Attentional Bias For Alcohol Cues Research Articles

A Randomized Controlled Trial of Attentional Control Training for Treating Alcohol Use Disorder.

Background: There is consistent evidence that community and clinical samples of individuals with an alcohol use disorder (AUD) have attentional biases toward alcohol cues. The alcohol attentional control training program (AACTP) has shown promise for retraining these biases and decreasing alcohol consumption in community samples of excessive drinkers. However, there is a lack of evidence regarding the effectiveness of ACTP in clinical AUD samples. The main aim of the present study is to investigate whether primary pharmacological and psychological, evidence-based alcohol treatment can be enhanced by the addition of a gamified AACTP smartphone application for patients with an AUD.Design and Methods: The study will be implemented as a randomized controlled trial. A total of 317 consecutively enrolled patients with AUD will be recruited from alcohol outpatient clinics in Denmark. Patients will be randomized to one of three groups upon initiation of primary alcohol treatment: Group A: a gamified AACTP smartphone application + treatment as usual (TAU); Group B: a gamified AACTP sham-control application + TAU; or Group C: only TAU. Treatment outcomes will be assessed at baseline, post-treatment, and at 3- and 6-month follow-ups. Repeated measures MANOVA will be used to compare the trajectories of the groups over time on alcohol attentional bias, alcohol craving, and drinking reductions. It is hypothesized that Group A will achieve better treatment outcomes than either Group B or Group C.Perspectives: Because attentional bias for alcohol cues is proportional to the amount of alcohol consumed, and these biases are not addressed within current evidence-based treatment programs, this study is expected to provide new evidence regarding the effectiveness of the gamified AACTP in a clinical population. Furthermore, due to promising results found using AACTP in community samples of excessive drinkers, there is a high probability that the AACTP treatment in this study will also be effective, thereby allowing AACTP to be readily implemented in clinical settings. Finally, we expect that this study will increase the effectiveness of evidence-based AUD treatment and introduce a new, low-cost gamified treatment targeting patients with an AUD. Overall, this study is likely to have an impact at the scientific, clinical, and societal levels.Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05102942?term=NCT05102942&draw=2&rank=1, identifier: NCT05102942.

Attentional bias for alcohol cues in visual search—Increased engagement, difficulty to disengage or both?

Cognitive models emphasise the importance of attentional bias in addiction. However, many attentional bias tasks have been criticised for questionable psychometric properties and inability to differentiate between engagement and disengagement processes. This study therefore examined the suitability of two alternative tasks for assessing attentional bias within the context of alcohol use. Participants were undergraduate students (N = 169) who completed the Visual Search Task and Odd-One-Out Task, the latter of which is designed to differentiate between engagement and disengagement processes of attention, at baseline and one week later. Participants also completed baseline measures of alcohol consumption, craving, and alcohol use problems. Internal consistency was adequate for the Visual Search Task index, and weak for the Odd-One-Out Task indices. Test-retest reliability was weak for both tasks. The Visual Search Task index and the disengagement (but not the engagement) index of the Odd-One-Out Task showed a positive association with alcohol consumption. This study was restricted to a non-clinical student sample. The relatively high error rate of the Odd-One-Out Task might have reduced its sensitivity as an index of attentional bias. Both tasks showed some merit as attentional bias measures, and results suggested that attentional disengagement might be particularly related to alcohol use. However, the reliability of the current measures was inadequate. One potential explanation for the low reliability is that non-clinical samples may have weak and unstable attentional biases to alcohol. Future efforts should be made to improve the psychometric qualities of both tasks and to administer them in a clinical sample.

Interaction Effects between the Cumulative Genetic Score and Psychosocial Stressor on Self-Reported Drinking Urge and Implicit Attentional Bias for Alcohol: A Human Laboratory Study.

