Approach bias modification during alcohol withdrawal treatment: Results from a multi-site double-blind randomised controlled trial

Background: Approximately half of patients undergoing inpatient withdrawal treatment (i.e., “detoxification”) for alcohol use disorders (AUD) resume drinking within 2-weeks of discharge, and around 85% relapse within 1 year. Approach Bias Modification (ApBM), a computerised neurocognitive training task that aims to reduce impulses to approach alcohol-related stimuli, has proven effective at reducing likelihood of relapse in other treatment settings. We conducted the world’s first multi-site trial of delivering ApBM in inpatient withdrawal treatment settings.

Methods: A double-blind, sham-controlled, randomised controlled trial tested the efficacy of 4 consecutive daily 15-minute sessions of ApBM, delivered during inpatient withdrawal treatment, at increasing the rate of abstinence from alcohol during the first 2 weeks post-discharge, and the rate of past-month abstinence 3, 6 and 12-months post-discharge, in 300 AUD patients.

Results: The abstinence rate during the first 2 weeks following discharge from inpatient treatment was significantly higher in the ApBM group than controls (54.4% versus 42.5%; p=.039). The past-month abstinence rate was also higher in the ApBM group at the 3-month follow-up (34.7% versus 21.6%, p=.001), but not at the 6-month (20.4% versus 19.6%; p=.86) or 12-month (19.7% versus 15.7%; p=.36) follow-ups.

Conclusion: These findings add further weight to the growing body of research supporting the efficacy of ApBM in the treatment of AUD. Prior studies delivered ApBM in other settings (e.g., residential rehabilitation), which often allowed delivery of more sessions spaced over several weeks, and have reported significant benefits at 1-year follow-up. In our study, where the constraints of short-term withdrawal treatment only allowed for 4 consecutive days of ApBM sessions, effects were significant at 2-week and 3-month follow-ups, but not at later follow-ups. Future research could test whether beneficial effects could be prolonged by continuing to provide ApBM following discharge from inpatient treatment (e.g., via a smartphone app).

Impact Statement: Being safe and easy-to-implement, requiring only a computer, joystick and no specialist staff training, ApBM could be routinely offered during withdrawal treatment to prevent early relapse. Abstinence during the early post-discharge period could facilitate patients’ engagement in post-withdrawal care (e.g., counselling, rehabilitation) to improve longer-term outcomes. These findings have already led to routine adoption of ApBM in one Melbourne withdrawal treatment service, and interest in implementing it in several others.