Attempted Training of Alcohol Approach and Drinking Identity Associations in US Undergraduate Drinkers: Null Results from Two Studies

Abstract

There is preliminary evidence that approach avoid training can shift implicit alcohol associations and improve treatment outcomes. We sought to replicate and extend those findings in US undergraduate social drinkers (Study 1) and at-risk drinkers (Study 2). Three adaptations of the approach avoid task (AAT) were tested. The first adaptation – the approach avoid training – was a replication and targeted implicit alcohol approach associations. The remaining two adaptations – the general identity and personalized identity trainings – targeted implicit drinking identity associations, which are robust predictors of hazardous drinking in US undergraduates. Study 1 included 300 undergraduate social drinkers. They were randomly assigned to real or sham training conditions for one of the three training adaptations, and completed two training sessions, spaced one week apart. Study 2 included 288 undergraduates at risk for alcohol use disorders. The same training procedures were used, but the two training sessions occurred within a single week. Results were not as expected. Across both studies, the approach avoid training yielded no evidence of training effects on implicit alcohol associations or alcohol outcomes. The general identity training also yielded no evidence of training effects on implicit alcohol associations or alcohol outcomes with one exception; individuals who completed real training demonstrated no changes in drinking refusal self-efficacy whereas individuals who completed sham training had reductions in self-efficacy. Finally, across both studies, the personalized identity training yielded no evidence of training effects on implicit alcohol associations or alcohol outcomes. Despite having relatively large samples and using a well-validated training task, study results indicated all three training adaptations were ineffective at this dose in US undergraduates. These findings are important because training studies are costly and labor-intensive. Future research may benefit from focusing on more severe populations, pairing training with other interventions, increasing training dose, and increasing gamification of training tasks.

Implicit alcohol associations, especially drinking identity, predict drinking over time.

“…Existing evidence-based interventions for college student hazardous drinking might be strengthened by incorporating strategies designed to change drinking identity. Also, recent advances in cognitive bias modification (see Wiers et al, 2013, but also see Lindgren et al, 2015) and mindfulness training (Ostafin, Bauser, & Myxters, 2012) suggest that IAAs themselves can be changed and that doing so may augment treatment efforts.…”

Attentional Bias Modification With Serious Game Elements: Evaluating the Shots Game

“…Despite these promising results, application of cognitive training in younger populations has proven more difficult [14], for a number of reasons. First, youngsters tend to perceive stronger positive than negative effects of their alcohol use [15], perhaps because positive effects of alcohol tend to occur sooner than the negative effects [16], making those positive associations stronger.…”

A Single Session of Attentional Bias Modification Reduces Alcohol Craving and Implicit Measures of Alcohol Bias in Young Adult Drinkers

“…In a recent study, Lindgren et al (2015) found that a training paradigm designed to reduce implicit alcohol approach tendencies in a non-treatment-seeking sample of undergraduate social and risky drinkers did not reduce implicit alcohol associations or drinking outcomes. In a second study, McGeary et al (2014) reported that an online dot-probe based attentional training program did result in significant reductions in alcohol consumption in a group of non-treatment-seeking but heavy-drinking undergraduate students.…”

“…In a related literature, a number of studies (e.g., Lindgren et al, 2015; Wiers et al, 2011) have investigated the efficacy of cognitive bias modification (CBM) techniques to modify implicit alcohol-related approach-avoid expectancies (e.g., Palfai and Ostafin, 2003). Research has found that heavy drinkers are faster to use a joystick to “pull” (i.e., approach) computer-presented images of alcohol toward them than they are to “push” (avoid) those same images away (Wiers et al, 2009).…”

“…Recent research has shown that alcohol-related biases can be measured in adolescents soon after they begin drinking (Peeters et al, 2013, 2012), so that young adult drinkers, even if they have only been drinking for a short time, are likely to have developed biases that can be modified by ABM training. In particular, more evidence about the efficacy of ABM programs in different types of drinkers will help determine whether there are different groups for whom such training may be clinically useful, especially as different studies have offered alternate views about whether treatment-seeking participants respond to ABM programs differently than non-treatment-seeking participants (e.g., Lindgren et al, 2015; McGeary et al, 2014). This approach will allow practitioners to more accurately tailor their treatment offerings and help behavioral interventions move toward a model of precision medicine.…”