Internet-based attentional bias modification training as add-on to regular treatment in alcohol and cannabis dependent outpatients: a study protocol of a randomized control trial.

BACKGROUND: The automatic tendency to attend to and focus on substance-related cues in the environment (attentional bias), has been found to contribute to the persistence of addiction. Attentional bias modification (ABM) interventions might, therefore, contribute to treatment outcome and the reduction of relapse rates. Based on some promising research findings, we designed a study to test the clinical relevance of ABM as an add-on component of regular intervention for alcohol and cannabis patients. DESIGN/METHODS: The current protocol describes a study which will investigate the effectiveness and cost-effectiveness of a newly developed home-delivered, multi-session, internet-based ABM (iABM) intervention as an add-on to treatment as usual (TAU). TAU consists of cognitive behavioural therapy-based treatment according to the Dutch guidelines for the treatment of addiction. Participants (N = 213) will be outpatients from specialized addiction care institutions diagnosed with alcohol or cannabis dependency who will be randomly assigned to one of three conditions: TAU + iABM; TAU + placebo condition; TAU-only. Primary outcome measures are substance use, craving, and rates of relapse. Changes in attentional bias will be measured to investigate whether changes in primary outcome measures can be attributed to the modification of attentional bias. Indices of cost-effectiveness and secondary physical and psychological complaints (depression, anxiety, and stress) are assessed as secondary outcome measures. DISCUSSION: This randomized control trial will be the first to investigate whether a home-delivered, multi-session iABM intervention is (cost-) effective in reducing relapse rates in alcohol and cannabis dependency as an add-on to TAU, compared with an active and a waiting list control group. If proven effective, this ABM intervention could be easily implemented as a home-delivered component of current TAU. TRIAL REGISTRATION: Netherlands Trial Register, NTR5497 , registered on 18th September 2015.

Patients With Autism Spectrum Disorder and Co-occurring Substance Use Disorder: A Clinical Intervention Study.

Background: The prevalence of substance use disorders (SUD) in individuals with autism spectrum disorders (ASD) appears to be higher than previously described. Attention has been drawn to developing new treatment approaches for this patient population, as they appear to do less well with traditional addiction treatment. There is very little research addressing treatment outcome. This study aims to introduce and evaluate a manualized group treatment intervention developed specifically for patients with ASD and co-occurring SUD. Methods: We developed a group treatment based on cognitive behavioural therapy (CBT) and evaluated outcome measures at the end of treatment and 3-month follow-up. Fifty-seven patients with ASD and co-occurring SUD were included of which 30 completed the group intervention, 27 of them also participated at 3-month follow-up. Results: The findings suggest that group treatment can work for patients with ASD and co-occurring SUD. Lower levels of alcohol use (t = 3.61, P = .002, d = 0.75), craving (t = 2.65, P = .013, d = 0.51), passive coping styles (t = 2.32, P = .030, d = 0.48), depression (t = 3.48, P = .002, d = 0.67), anxiety (t = 3.02, P = .006, d = 0.58), and stress (t = 2.62, P = .015, d = 0.51) symptoms were reported after completing the group intervention, with even stronger effects at 3 months follow-up. Conclusions: The present study shows promising results of a tailor-made group intervention in a heterogeneous patient population with ASD and co-occurring SUD with positive effects on both symptoms of ASD and SUD.

Effectiveness of attentional bias modification training as add-on to regular treatment in alcohol and cannabis use disorder: A multicenter randomized control trial.

BACKGROUND: Attentional bias for substance-relevant cues has been found to contribute to the persistence of addiction. Attentional bias modification (ABM) interventions might, therefore, increase positive treatment outcome and reduce relapse rates. The current study investigated the effectiveness of a newly developed home-delivered, multi-session, internet-based ABM intervention, the Bouncing Image Training Task (BITT), as an add-on to treatment as usual (TAU). METHODS: Participants (N = 169), diagnosed with alcohol or cannabis use disorder, were randomly assigned to one of two conditions: the experimental ABM group (50%; TAU+ABM); or the control group (50%; split in two subgroups the TAU+placebo group and TAU-only group, 25% each). Participants completed baseline, post-test, and 6 and 12 months follow-up measures of substance use and craving allowing to assess long-term treatment success and relapse rates. In addition, attentional bias (both engagement and disengagement), as well as secondary physical and psychological complaints (depression, anxiety, and stress) were assessed. RESULTS: No significant differences were found between conditions with regard to substance use, craving, relapse rates, attentional bias, or physical and psychological complaints. CONCLUSIONS: The findings may reflect unsuccessful modification of attentional bias, the BITT not targeting the relevant process (engagement vs. disengagement bias), or may relate to the diverse treatment goals of the current sample (i.e., moderation or abstinence). The current findings provide no support for the efficacy of this ABM approach as an add-on to TAU in alcohol or cannabis use disorder. Future studies need to delineate the role of engagement and disengagement bias in the persistence of addiction, and the role of treatment goal in the effectiveness of ABM interventions.

