title: Cognitive Bias Modification Training During Inpatient Alcohol Detoxification Reduces Early Relapse: A Randomized Controlled Trial.
abstract: Relapse is common in alcohol-dependent individuals and can be triggered by alcohol-related cues in the environment. It has been suggested that these individuals develop cognitive biases, in which cues automatically capture attention and elicit an approach action tendency that promotes alcohol seeking. The study aim was to examine whether cognitive bias modification (CBM) training targeting approach bias could be delivered during residential alcohol detoxification and improve treatment outcomes.
  
  
  
  Using a 2-group parallel-block (ratio 1:1) randomized controlled trial with allocation concealed to the outcome assessor, 83 alcohol-dependent inpatients received either 4 sessions of CBM training where participants were implicitly trained to make avoidance movements in response to pictures of alcoholic beverages and approach movements in response to pictures of nonalcoholic beverages, or 4 sessions of sham training (controls) delivered over 4 consecutive days during the 7-day detoxification program. The primary outcome measure was continuous abstinence at 2 weeks postdischarge. Secondary outcomes included time to relapse, frequency and quantity of alcohol consumption, and craving. Outcomes were assessed in a telephonic follow-up interview.
  
  
  
  Seventy-one (85%) participants were successfully followed up, of whom 61 completed all 4 training sessions. With an intention-to-treat approach, there was a trend for higher abstinence rates in the CBM group relative to controls (69 vs. 47%, p = 0.07); however, a per-protocol analysis revealed significantly higher abstinence rates among participants completing 4 sessions of CBM relative to controls (75 vs. 45%, p = 0.02). Craving score, time to relapse, mean drinking days, and mean standard drinks per drinking day did not differ significantly between the groups.
  
  
  
  This is the first trial demonstrating the feasibility of CBM delivered during alcohol detoxification and supports earlier research suggesting it may be a useful, low-cost adjunctive treatment to improve treatment outcomes for alcohol-dependent patients.
authors.affiliation: Turning Point, Eastern Health, Fitzroy, Victoria, Australia.|Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.
authors.forename: Victoria
authors.initials: V
authors.lastname: Manning
authors.affiliation: School of Psychology, Deakin University, Burwood, Victoria, Australia.
authors.forename: Petra K
authors.initials: PK
authors.lastname: Staiger
authors.affiliation: School of Psychology, Deakin University, Burwood, Victoria, Australia.|Centre for Youth AOD Practice Development, Youth Support and Advocacy Service, Fitzroy, Victoria, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Hall
authors.affiliation: Turning Point, Eastern Health, Fitzroy, Victoria, Australia.|Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.
authors.forename: Joshua B B
authors.initials: JB
authors.lastname: Garfield
authors.affiliation: Turning Point, Eastern Health, Fitzroy, Victoria, Australia.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Flaks
authors.affiliation: School of Psychology, Deakin University, Burwood, Victoria, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Leung
authors.affiliation: School of Psychology, Deakin University, Burwood, Victoria, Australia.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Hughes
authors.affiliation: School of Psychology, Deakin University, Burwood, Victoria, Australia.
authors.forename: Jarrad A G
authors.initials: JA
authors.lastname: Lum
authors.affiliation: Turning Point, Eastern Health, Fitzroy, Victoria, Australia.|Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.
authors.forename: Dan I
authors.initials: DI
authors.lastname: Lubman
authors.affiliation: Turning Point, Eastern Health, Fitzroy, Victoria, Australia.|School of Psychological Sciences & Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, Australia.
authors.forename: Antonio
authors.initials: A
authors.lastname: Verdejo-Garcia
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology* / Q000628:therapy*; D003071:Cognition / Q000502:physiology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003463:Cues; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation / Q000379:methods*; D011287:Prejudice / Q000523:psychology*; D011597:Psychomotor Performance / Q000502:physiology; D012008:Recurrence; D016320:Substance Abuse Treatment Centers / Q000379:methods
keywords: Abstinence; Alcohol; Cognitive Bias Modification; Inpatient Withdrawal; Randomized Controlled Trial