Pushing or Pulling Your “Poison”: Clinical Correlates of Alcohol Approach and Avoidance Bias Among Inpatients Undergoing Alcohol Withdrawal Treatment

Abstract

Introduction: Alcohol approach bias, the tendency to automatically move toward alcohol cues, has been observed in people who drink heavily. However, surprisingly, some alcohol-dependent patients demonstrate an alcohol avoidance bias. This inconsistency could be explained by the clinical or demographic profile of the population studied, yet this has not been examined in approach bias modification (ABM) trials to date. We aimed to determine the proportion of patients with an approach or avoidance bias, assess whether they differ on demographic and drinking measures, and to examine the clinical correlates of approach bias.Method: These research questions were addressed using baseline data from 268 alcohol-dependent patients undergoing inpatient withdrawal treatment who then went on to participate in a trial of ABM.Results: At trial entry (day 3 or 4 of inpatient withdrawal), 155 (57.8%) had an alcohol approach bias and 113 (42.2%) had an avoidance bias. These two groups did not differ on any demographic or relevant drinking measures. Approach bias was significantly and moderately associated with total standard drinks consumed in the past 30 days (r = 0.277, p = 0.001) but no other indices of alcohol consumption or problem severity.Conclusion: Whilst the majority of alcohol-dependent patients showed an alcohol approach bias, those with an avoidance bias did not differ in demographic or clinical characteristics, and the strength of approach bias related only to recent consumption. Further research is needed to develop more accurate and personally tailored measures of approach bias, as these findings likely reflect the poor reliability of standard approach bias measures.

‘A circuit breaker’ – Interrupting the alcohol autopilot: A qualitative exploration of participants’ experiences of a personalised mHealth approach bias modification intervention for alcohol use

“…Accumulating evidence suggests that approach bias modification (ApBM) may be an effective adjunctive intervention for hazardous alcohol use ( Eberl et al, 2013 , Rinck et al, 2018 , Salemink et al, 2021 , Wiers et al, 2011 ). ApBM is a computerised cognitive training intervention which aims to re-train implicit alcohol ‘approach biases’ associated with heavy drinking ( Bechara, 2005 , Field et al, 2008 , Piercy et al, 2021 , Wiers et al, 2011 ) by having participants repeatedly ‘avoid’ alcohol-related images and ‘approach’ non-alcohol related images ( Wiers, Rinck, Dictus, & van den Wildenberg, 2009 ). Although findings from earlier systematic reviews were mixed ( Cristea et al, 2016 , Kakoschke et al, 2017 ), these reviews have been criticised for pooling experimental lab studies and clinical trials in the same analysis ( Wiers, Boffo, & Field, 2018a ).…”

Automatic Approach Behaviors in Alcohol Dependence: Does a Cognitive Bias Modification Training Affect Pavlovian-to-Instrumental Transfer Effects?

“…It has been suggested that CBM training works via the change of alcohol approach bias [20,31,58,59]. We may not have observed an effect of CBM on the strength of any PIT effect because there was no significant effect of our CBM training on the alcohol approach bias as assessed with the aAAT.…”

“…With respect to our exploratory assessment of CBM training on future relapse risk, we failed to observe a significant effect. Previous research of CBM intervention targeting on the alcohol approach bias and treatment outcome also showed discrepant results [59,65,66]. Although several studies reported prominent effect of CBM on reducing the alcohol approach bias and decreasing future relapse risk or drinking behavior [19,20,23,24,27], there are also studies did not find similar effects on drinking behavior [22].…”

“…Although several studies reported prominent effect of CBM on reducing the alcohol approach bias and decreasing future relapse risk or drinking behavior [19,20,23,24,27], there are also studies did not find similar effects on drinking behavior [22]. Wiers et al [22] discussed the controversial findings, and pointed out several factors that could influence the CBM intervention efficacy, including the types of study (experimental study or clinical trial) and the settings (clinical or online) [59]. It should also be noted that two clinical studies that reported prominent CBM effect did not use CBM intervention as the only but as an add-on intervention to cognitive behavior therapy to AD patients [19,20].…”

Dual-feature AAT: Combining relevant- and irrelevant-feature approach-avoidance tasks

“…However, this does not imply that both versions measure something completely different. Typically, irrelevant-feature AATs show low reliability scores (e.g., Hahn et al, 2019;Piercy et al, 2021;Reinecke et al, 2010), while relevant-feature AATs yield sufficient reliability scores more often (e.g., Schippers & Smid, 2021). Hence, the irrelevant-feature task could create random noise which should not correlate with the relevant-feature task.…”