Cue avoidance training and inhibitory control training for the reduction of alcohol consumption: a comparison of effectiveness and investigation of their mechanisms of action

Abstract

RationaleBoth cue avoidance training (CAT) and inhibitory control training (ICT) reduce alcohol consumption in the laboratory. However, these interventions have never been directly compared and their mechanisms of action are poorly understood.ObjectivesWe compared the effects of both types of training on alcohol consumption and investigated if they led to theoretically predicted changes in alcohol avoidance (CAT) or alcohol inhibition (ICT) associations and changes in evaluation of alcohol cues.MethodsHeavy drinking young adults (N = 120) were randomly assigned to one of four groups: (1) CAT (repeatedly pushing alcohol cues away with a joystick), (2) sham (control) CAT; (3) ICT (repeatedly inhibiting behaviour in response to alcohol cues); or (4) sham (control) ICT. Changes in reaction times and automatic evaluations of alcohol cues were assessed before and after training using assessment versions of tasks used in training and the implicit association test (IAT), respectively. Finally, participants completed a bogus taste test as a measure of ad libitum alcohol consumption.ResultsCompared to sham conditions, CAT and ICT both led to reduced alcohol consumption although there was no difference between the two. Neither intervention affected performance on the IAT, and changes in reaction time did not suggest the formation of robust alcohol avoidance (CAT) or alcohol inhibition (ICT) associations after training.ConclusionsCAT and ICT yielded equivalent reductions in alcohol consumption in the laboratory. However, these behavioural effects were not accompanied by devaluation of stimuli or the formation of alcohol avoidance or alcohol inhibition associations.Electronic supplementary materialThe online version of this article (doi:10.1007/s00213-017-4639-0) contains supplementary material, which is available to authorized users.

A Roadmap for Integrating Neuroscience Into Addiction Treatment: A Consensus of the Neuroscience Interest Group of the International Society of Addiction Medicine

“…In a seminal study, a beer-GNG task which trained heavily drinking students to inhibit responses to "beer" stimuli resulted in significantly reduced weekly alcohol intake relative to students trained towards "beer" stimuli (175). A recent RCT of 120 heavily drinking students found that a single session of either ICT or approach bias modification (ApBM, described below) led to significant reductions in alcohol consumption relative to matched controls (176). Similarly, Kilwein et al (177) found that a single session of ICT (GNG) reduced alcohol consumption and alcohol approach tendencies in a small sample (n = 23) of heavily drinking men (177).…”

Event-related and readiness potentials when preparing to approach and avoid alcohol cues following cue avoidance training in heavy drinkers

“…We recruited young adult heavy drinkers in accordance with previous laboratory studies of CAT (e.g. Di Lemma and Field 2017;Korucuoglu et al 2014;Wiers et al 2011): heavy drinkers are well-represented in this population, in whom acute alcoholrelated harm is problematic. The study was approved by the University of Liverpool Research Ethics Committee.…”

“…Twenty pairs of alcohol-related and matched neutral (control) pictures were used in the computer tasks (Barkby et al 2012;Di Lemma and Field 2017;Field et al 2004). Alcohol pictures depicted alcoholic drinks (e.g.…”

“…The research on approach tendencies evoked by substancerelated cues has a clinical application in the form of cognitive bias modification (CBM), a group of computerised behaviour change interventions that have the common goal to train participants to overcome automatic approach tendencies and other cognitive biases, with a view to reducing alcohol consumption or other appetitive motivated behaviours such as food intake (Di Lemma and Field 2017;Gladwin et al 2016;Kakoschke et al 2017;Wiers et al 2013). A specific form of CBM is cue avoidance training (CAT), based on the AAT in which participants categorise alcohol-related and control pictures by making approach and avoidance movements using a joystick.…”

“…This intervention results in a reduction in the strength of automatic alcohol-approach associations such that alcohol cues evoke automatic avoidance responses when they are encountered in the future (Wiers et al 2011). Importantly, compared to control interventions, CAT prompts reductions in alcohol consumption in the laboratory among non-dependent heavy drinkers (see Di Lemma and Field 2017;Sharbanee et al 2014;Wiers et al 2010) and it reduces the likelihood of relapse to drinking after treatment in alcohol-dependent patients (Wiers et al 2011;Eberl et al 2013;Manning et al 2016;Rinck et al 2018). Despite some consistent findings for CAT, there are concerns about the robustness and replicability of these findings (Cristea et al 2016;Leeman et al 2018;Wiers et al 2018).…”