Long-term effects of alcohol-avoidance training: Do changes in approach bias predict who will remain abstinent?

BACKGROUND: Patients with alcohol use disorder (AUD) tend to selectively approach alcohol cues in the environment, demonstrating an alcohol-approach bias. Alcohol-approach-bias modification (Alcohol-ApBM) effectively increases abstinence rates in patients with AUD when added to abstinence-focused treatment, but the evidence for its proposed working mechanism (reduction of the alcohol-approach bias) is limited. Moreover, not all patients benefit from Alcohol-ApBM, and previous research did not identify reliable pretreatment predictors of Alcohol-ApBM effectiveness. Therefore, the current study focused on learning processes during the Alcohol-ApBM training itself. Specifically, we examined whether changes in approach-avoidance tendencies over the course of Alcohol-ApBM would predict abstinence after inpatient treatment. METHODS: The training data of 543 AUD patients in Germany (70% male, M = 47.96, SD = 9.08), receiving Alcohol-ApBM training during inpatient treatment, were used to examine whether various aspects of learning during training predicted abstinence 1 year after treatment discharge, both separately and in interaction with potential sociodemographic and clinical moderators of Alcohol-ApBM effectiveness. RESULTS: Overall, successful learning across six Alcohol-ApBM training sessions was observed; that is, the approach tendency toward alcoholic stimuli was reduced over time. However, none of the examined learning parameters were predictive of abstinence, neither separately nor in combination with clinical or sociodemographic variables. CONCLUSIONS: Previous studies have shown that Alcohol-ApBM is an effective add-on to abstinence-focused treatment for AUD, and this study showed that learning took place during Alcohol-ApBM training. However, specific learning parameters during training did not predict abstinence 1 year after treatment discharge. Therefore, we cannot specify which patients are most likely to benefit from ApBM with regard to abstinence after 1 year.

Implementing Approach-Bias Modification as Add-On to Varieties of Clinical Treatment for Alcohol Use Disorders: Results of a Multicenter RCT.

INTRODUCTION: Abstinence rates after inpatient treatment for alcohol use disorder (AUD) are modest (1-year rate around 50%). One promising approach is to re-train the automatically activated action tendency to approach alcohol-related stimuli (alcohol-approach bias) in AUD patients, as add-on to regular treatment. As efficacy has been demonstrated in well-controlled randomized controlled trials, the important next step is to add alcohol-approach-bias modification (alcohol-ApBM) to varieties of existing treatments for AUD. Therefore, this prospective, multicenter implementation-RCT examined whether adding alcohol-ApBM to regular treatments (various abstinence-oriented treatments including both individual and group-based interventions) would significantly increase abstinence rates compared to receiving regular treatment only, in a variety of naturalistic settings with different therapeutic approaches. METHODS: A total of 1,586 AUD inpatients from 9 German rehabilitation clinics were randomly assigned to receive either ApBM in addition to regular treatment or not. Training satisfaction of patients and therapists was measured after training. Success rates were determined at 3, 6, and 12 months post-treatment. RESULTS: Return rates of the post-treatment assessments varied greatly between clinics, often being low (18-76%). Nevertheless, ApBM significantly increased success rates after 3 months. After 6 and 12 months, the differences were not significant. ApBM was evaluated mostly positively by patients and therapists. DISCUSSION/CONCLUSION: ApBM was an effective add-on to regular treatment of AUD at 3 months follow-up, across a variety of AUD treatment settings. However, low return rates for the clinical outcomes reduced the effect size of ApBM considerably. The application of ApBM proved feasible in varying clinical settings, offering the opportunity to modify automatic processes and to promote abstinence.

Does selective inhibition training reduce relapse rates when added to standard treatment of alcohol use disorder? A randomized controlled trial.

BACKGROUND: Alcohol-dependent individuals tend to selectively approach alcohol cues in the environment, demonstrating an alcohol approach bias. Because approach bias modification (ApBM) training can reduce the approach bias and decrease relapse rates in alcohol-dependent patients when added to abstinence-focused treatment, it has become a part of regular treatment. Moreover, in selective inhibition (SI) training, responses to one category of stimuli (i.e., alcohol stimuli) are selectively inhibited in an adapted Go/No-Go task. SI-Training has been found to effectively devalue the inhibited category and to reduce consumption of alcohol among social drinkers. This study investigated whether SI-Training can further improve the effects of treatment as usual that includes ApBM, and if so, whether the effect is mediated by a devaluation of the inhibited alcohol stimuli. METHODS: Abstinent alcohol-dependent inpatients (N=434) were randomly assigned to receive 6 sessions of either active (n = 214, 32% female) or sham (n = 220, 38% female) SI-Training, in addition to standard treatment that includes active ApBM. Ratings were used to assess changes in the evaluation of alcohol stimuli after the training. Relapse rates were assessed 3 and 12 months after treatment discharge. RESULTS: Alcohol stimuli were rated negatively before and after the training, and the training did not influence these ratings. Evaluation of nonalcoholic drinks became more positive after active SI-Training. Both ApBM and SI-Training showed the expected training effects on reaction times. Contrary to expectations, SI-Training conditions did not yield different abstinence rates 3 or 12 months after treatment. CONCLUSIONS: We found no evidence supporting the hypothesis that SI-Training amplifies the relapse-preventing effect of ApBM. Moreover, alcohol stimuli were rated negatively before and after treatment and were not influenced by SI-Training.