The current candidate gene and environment interaction (cGxE) study examined whether the effects of an experimentally manipulated psychosocial stressor on self-reported drinking urge and implicit attentional bias for alcohol cues differ as a function of a cumulative genetic score of 5-HTTLPR, MAO-A, DRD4, DAT1 and DRD2 genotypes. The current study also examined whether salivary alpha-amylase level or self-reported anxiety state mediate these cGxE effects. Individuals with high cumulative genetic risk score of the five monoamergic genotypes showed greater attentional bias toward alcohol cues when exposed to a psychosocial stressor than when not exposed. Frequent binge-drinking Caucasian young adults (N = 105; mean age = 19; 61% male) completed both the control condition and stress condition (using the Trier Social Stress Test) in order. Regarding attentional bias, individuals with high and medium cumulative genetic risk scores showed greater attentional bias toward alcohol stimuli in the stress condition than in the control condition, whereas, those with low genetic risk scores showed greater attentional bias toward alcohol stimuli in the control condition than in the stress condition. No mediating roles of salivary alpha-amylase and anxiety state in the cGxE effect were found. Regarding self-reported drinking urge, individuals with high cumulative genetic score reported greater drinking urge than those with low genetic score regardless of experimental conditions. Although replication is necessary, the findings suggest that the association of a psychosocial stressor on implicit (but not explicit, self-reported) alcohol outcomes may differ as a function of the collective effects of five monoamine genes.

Implicit Cognition for Alcohol in the Workplace: An Essay Review Article for Health Promotion and Human Resources Management

Alcohol misuse is an occupational risk factor and, therefore, a regular theme in health-promotion programs in the workplace. However, Human Resources Management could expand the effectiveness of these programs, especially if implicit measures, such as attentional bias for alcohol cues were assessed. Attentional bias is an automatic behavior, which is the tendency to direct attention to emotionally relevant stimuli (e.g., pleasure, reward, danger). It was previously observed in alcohol-dependent (and non-dependent) adults and appointed as a risk marker to alcohol misuse. Thus, the aim of this paper is to theoretically address possible relationships between frequency of participation in alcohol-prevention programs in the workplace and attentional bias to alcohol cues related to drinking. We suggest that implicit measures of risk for alcohol misuse could be assessed by the organizations and that lower results could be found in employees with frequent participation in alcohol-prevention programs at work. This discussion can contribute to definitions about frequency schedules for preventive actions at work and can support the development of cognitive-oriented technologies to identify employees’ implicit motivational states in relation to health goals.

Reward sensitivity, attentional bias, and executive control in early adolescent alcohol use

This study examined whether attentional bias for alcohol stimuli was associated with alcohol use in young adolescents, and whether the frequently demonstrated relationship between reward sensitivity and adolescent alcohol use would be partly mediated by attentional bias for alcohol cues. In addition, this study investigated the potential moderating role of executive control (EC), and tested whether the relationship between alcohol-related attentional bias and alcohol use was especially present in young adolescents with weak EC. Participants were 86 adolescents (mean age=14.86), who completed a Visual Probe Task (VPT) as an index of attentional bias, a flanker-task based Attention Network Task (ANT) as an index of EC, the sensitivity of punishment and sensitivity of reward questionnaire (SPSRQ) as an index of reward sensitivity, and an alcohol use questionnaire. High reward sensitivity, high alcohol-related attentional bias, and weak EC were all related to alcohol use. The relationship between reward sensitivity and alcohol use was not mediated by alcohol-related attentional bias. As hypothesized, attentional bias was only associated with alcohol use in participants with weak EC. Together, the present findings are consistent with the view that high reward sensitivity and low EC may be considered as risk factors for adolescent alcohol use. The independent contribution of reward sensitivity and attentional bias might suggest that adolescents who are highly reward sensitive and display an attentional bias for alcohol cues are at even higher risk for excessive alcohol use and developing alcohol abuse problems. Future research using a longitudinal approach would allow an examination of these risk factors on subsequent alcohol use. Treatment implications are discussed, including the importance of strengthening EC and reducing the rewarding value of alcohol use.

