Combining approach bias modification with working memory training during inpatient alcohol withdrawal: An open-label pilot trial of feasibility and acceptability

Victoria Manning, Katherine Mroz, Joshua B.B. Garfield, Petra K. Staiger, Kate Hall, Dan I. Lubman, Antonio Verdejo-Garcia

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: According to contemporary neurocognitive models, addiction is maintained by the biasing of information-processing and decision-making systems towards relatively automatic, impulsive, reward-seeking responses to drug-related stimuli, and away from more controlled, deliberative, "reflective" states of processing that could result in decisions to delay or avoid drug use. Cognitive training programs aimed at either countering "impulsive" processing or enhancing "reflective" processing alone have shown promise. However, there has been no attempt to simultaneously target both aspects of processing with a combined training program. We aimed to test the feasibility and acceptability of a novel 'dual-training' program targeting both processes during residential alcohol withdrawal, and to measure abstinence rates following discharge. Methods: Thirty-seven patients undergoing alcohol withdrawal at a residential unit participated in this open-label pilot feasibility study. We tested a 4-session program of dual cognitive training targeting both impulsive (approach bias) and reflective (working memory) aspects of processing. Descriptive statistics were used to examine feasibility (training uptake and completion rates) and acceptability (withdrawal from the study; participants' ratings of the tasks). Alcohol abstinence rates were examined 2-weeks post-discharge. Results: Seven participants withdrew after commencing training. Twenty-six (70%) completed the 4-session training protocol, and four completed 3 sessions before discharging. Among participants who provided ratings, nearly all (93%) rated the training as interesting. Most (87%) indicated that they felt it had improved their attention. However, most did not feel it had decreased their craving for alcohol. At 2-weeks post-discharge, 16 (53%) participants reported abstaining from alcohol. For comparison, an earlier pilot trial in the same setting found a 68% abstinence rate with approach bias training alone, and 47% abstinence in a non-training control group. Conclusions: Dual training during residential alcohol detoxification appears to be both acceptable and feasible, suggesting that future research is warranted to test its effectiveness at reducing likelihood of relapse.

Original languageEnglish
Article number24
Number of pages6
JournalSubstance Abuse: Treatment, Prevention, and Policy
Volume14
Issue number1
DOIs
Publication statusPublished - 6 Jun 2019

Keywords

  • Alcohol use disorder
  • Approach bias
  • Cognitive bias
  • Cognitive training
  • Detoxification
  • Withdrawal
  • Working memory

Cite this

@article{2b547b146f794ac382901caab1560143,
title = "Combining approach bias modification with working memory training during inpatient alcohol withdrawal: An open-label pilot trial of feasibility and acceptability",
abstract = "Background: According to contemporary neurocognitive models, addiction is maintained by the biasing of information-processing and decision-making systems towards relatively automatic, impulsive, reward-seeking responses to drug-related stimuli, and away from more controlled, deliberative, {"}reflective{"} states of processing that could result in decisions to delay or avoid drug use. Cognitive training programs aimed at either countering {"}impulsive{"} processing or enhancing {"}reflective{"} processing alone have shown promise. However, there has been no attempt to simultaneously target both aspects of processing with a combined training program. We aimed to test the feasibility and acceptability of a novel 'dual-training' program targeting both processes during residential alcohol withdrawal, and to measure abstinence rates following discharge. Methods: Thirty-seven patients undergoing alcohol withdrawal at a residential unit participated in this open-label pilot feasibility study. We tested a 4-session program of dual cognitive training targeting both impulsive (approach bias) and reflective (working memory) aspects of processing. Descriptive statistics were used to examine feasibility (training uptake and completion rates) and acceptability (withdrawal from the study; participants' ratings of the tasks). Alcohol abstinence rates were examined 2-weeks post-discharge. Results: Seven participants withdrew after commencing training. Twenty-six (70{\%}) completed the 4-session training protocol, and four completed 3 sessions before discharging. Among participants who provided ratings, nearly all (93{\%}) rated the training as interesting. Most (87{\%}) indicated that they felt it had improved their attention. However, most did not feel it had decreased their craving for alcohol. At 2-weeks post-discharge, 16 (53{\%}) participants reported abstaining from alcohol. For comparison, an earlier pilot trial in the same setting found a 68{\%} abstinence rate with approach bias training alone, and 47{\%} abstinence in a non-training control group. Conclusions: Dual training during residential alcohol detoxification appears to be both acceptable and feasible, suggesting that future research is warranted to test its effectiveness at reducing likelihood of relapse.",
keywords = "Alcohol use disorder, Approach bias, Cognitive bias, Cognitive training, Detoxification, Withdrawal, Working memory",
author = "Victoria Manning and Katherine Mroz and Garfield, {Joshua B.B.} and Staiger, {Petra K.} and Kate Hall and Lubman, {Dan I.} and Antonio Verdejo-Garcia",
year = "2019",
month = "6",
day = "6",
doi = "10.1186/s13011-019-0209-2",
language = "English",
volume = "14",
journal = "Substance Abuse: Treatment, Prevention, and Policy",
issn = "1747-597X",
publisher = "Springer-Verlag London Ltd.",
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TY - JOUR

T1 - Combining approach bias modification with working memory training during inpatient alcohol withdrawal

T2 - An open-label pilot trial of feasibility and acceptability

AU - Manning, Victoria

AU - Mroz, Katherine

AU - Garfield, Joshua B.B.

