alcohol use disorder could be improved by focusing on those processes that are primarily automatic. A second study in the same clinic replicated the main findings and showed that the effects on relapse were mediated by change in approach bias [23] While these studies tested the added effect of CBM training on top of treatment as usual (TAU), recent studies examined the effect of the training as a stand-alone intervention and failed to observe positive training effects [24,25]. We are interested in whether the positive added effects found in clinical inpatient samples [21] with the CBM training on local desktop computers in the clinic is possible to reproduce when the CBM is administered online in an outpatient sample
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