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

Introduction and Aims: More than half of patients undergoing inpatient withdrawal treatment for alcohol use disorders (AUD) relapse within two weeks of discharge, thus novel approaches that reduce early relapse are needed. In a previous pilot-randomised controlled trial, we found that four sessions of cognitive bias modification (CBM) reduced relapse rate at two weeks by 22%. We therefore aimed to replicate these findings in a multi-site, fully-powered randomised controlled trial examining short and long-term outcomes.
Design and Methods: Using a double-blind, sham-controlled, parallel-group design, the efficacy of four consecutive daily sessions of CBM (targeting approach bias) to increase abstinence rates at two weeks (primary outcome; already published [1]), three, six and 12-months following discharge was examined, in 300 AUD patients from four withdrawal units. Abstinence (zero alcohol consumption during assessment period) was assessed using the Time-Line Follow-Back tool.
Results: With Intention-to-Treat analysis, the rate of abstinence was significantly higher in the CBM group relative to controls at two weeks (54.4% vs. 42.5%; P=0.039), and at three months (34.7% vs. 21.6%, P=0.001). However, no significant differences were found at six months (20.4% vs. 19.6%; P=0.86) or 12-months (19.7% vs. 15.7%; P=0.36).
Discussions and Conclusions: These findings add further weight to the growing body of research supporting the clinical efficacy of CBM in the treatment of AUDs. Being safe and easy-to-implement, requiring only a computer, joystick and no specialist staff training, CBM should be routinely offered during withdrawal treatment to prevent early relapse. Future research should examine whether continuing to deliver CBM following discharge (e.g. via smartphones) could extend relapse-prevention effects beyond three months.