AU - Staiger, Petra K.

AU - Hall, Kate

AU - Lubman, Dan I.

AU - Verdejo-Garcia, Antonio

PY - 2019/6/6

Y1 - 2019/6/6

N2 - Background: According to contemporary neurocognitive models, addiction is maintained by the biasing of information-processing and decision-making systems towards relatively automatic, impulsive, reward-seeking responses to drug-related stimuli, and away from more controlled, deliberative, "reflective" states of processing that could result in decisions to delay or avoid drug use. Cognitive training programs aimed at either countering "impulsive" processing or enhancing "reflective" processing alone have shown promise. However, there has been no attempt to simultaneously target both aspects of processing with a combined training program. We aimed to test the feasibility and acceptability of a novel 'dual-training' program targeting both processes during residential alcohol withdrawal, and to measure abstinence rates following discharge. Methods: Thirty-seven patients undergoing alcohol withdrawal at a residential unit participated in this open-label pilot feasibility study. We tested a 4-session program of dual cognitive training targeting both impulsive (approach bias) and reflective (working memory) aspects of processing. Descriptive statistics were used to examine feasibility (training uptake and completion rates) and acceptability (withdrawal from the study; participants' ratings of the tasks). Alcohol abstinence rates were examined 2-weeks post-discharge. Results: Seven participants withdrew after commencing training. Twenty-six (70%) completed the 4-session training protocol, and four completed 3 sessions before discharging. Among participants who provided ratings, nearly all (93%) rated the training as interesting. Most (87%) indicated that they felt it had improved their attention. However, most did not feel it had decreased their craving for alcohol. At 2-weeks post-discharge, 16 (53%) participants reported abstaining from alcohol. For comparison, an earlier pilot trial in the same setting found a 68% abstinence rate with approach bias training alone, and 47% abstinence in a non-training control group. Conclusions: Dual training during residential alcohol detoxification appears to be both acceptable and feasible, suggesting that future research is warranted to test its effectiveness at reducing likelihood of relapse.

AB - Background: According to contemporary neurocognitive models, addiction is maintained by the biasing of information-processing and decision-making systems towards relatively automatic, impulsive, reward-seeking responses to drug-related stimuli, and away from more controlled, deliberative, "reflective" states of processing that could result in decisions to delay or avoid drug use. Cognitive training programs aimed at either countering "impulsive" processing or enhancing "reflective" processing alone have shown promise. However, there has been no attempt to simultaneously target both aspects of processing with a combined training program. We aimed to test the feasibility and acceptability of a novel 'dual-training' program targeting both processes during residential alcohol withdrawal, and to measure abstinence rates following discharge. Methods: Thirty-seven patients undergoing alcohol withdrawal at a residential unit participated in this open-label pilot feasibility study. We tested a 4-session program of dual cognitive training targeting both impulsive (approach bias) and reflective (working memory) aspects of processing. Descriptive statistics were used to examine feasibility (training uptake and completion rates) and acceptability (withdrawal from the study; participants' ratings of the tasks). Alcohol abstinence rates were examined 2-weeks post-discharge. Results: Seven participants withdrew after commencing training. Twenty-six (70%) completed the 4-session training protocol, and four completed 3 sessions before discharging. Among participants who provided ratings, nearly all (93%) rated the training as interesting. Most (87%) indicated that they felt it had improved their attention. However, most did not feel it had decreased their craving for alcohol. At 2-weeks post-discharge, 16 (53%) participants reported abstaining from alcohol. For comparison, an earlier pilot trial in the same setting found a 68% abstinence rate with approach bias training alone, and 47% abstinence in a non-training control group. Conclusions: Dual training during residential alcohol detoxification appears to be both acceptable and feasible, suggesting that future research is warranted to test its effectiveness at reducing likelihood of relapse.

KW - Alcohol use disorder

KW - Approach bias

KW - Cognitive bias

KW - Cognitive training

KW - Detoxification

KW - Withdrawal

KW - Working memory

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U2 - 10.1186/s13011-019-0209-2

DO - 10.1186/s13011-019-0209-2

M3 - Article

VL - 14

JO - Substance Abuse: Treatment, Prevention, and Policy

JF - Substance Abuse: Treatment, Prevention, and Policy

SN - 1747-597X

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M1 - 24

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