EPA-0843 - Relationship between psychophysiological processes involved in alcohol dependence

Current data suggest that at least three psychophysiological paradigms are involved in Alcohol Dependence: attentional bias; affective modulation of the startle reflex and behavioural inhibition. These three paradigms have not been studied together in a sample of alcohol dependent subjects. To show that the performance on these three psychophysiological processes allows discriminating alcohol dependent subjects (with different severity) from healthy controls. 59 alcohol dependent subjects were assessed with the following three psychophysiological tasks: The dot probe task (which assesses attentional bias), the startle response when viewing alcohol cues (which evaluates affective modulation of the startle reflex), and the Modified- Stop Signal-Task (which measures behavioral inhibition). The Severity of Alcohol Dependence Scale (SAD) was used for grouping patients based on their dependence severity. 52 healthy subjects were assessed as the control group. All three paradigms correctly discriminated between patients and controls. Patients were divided into three subgroups according to their scores on the SAD (mild, moderate and severe dependence). The performance of the three groups in the three paradigms studied was also different. Patients with more severe dependence had more attentional bias for alcohol cues, exhibited lower magnitudes of startle response when viewing alcohol cues, and showed lower capacity to inhibit their behaviour when words related to alcohol were being seen. Subjects with alcohol dependence showed different psychophysiological response patterns compared to controls in the three paradigms studied. These response patterns seem to be associated with the severity of dependence, and they could be used to determine the outcome of the treatment in patients with alcohol dependence.

The contributions of value‐based decision‐making and attentional bias to alcohol‐seeking following devaluation

AimsTo investigate the mediating role of attentional bias for alcohol cues on alcohol-seeking following devaluation of alcohol.DesignBetween subject.SettingEye-tracking laboratory at the University of Liverpool.ParticipantsStudent social drinkers (n = 64).MeasurementsAn operant choice task in which participants chose between simultaneously presented alcohol and non-alcohol drink rewards, while attentional bias for alcohol and non-alcohol drink cues was inferred from eye movements. Participants then consumed 30 mL of an alcoholic beverage, which was either presented alone (no devaluation: n = 32) or had been adulterated to taste unpleasant (devaluation: n = 32). Choice and attentional bias for the alcohol and non-alcohol drink pictures were then measured again.FindingsAlcohol devaluation reduced behavioural choice for alcohol (F = 32.64, P < 0.001) and attentional bias for the alcohol pictures indexed by dwell time (F = 22.68, P < 0.001), initial fixation (F = 7.08, P = 0.01) and final fixation (F = 22.44, P < 0.001). Mediation analysis revealed that attentional bias partially mediated the effect of devaluation on alcohol choice; however, the proportion of the variance accounted for by attentional bias is low to moderate (∼30%).ConclusionsAmong student social drinkers, attentional bias is only a partial mediator of alcohol choice following devaluation of alcohol. Value-based decision-making may be a more important determinant of drinking behaviour among student social drinkers than attentional bias.

Attentional biases in abstinent alcoholics and their association with craving.

Previous investigations of attentional bias for alcohol cues in abstinent alcoholics indicate enhanced processing of alcohol cues on the modified Stroop task, and a more complicated "vigilance-avoidance" pattern of attentional bias on the visual probe task. Given that, in general, subjective craving is positively associated with attentional bias, we predicted that attentional biases in abstinent alcoholics would depend on their level of alcohol craving. In the present study 28 alcoholic patients, who had recently commenced a day treatment program, and 26 social drinking controls completed an alcohol Stroop task, a visual probe task with three stimulus durations (200, 500, and 2,000 ms), and self-report assessments of craving and alcohol dependence. On the alcohol Stroop task, abstinent alcoholics showed a greater interference effect for alcohol-related than neutral words, relative to social drinkers. On the visual probe task, alcoholic patients who reported a high level of craving exhibited a greater attentional bias toward alcohol cues, relative to both patients reporting a low level of craving, and social drinker controls. Alcoholics who reported low levels of craving showed avoidance of alcohol cues at 500 ms, relative to social drinkers. Among alcoholics, early dropout from treatment was associated with the severity of alcohol dependence and the strength of subjective craving, but it was not associated with measures of attentional bias. These results clarify the importance of subjective craving as a correlate of attentional biases in abstinent alcoholics.

