Abstract
BackgroundAttentional bias for substance-relevant cues has been found to contribute to the persistence of addiction. Attentional bias modification (ABM) interventions might, therefore, increase positive treatment outcome and reduce relapse rates. The current study investigated the effectiveness of a newly developed home-delivered, multi-session, internet-based ABM intervention, the Bouncing Image Training Task (BITT), as an add-on to treatment as usual (TAU).MethodsParticipants (N = 169), diagnosed with alcohol or cannabis use disorder, were randomly assigned to one of two conditions: the experimental ABM group (50%; TAU+ABM); or the control group (50%; split in two subgroups the TAU+placebo group and TAU-only group, 25% each). Participants completed baseline, post-test, and 6 and 12 months follow-up measures of substance use and craving allowing to assess long-term treatment success and relapse rates. In addition, attentional bias (both engagement and disengagement), as well as secondary physical and psychological complaints (depression, anxiety, and stress) were assessed.ResultsNo significant differences were found between conditions with regard to substance use, craving, relapse rates, attentional bias, or physical and psychological complaints.ConclusionsThe findings may reflect unsuccessful modification of attentional bias, the BITT not targeting the relevant process (engagement vs. disengagement bias), or may relate to the diverse treatment goals of the current sample (i.e., moderation or abstinence). The current findings provide no support for the efficacy of this ABM approach as an add-on to TAU in alcohol or cannabis use disorder. Future studies need to delineate the role of engagement and disengagement bias in the persistence of addiction, and the role of treatment goal in the effectiveness of ABM interventions.
Highlights
The persistent nature of substance use disorders is well known among researchers and professionals working with addicted patients [1, 2]
The current findings provide no support for the efficacy of this Attentional bias modification (ABM) approach as an add-on to treatment as usual (TAU) in alcohol or cannabis use disorder
Future studies need to delineate the role of engagement and disengagement bias in the persistence of addiction, and the role of treatment goal in the effectiveness of ABM interventions
Summary
The persistent nature of substance use disorders is well known among researchers and professionals working with addicted patients [1, 2]. AB is defined as heightened attentional capture of substance-relevant cues and can be characterized by an initial direction of attention towards substance-relevant cues (i.e., engagement bias) and/or increased difficulty to disengage attention from these cues (i.e., disengagement bias; [5, 6]) Both components of AB may contribute to increased salience of substance-relevant cues, which in turn may contribute to the development of craving, thereby lowering the threshold for actual substance use (e.g., [7]). People may enter a self-reinforcing bias-craving-bias cycle that might gear them to repeated use of addictive substances [8] Consistent with this possibility, it has been found that AB towards substance-relevant cues has been related to the severity of addiction and the probability of relapse after treatment ([9, 10]; but see [11] for a critical appraisal of the existing evidence). The current study investigated the effectiveness of a newly developed home-delivered, multi-session, internet-based ABM intervention, the Bouncing Image Training Task (BITT), as an add-on to treatment as usual (TAU)
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