Temporal stability of pathological scratchcard gambling among adult scratchcard buyers two years later.

AIMS: To estimate the 2-year cumulative incidence of pathological scratchcard gambling (PSG) among a representative sample of high-risk scratchcard buyers, to assess the 2-year temporal stability of PSG and scratchcard-related problems and to estimate the adjusted 1-year prevalence for PSG taking into account the temporal dynamics of this diagnosis. DESIGN: A prospective study with two assessments was applied to a non-proportional stratified random sample of 12,222 adult scratchcard buyers in the Netherlands. A cost-effective design was used and only those scratchcard buyers (n=201) who had already experienced some scratchcard-related problems at initial assessment were followed-up 2 years later. PARTICIPANTS: Two independent cohorts of buyers with scratchcard-related problems were followed-up: a cohort of 173 potential problematic scratchcard gamblers (PPSG) at increased risk for PSG and a cohort of 28 pathological scratchcard gamblers. Incidence and prevalence estimates were calculated for the total sample of adult scratchcard buyers and for the Dutch adult population. FINDINGS: Of the PPSG group 6.72% (95% CI 2.30-8.90%) became addicted to scratchcards during the 2-year period. The 2-year cumulative incidence of PSG among Dutch adult scratchcard players was 0.24% (95% CI 0.16-0.34%). The stability of the Diagnostic and Statistical Manual 4th edition (DSM-IV) diagnosis of PSG ranged from 11.1% to 42.9%, depending on whether or not those lost to follow-up were considered to be cases of PSG. Taking into account the dynamics of this disorder, using the most conservative assumption, the adjusted 1-year prevalence of PSG for the total sample of adult scratchcard buyers was 0.33% (95% CI 0.23-0.45%). CONCLUSIONS: PSG proves to be a rare phenomenon among adult scratchcard buyers in the Netherlands. Both incidence and prevalence of the DSM-IV diagnosis PSG were low. Stability of the DSM-IV diagnosis PSG, DSM-IV criteria and South Oaks Gambling Screening-S (SOGS-S) problems were low. Prevalence was stable over the time because incidence and recovery rates were very similar.

Are scratchcards addictive? The prevalence of pathological scratchcard gambling among adult scratchcard buyers in the Netherlands.

AIMS: To determine the prevalence of regular, potential problematic and pathological scratchcard gambling (PSG) 5 years after the introduction of scratchcards in the Netherlands. DESIGN AND PARTICIPANTS: A non-proportional stratified random sample of 12,222 scratchcard buyers was approached. Regular scratchcard buyers (n = 3342) were asked to fill out the South Oaks Gambling Screen (SOGS). Those with a SOGS score of 3 or more (n = 340) were interviewed with the gambling section of the DSM-IV Diagnostic Interview Schedule (DIS-T). Weighted data were used to obtain unbiased prevalence estimates. FINDINGS: The estimated prevalence of regular and potential problematic scratchcard gambling were 28.4% and 2.68%, respectively. Only 0.24% met DSM-IV criteria for PSG. Of those, only 0.09% were addicted uniquely to scratchcards. The remaining 0.15% were also addicted to other games of chance. Demographic and gambling characteristics of these 'combined' PSG (young men, mainly slot-machine players) resembled characteristics of pathological gamblers in general. In contrast to these 'combined' PSG, 'unique' PSG were mainly women between 25 and 34 years who spent relatively small amounts of money on scratchcards (equivalent to one scratchcard a day). CONCLUSION: Scratchcards have a very low addiction potential among adults in the Netherlands. Given the specific characteristics of the unique PSG and the relatively small amount of money they spent, the appropriateness of DSM criteria for this particular form of gambling can be questioned.