Abstract
BackgroundPeople with alcohol use disorders often exhibit an “alcohol approach bias”, the automatically triggered action tendency to approach alcohol. Approach bias is likely to persist following withdrawal from alcohol, and contribute to the high rate of relapse following withdrawal treatment. Cognitive bias modification (CBM) training has been shown to attenuate approach biases and lead to reduced relapse rates. However, no large multisite trial of CBM specifically within a residential withdrawal treatment setting has previously been conducted. This study aims to test whether CBM delivered during residential withdrawal treatment leads to reduced relapse rates and reduced use of acute health services following discharge, and to test possible moderators of CBM’s effect on alcohol use.MethodsThree hundred alcohol-dependent inpatients are being recruited from three withdrawal treatment units in the Melbourne metropolitan area. Participants complete baseline measures of alcohol approach bias and cue-evoked desire for alcohol, followed by four daily sessions of computerised CBM training (or sham training if randomised to the control group). Approach bias and cue-evoked desire are re-assessed following the fourth training session. Follow-up assessments administered 2 weeks and 3, 6, and 12 months following discharge from the withdrawal treatment unit compare abstinence rates and acute and emergency healthcare service use between conditions. Pre-admission and follow-up substance use is derived from the timeline follow-back method, and approach bias towards alcohol with a computerised Approach Avoidance Task.DiscussionThis study is the first multisite randomised controlled trial of cognitive bias modification delivered during acute alcohol withdrawal treatment. Withdrawal is theoretically an ideal period to deliver neurocognitive interventions due to heightened neuroplasticity and cognitive recovery. If effective, the low cost and easy implementation of CBM training means it could be widely used as a standard part of alcohol withdrawal treatment to improve treatment outcomes. Moderation analyses may help better determine whether certain subgroups of patients are most likely to benefit from it and therefore should be prioritised for CBM during alcohol withdrawal treatment.Trial RegistrationVersion 4 of the protocol (dated 1 August 2017) is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12617001241325. Registered on 25 August 2017 (retrospectively registered).
Highlights
People with alcohol use disorders often exhibit an “alcohol approach bias”, the automatically triggered action tendency to approach alcohol
We focused on outcomes during the first 2 weeks following discharge because this is a crucial time for commencing engagement in ongoing post-withdrawal treatment, which often fails to occur due to rapid relapse
This study is the first multisite randomised controlled trial of cognitive bias modification as a stand-alone intervention delivered during residential alcohol withdrawal treatment
Summary
People with alcohol use disorders often exhibit an “alcohol approach bias”, the automatically triggered action tendency to approach alcohol. Approach bias is likely to persist following withdrawal from alcohol, and contribute to the high rate of relapse following withdrawal treatment. Cognitive bias modification (CBM) training has been shown to attenuate approach biases and lead to reduced relapse rates. This study aims to test whether CBM delivered during residential withdrawal treatment leads to reduced relapse rates and reduced use of acute health services following discharge, and to test possible moderators of CBM’s effect on alcohol use. Standard treatment for severe alcohol dependence in Australia often involves costly, intensive inpatient withdrawal treatment to manage acute withdrawal symptoms, followed by outpatient counselling and/or alcohol pharmacotherapy. Repeated readmission to withdrawal treatment, combined with this patient group's high rate of acute health service use, puts a high burden on the healthcare system. Novel interventions that reduce the proportion of patients who relapse have the potential to deliver cost savings to health and social welfare systems, and benefit alcohol-dependent individuals’ health and wellbeing, as well as their families
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