BackgroundConventional psychology therapies are unable to address automatic biases that result in individuals relapsing into their substance use disorder. Advances in experimental psychology have led to a better understanding of attention and approach biases and methods to modify these biases. Several studies have demonstrated the effectiveness of bias modification among clinical cohorts. The advances in mobile health technologies have allowed remote delivery of these interventions. To date, there is a lack of studies examining bias modification in a substance-using non-Western sample.ObjectiveThis study was designed to determine the feasibility of an attention bias modification intervention and an attention bias modification smartphone app for the reduction of attention biases among treatment-seeking individuals. The secondary aim is to determine the acceptability of the intervention.MethodsA feasibility study was conducted among inpatients who were in their rehabilitation phase at the National Addictions Management Service. Participants were to complete a set of baseline questionnaires, and on each day that they are in the study, undertake an attention bias assessment and modification task while completing a visual analogue scale to assess their craving. Feasibility was determined by the acceptance rate of participation and participants’ adherence to the interventions. Acceptability was assessed by a perception questionnaire. Descriptive statistical analyses were performed using SPSS version 22. A thematic analysis approach was used in the qualitative synthesis of users’ perceptions.ResultsOf the 40 participants invited to participate in the feasibility study, 10 declined, yielding an acceptance rate of 75%. Of the recruited participants, 6 participants were diagnosed with alcohol dependence; 17, with opioid dependence; 2, with cannabis dependence; and 5, with stimulant dependence. In addition, of the final 30 participants, 11 (37%) failed to complete all the planned interventions and 22 (73%) completed the perspective questionnaires; of these 22 participants, 100% rated the app as extremely and very easy, 77% rated it as extremely or very interactive, 54% rated it as extremely or very motivating, and 33% reported a change in their confidence levels.ConclusionsOur results highlight the feasibility of recruiting participants to undertake attention bias modification interventions. Participants generally accept use of a mobile version of such an intervention. Nevertheless, our acceptability data indicate that there could be improvements in the existing app, and a participatory design approach might be helpful in its future conceptualization.International Registered Report Identifier (IRRID)RR2-10.2196/11822
Genetics intersects with environmental, cultural, and social factors in the development of addictive disorders. This study reports the feasibility of whole-exome sequencing of trios (subject and two family members) to discover potential genetic variants in the development of substance use disorders (SUD). Family trios were recruited from the National Addictions Management Service in Singapore during the 2016–2018 period. Recruited subjects had severe alcohol use disorder (AUD) or opioid use disorder (OUD), with nicotine dependence (ND) and a family history of addictive disorders. Demographic characteristics and severity of addiction were captured. Whole-exome sequencing (WES) and analysis were performed on salivary samples collected from the trios. WES revealed variants in several genes in each individual and disruptive protein mutations in most. Variants were identified in genes previously associated with SUDs, such as Pleckstrin homology domain-containing family M member 3 (PLEKHM3), coiled-coil serine-rich protein 1 (CCSER1), LIM and calponin homology domains-containing protein 1 (LIMCH1), dynein axonemal heavy chain 8 (DNAH8), and the taste receptor type 2 member 38 (TAS2R38) involved in the perception of bitterness. The feasibility study suggests that subjects with a severe addiction profile, polysubstance use, and family history of addiction may often harbor gene variants that may predispose them to SUDs. This study could serve as a model for future precision medicine-based personalized interventional strategies for behavioral addictions and SUDs and for the discovery of potentially pathogenic genetic variants.