Effects of 0.4g/kg alcohol on attentional bias and alcohol-seeking behaviour in heavy and moderate social drinkers

Alcohol intoxication is known to influence attentional biases for alcohol-related cues and alcohol-seeking behaviour. It is unknown if heavier drinkers are more or less sensitive to these effects of alcohol, or whether the effects of alcohol on attentional bias are associated with subsequent alcohol-seeking behaviour. In the present study, 55 social drinkers were administered either 0.4g/kg alcohol or placebo in a repeated measures, double-blind experimental design. Participants completed a visual probe task with eye movement monitoring (to measure attentional bias) and a bogus taste test (to measure alcohol-seeking) in both alcohol and placebo sessions. Heavy drinkers showed an attentional bias for alcohol cues that was unaffected by alcohol, whereas in moderate drinkers attentional bias was present after alcohol administration, but was absent after placebo. All participants voluntarily consumed more beer during the taste test after administration of alcohol compared with placebo. The effects of alcohol on attentional bias were unrelated to the effects of alcohol on beer consumption. Results are consistent with the development of tolerance, rather than sensitization, to the acute effects of alcohol on attentional biases in heavy drinkers. However, alcohol-induced increases in attentional bias were not related to the effects of alcohol on the motivation to drink.

The Effect of Self‐Control on Attentional Bias for Alcohol Cues in Male Heavy Drinkers1

Attentional bias for alcohol cues increases craving and subsequent alcohol consumption. Override processes can be used to disengage attention from alcohol cues. This requires self‐control and implies that depletion of self‐control would impair the ability to disengage attention from alcohol cues. This study examined the effect of self‐control on attentional bias among male heavy drinkers. To manipulate self‐control resources, an expression control task was used. Attentional bias was measured with a visual probe task. The Obsessive Compulsive Drinking Scale (OCDS; Anton, Moak, &amp; Latham, 1996) assessed the urge to drink and persistent thoughts about alcohol. The results suggest that participants who scored relatively high on the OCDS showed more attentional bias after controlled emotional expression, compared to free emotional expression.

Alcohol expectancy moderates attentional bias for alcohol cues in light drinkers

Theoretical models suggest that attentional bias for alcohol-related cues develops because cues signal the availability of alcohol, and the expectancy elicited by alcohol cues is responsible for the maintenance of attentional bias among regular drinkers. We investigated the moderating role of alcohol expectancy on attentional bias for alcohol-related cues. Within-subjects experimental design. Psychology laboratories. Adult social drinkers (n=58). On a trial-by-trial basis, participants were informed of the probability (100%, 50%, 0%) that they would receive beer at the end of the trial before their eye movements towards alcohol-related and control cues were measured. Heavy social drinkers showed an attentional bias for alcohol-related cues regardless of alcohol expectancy. However, in light social drinkers, attentional bias was only seen on 100% probability trials, i.e. when alcohol was expected imminently. Attentional bias for alcohol-related cues is sensitive to the current expectancy of receiving alcohol in light social drinkers, but it occurs independently of the current level of alcohol expectancy in heavy drinkers.

Mild stress increases attentional bias in social drinkers who drink to cope: A replication and extension.

