Cue avoidance training and inhibitory control training for the reduction of alcohol consumption: a comparison of effectiveness and investigation of their mechanisms of action

Lisa C. G. Di Lemma,Matt Field

doi:10.1007/s00213-017-4639-0

Lisa C. G. Di Lemma, Matt Field

Open Access

https://doi.org/10.1007/s00213-017-4639-0

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Abstract

RationaleBoth cue avoidance training (CAT) and inhibitory control training (ICT) reduce alcohol consumption in the laboratory. However, these interventions have never been directly compared and their mechanisms of action are poorly understood.ObjectivesWe compared the effects of both types of training on alcohol consumption and investigated if they led to theoretically predicted changes in alcohol avoidance (CAT) or alcohol inhibition (ICT) associations and changes in evaluation of alcohol cues.MethodsHeavy drinking young adults (N = 120) were randomly assigned to one of four groups: (1) CAT (repeatedly pushing alcohol cues away with a joystick), (2) sham (control) CAT; (3) ICT (repeatedly inhibiting behaviour in response to alcohol cues); or (4) sham (control) ICT. Changes in reaction times and automatic evaluations of alcohol cues were assessed before and after training using assessment versions of tasks used in training and the implicit association test (IAT), respectively. Finally, participants completed a bogus taste test as a measure of ad libitum alcohol consumption.ResultsCompared to sham conditions, CAT and ICT both led to reduced alcohol consumption although there was no difference between the two. Neither intervention affected performance on the IAT, and changes in reaction time did not suggest the formation of robust alcohol avoidance (CAT) or alcohol inhibition (ICT) associations after training.ConclusionsCAT and ICT yielded equivalent reductions in alcohol consumption in the laboratory. However, these behavioural effects were not accompanied by devaluation of stimuli or the formation of alcohol avoidance or alcohol inhibition associations.

Highlights

According to dual-process models of addiction, loss of control over substance use arises from conflict between two partially independent systems: a fast ‘impulsive’ system that is triggered by automatic appetitive responses to substance-related cues and a slower ‘reflective’ system that is dependent on the integrity of executive functions which are weakened by chronic substance use and exposure to substance-related cues (Wiers et al 2007; Hofmann et al 2009; Gladwin and Figner 2014; McClure and Bickel 2014).Regarding automatic processes, there is compelling evidence that alcohol-related cues evoke automatic approach tendencies
cue avoidance training (CAT) and inhibitory control training (ICT) yielded equivalent reductions in alcohol consumption in the laboratory. These behavioural effects were not accompanied by devaluation of stimuli or the formation of alcohol avoidance or alcohol inhibition associations
In order to investigate changes in cue-approach and cue-inhibition associations in the avoidance task (AAT) and GNG tasks after CAT and ICT, respectively, we first excluded trials with errors and those with outlying reaction times before comparing

Summary

Introduction

There is compelling evidence that alcohol-related cues evoke automatic approach tendencies. The strength of these tendencies can be assessed with the approach avoidance task (AAT; Wiers et al 2009) or related tasks (Field et al 2008). During the AAT, participants are instructed to ‘approach’ or ‘avoid’ alcohol or control pictures by moving a joystick towards or away from them. A number of studies with non-dependent drinkers have confirmed that, compared to light drinkers, heavy drinkers are faster when required to approach rather than avoid alcohol-related pictures (see Kersbergen et al 2015; Watson et al 2012)

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