BackgroundSubstance use disorders are highly prevalent globally. Relapse rates following conventional psychological interventions for substance use disorders remain high. Recent reviews have highlighted attentional and approach or avoidance biases to be responsible for multiple relapses. Other studies have reported the efficacy of interventions to modify biases. With advances in technologies, there are now mobile versions of conventional bias modification interventions. However, to date, no study has evaluated bias modification in a substance-using, non-Western sample. Existing evaluations of mobile technologies for the delivery of bias interventions are also limited to alcohol or tobacco use disorders.ObjectiveThis study aims to examine the feasibility of mobile-based attention bias modification intervention among treatment-seeking individuals with substance use and alcohol use disorders.MethodsThis is a feasibility study, in which inpatients who are in their rehabilitation phase of clinical management will be recruited. On each day that they are in the study, they will be required to complete a craving visual analogue scale and undertake both a visual probe-based assessment and and modification task in a smartphone app . Reaction time data will be collated for the computation of baseline attentional biases and to determine whether there is a reduction of attentional bias across the interventions. Feasibility will be determined by the number of participants recruited and participants’ adherence to the planned interventions up until the completion of their rehabilitation program and by the ability of the app in detecting baseline biases and changes in biases. Acceptability of the intervention will be assessed by a short questionnaire of users’ perceptions of the intervention. Statistical analyses will be performed using SPSS version 22.0, while qualitative analysis of the perspectives will be performed using NVivo version 10.0.ResultsThis study was approved by the National Healthcare Group Domain Specific Research Board, with approval number (2018/00316). Results will be disseminated by means of conferences and publications.Currently, we are in the process of recruitment for this study.ConclusionsTo the best of our knowledge, this is the first study to evaluate the feasibility and acceptability of a mobile attention bias modification intervention for individuals with substance use disorders. The data pertaining to the feasibility and acceptability are undoubtedly crucial because they imply the potential use of mobile technologies in retraining attentional biases among inpatients admitted for medical-assisted detoxification and rehabilitation. Participants’ feedback pertaining to the ease of use, interactivity, and motivation to continue using the app is crucial because it will determine whether a codesign approach might be warranted to design an app that is acceptable for participants and that participants themselves would be motivated to use.International Registered Report Identifier (IRRID)PRR1-10.2196/11822
BACKGROUND Conventional psychology therapies are unable to address automatic biases that result in individuals relapsing into their substance use disorder. Advances in experimental psychology have led to a better understanding of attention and approach biases and methods to modify these biases. Several studies have demonstrated the effectiveness of bias modification among clinical cohorts. The advances in mobile health technologies have allowed remote delivery of these interventions. To date, there is a lack of studies examining bias modification in a substance-using non-Western sample. OBJECTIVE This study was designed to determine the feasibility of an attention bias modification intervention and an attention bias modification smartphone app for the reduction of attention biases among treatment-seeking individuals. The secondary aim is to determine the acceptability of the intervention. METHODS A feasibility study was conducted among inpatients who were in their rehabilitation phase at the National Addictions Management Service. Participants were to complete a set of baseline questionnaires, and on each day that they are in the study, undertake an attention bias assessment and modification task while completing a visual analogue scale to assess their craving. Feasibility was determined by the acceptance rate of participation and participants’ adherence to the interventions. Acceptability was assessed by a perception questionnaire. Descriptive statistical analyses were performed using SPSS version 22. A thematic analysis approach was used in the qualitative synthesis of users’ perceptions. RESULTS Of the 40 participants invited to participate in the feasibility study, 10 declined, yielding an acceptance rate of 75%. Of the recruited participants, 6 participants were diagnosed with alcohol dependence; 17, with opioid dependence; 2, with cannabis dependence; and 5, with stimulant dependence. In addition, of the final 30 participants, 11 (37%) failed to complete all the planned interventions and 22 (73%) completed the perspective questionnaires; of these 22 participants, 100% rated the app as extremely and very easy, 77% rated it as extremely or very interactive, 54% rated it as extremely or very motivating, and 33% reported a change in their confidence levels. CONCLUSIONS Our results highlight the feasibility of recruiting participants to undertake attention bias modification interventions. Participants generally accept use of a mobile version of such an intervention. Nevertheless, our acceptability data indicate that there could be improvements in the existing app, and a participatory design approach might be helpful in its future conceptualization. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/11822
BackgroundAdvances in experimental psychology have led to a better understanding of unconscious, automatic processes that result in individuals relapsing into their substance-using habits. While some reviews have demonstrated the effectiveness of bias retraining of these unconscious biases, there have been other reviews that have highlighted that bias retraining is not always effective. Other studies have revealed there was no baseline biases among some participants. An examination of mobile bias retraining interventions has also revealed mixed results, with some reporting effectiveness and others null findings. A recent feasibility and acceptability study, done by the authors, revealed that 53% of participants have had no baseline biases and 21% of those with positive baseline biases did not have a positive change in magnitude following intervention.ObjectiveThe aim of this paper was to explore potential variables (demographic and clinical) that could account for the negative baseline biases in the prior feasibility and acceptability study, and to discuss some of the factors that could account for the absence of baseline biases. We also explored potential reasons for why there was no reduction in the magnitude of attentional biases among individuals with baseline biases.MethodsParticipants who were in the rehabilitation phase of their treatment were invited to participate. During the study they had to complete a set of baseline questionnaires, and on each day that they were on the ward they had to complete an attention bias assessment and modification task and rate their cravings using a visual analogue scale. Attention bias was deemed to be present if individuals had a positive score.ResultsIn our study, 53% (16/30) of individuals did not present with baseline attentional biases, and among those with positive baseline biases a total of 21% (3/14) of participants did not have a reduction in the overall magnitude of attentional biases. Chi-square analyses undertaken to compare the demographic characteristics of participants with and without baseline biases did not reveal any significant findings. However, with respect to clinical characteristics, those who had positive baseline biases had experimented with more substances.ConclusionsOur study is one of the first to have explored negative findings in attention bias modification interventions for individuals with addictive disorders. We postulate that several factors could account for the absence of baseline biases and there being no changes following bias retraining. Future research ought to take into consideration these factors.
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