Cognitive Biases in Cannabis, Opioid, and Stimulant Disorders: A Systematic Review.

Melvyn W B Zhang,Helen E Smith,Jiangbo Ying,Guo Song,Tracey Wing,Daniel S S Fung

doi:10.3389/fpsyt.2018.00376

Melvyn W B Zhang, Helen E Smith + Show 4 more

Open Access

https://doi.org/10.3389/fpsyt.2018.00376

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Abstract

Background: Opiates, cannabis, and stimulants are highly abused and are prevalent disorders. Psychological interventions are crucial given that they help individuals maintain abstinence following a lapse or relapse into substance use. The dual-process theory has posited that while the repeated use of a substance leads to increased automatic processing and increased automatic tendencies to approach substance-specific cues, in addition to the inhibition of other normal cognitive processes. Prior reviews are limited, as they failed to include trials involving participants with these prevalent addictive disorders or have not reviewed the published literature extensively.Objectives: The primary aim of this review is to synthesize the evidence for cognitive biases in opioid use, cannabis use, and stimulant use disorders. The secondary aim of the review is to determine if cognitive bias could be consistently detected using the different methods. Lastly, this review will narratively synthesize the evidence of possible associations between cognitive biases and other addiction-related outcomes.Methods: A search was conducted from November 2017 to January 2018 on PubMed, MEDLINE, Embase, PsycINFO, Science Direct, Cochrane Central, and Scopus. Articles were included if participants had a primary diagnosis of opioid use, cannabis use, or stimulant use disorder. The selection process of the articles was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A qualitative synthesis was undertaken.Results: A total of 38 studies were identified. The main finding is the evidence that cognitive biases are present in the 38 studies identified, except for a single study on opioid use and stimulant use disorders. Cognitive biases were reported despite a variety of different methods being utilized. Synthesis of secondary outcome was not feasible, due to the varied outcomes reported.Conclusions: Cognitive biases have been consistently observed in opioid use, cannabis use, and stimulant use disorders, despite a range of assessment tools being utilized in the assessment for these biases.

Highlights

Attention bias in substance use disorder refers to the preferential allocation of attention to substance-related stimuli (1), while approach biases refer to the automatic action tendencies to reach out for substance-related cues (1)
There has been some initial research conducted on substance use disorders, both in determining whether cognitive biases are present for specific addictive disorders and in the evaluation of the effectiveness of bias modification (6, 7)
The main finding is the evidence that cognitive biases are present in the 38 studies identified, except for a single study on opioid use and stimulant use disorders

Summary

Introduction

Attention bias in substance use disorder refers to the preferential allocation of attention to substance-related stimuli (1), while approach biases refer to the automatic action tendencies to reach out for substance-related cues (1) This implies that for an individual with a substance use disorder, substancerelated cues can grab the individual’s attention (2). The cognitive control process, which normally serves to inhibit this automatic behavior, is itself inhibited (3) This coupled with the increased dopamine in the cortico-striatal circuit, results in individuals having increased attention and automatic tendencies toward substances, precipitating a relapse. The dual-process theory has posited that while the repeated use of a substance leads to increased automatic processing and increased automatic tendencies to approach substance-specific cues, in addition to the inhibition of other normal cognitive processes. As they failed to include trials involving participants with these prevalent addictive disorders or have not reviewed the published literature extensively

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Conclusion