The authors investigated the effects of a laboratory stressor task on rapid initial orienting and delayed disengagement aspects of attentional bias for alcohol-related cues in social drinkers (N = 58). Participants were randomly allocated to receive a stress induction or control manipulation before completing a visual probe task in which alcohol cues were presented for either 100 ms or 500 ms. Results indicated that participants who reported drinking alcohol to cope with negative affect had increased attentional bias for alcohol cues after stress induction. This effect of stress induction on attentional bias was evident when cues were presented for 100 ms and 500 ms, which suggests that stress increases both the initial orienting of attention toward and the delayed disengagement of attention from alcohol-related cues. Theoretical implications of this robust finding are discussed.

Stress increases attentional bias for alcohol cues in social drinkers who drink to cope

To investigate the effects of stress on alcohol craving and attentional bias for alcohol-related cues in a group of heavy social drinkers. Forty-four heavy social drinkers were exposed to either a laboratory stressor task or a control manipulation before completing a questionnaire measure of alcohol craving and a visual probe task which measured attentional bias for alcohol-related cues. Participants were subdivided into those with high and low levels of coping motives for drinking. Compared to a control manipulation, the laboratory stressor task produced increases in alcohol craving (P < 0.01). The laboratory stressor task also produced a significant attentional bias for alcohol-related cues, but only among participants who had high levels of coping motives (P < 0.05). Findings are broadly consistent with contemporary negative reinforcement models of substance abuse, and with models of subjective craving and attentional biases for substance-related cues.

Experimental manipulation of attentional biases in heavy drinkers: do the effects generalise?

In heavy drinkers, training attention towards alcohol cues increases alcohol craving, but it is not clear if effects of 'attentional training' generalise to novel stimuli and measurement procedures. We investigated possible generalisation of attentional training to novel alcohol cues and other methods of measuring cognitive bias. A modified visual probe task was used to train participants to direct their attention either towards ('attend alcohol' group) or away from ('avoid alcohol' group) alcohol cues; attentional bias was not manipulated in a control group (total N = 60). After attentional training, we measured cognitive bias (using visual probe, modified Stroop, flicker-induced change blindness and stimulus-response compatibility tasks), alcohol craving and alcohol consumption. Attentional bias for alcohol cues increased in the 'attend alcohol' group, and this effect generalised to novel stimuli, but not to other cognitive bias tasks. In the 'avoid alcohol' group, attentional bias was reduced for the stimuli that were used during attentional training, but these effects did not generalise to different stimuli or cognitive bias tasks. Alcohol craving increased among participants in the 'attend alcohol' group, but only among participants who were aware of the experimental contingencies during attentional training. There were no group differences in alcohol consumption. The effects of attentional training show limited generalisation to different alcohol cues and methods of measuring cognitive bias. Experimentally increased attentional bias seems to increase subjective craving, but only among participants who are aware of the experimental contingencies that were in place during attentional training.

Alcohol cues increase cognitive impulsivity in individuals with alcoholism

Individuals with alcoholism are characterized by both attentional bias for alcohol cues and prepotent response inhibition deficit. We tested the hypothesis that alcoholics exhibit greater cognitive disinhibition when the response to be suppressed is associated with alcohol-related information. Forty recently detoxified individuals with alcoholism were compared with 40 healthy non-substance abusers on the "Alcohol-Shifting Task", a variant of the go/no-go paradigm requiring a motor response to targets and no response to distracters. The aim was to test the ability of alcoholics to discriminate between alcohol-related and neutral words. Sometimes, the alcohol-related words were the targets for the "go" response, with neutral words as distracters, sometimes the reverse. Several shifts in target type occurred during the task. Alcoholics made significantly more commission errors (i.e., press a key when a distracter displayed) and more omission errors (i.e., not press a key when a target displayed) than controls. Moreover, the number of commission errors was greater in alcoholics when alcohol-related stimuli had to be detected. These results demonstrate that alcoholics exhibit a basic prepotent response inhibition deficit, which is enhanced when the response to be suppressed is related to alcohol. We discuss clinical and theoretical implications of these findings.