Attentional biases for alcohol cues in heavy and light social drinkers: the roles of initial orienting and maintained attention

Automatic attentional capture by food items in a visuospatial attention task - A study with event-related brain potentials

The incentive sensitization theory suggests that repeated exposure to rewarding substances or food shapes neural circuits to create an attentional bias towards these stimuli. There is ongoing debate about whether attentional capture by such stimuli is an early automatic process or a later stage in the processing cascade. Event-related brain potentials (ERPs) provide a means to pinpoint the timing and location of attentional capture. ERPs were recorded from 28 normal weight healthy women as they attended to the left or right hemifield of a visual display while fixating a central point. Stimuli comprised bars presented left and right of the fixation point simultaneously with the task being to respond to slightly smaller bars on the attended side by button press. The bars appeared superimposed on task-irrelevant distractor stimuli (either food pictures or pictures of non-food objects). The bilateral stimuli elicited a positivity that was largest as posterior sites contralateral to the attended hemifield between 75 and 250 ms. Critically, this contralateral attention effect was enhanced by food distractors on the attended side and diminished by food distractors on the unattended side, demonstrating signs of attention capture by food stimuli as early as 80 ms poststimulus.

Attentional bias to alcohol-related cues: effects of menstrual cycle phase and sex differences

RATIONALE

A recent study by our group found that women displayed greater attentional bias to alcohol-related cues during the late versus early follicular phase in both sober and intoxicated states, suggesting a greater risk of excessive drinking among women during this phase. Changes in attentional bias as a function of menstrual cycle phase raise questions about potential sex differences in the relative consistency by which women and men display attentional bias to alcohol over time.

OBJECTIVES

The present study tested sex differences in attentional bias to alcohol by comparing the change in women's attentional bias from early to late follicular phase to that observed in men over the same period.

METHODS

Twenty-five men and 25 women aged 21-32 participated in a placebo-controlled study examining sex differences in the rewarding properties of alcohol. Participants completed measures of attentional bias to alcohol-related cues during two sessions following both 0.6 g/kg alcohol and placebo. Test sessions occurred one week apart, and for female participants coincided with the early and late follicular phases.

RESULTS

Men consistently displayed attentional bias to alcohol-related cues across sessions under both doses. By contrast, women showed attentional bias only during the late follicular phase, at a magnitude greater than that observed in men, and persistent under both doses.

CONCLUSIONS

These findings highlight the potential role of sex and menstrual cycle phase in sensitizing drinkers to rewarding properties of alcohol-related cues. Men's motivation to drink may remain relatively consistent, whereas women may be most motivated during the late follicular phase.

Attentional bias in tobacco use disorder using eye tracking: A systematic review

Background

Attentional bias, defined as the disproportionate attentional allocation towards drug-related stimuli, is well-demonstrated in substance use disorders. However, studies investigating attentional bias in tobacco use disorder have revealed inconclusive findings. In recent years, eye-tracking technology has emerged as an innovative technique for exploring attentional bias. This systematic review aims to provide a comprehensive overview of eye-tracking studies examining attentional bias in tobacco use disorder.

Methods

Using PRISMA guidelines, 18 papers that assessed attentional bias using eye-tracking technology among people who smoke cigarettes were extracted from the following databases: PsychINFO, MEDLINE, and EMBASE. Search terms included "attentional bias", "tobacco use disorder", and "eye tracking" and their respective subject headings and synonyms. Selected papers were assessed for methodological quality using a standardized procedure. Selected studies reviewed were categorized into studies making comparisons between 1) people who smoke and people who do not smoke and 2) between smoking-related cues and neutral cues among people who smoke.

Results

Overall, most studies showed that people who smoke had significantly greater attentional bias to smoking-related cues, as indexed by greater dwell times and fixation counts. Although findings using measures of early orienting biases were mixed, people who smoke displayed a tendency to initially shift attention to smoking-related cues more frequently than neutral cues.

Conclusions

While methodological inconsistencies across studies preclude any definitive conclusions, findings suggest that maintained attention may be a more precise reflection of the specific attentional processes influenced by incentive salience. Suggestions for future research include establishing methodological standards for future eye-tracking studies.

Neural Correlates of the Attentional Bias Towards Subliminal Pornographic Cues in Individuals with Tendencies Toward Problematic Pornography Use: An ERP Study Using a Dot-Probe Task

Attentional bias toward addiction-related stimuli has been implicated in the development and maintenance of addiction disorders. Several previous studies have reported an attentional bias toward pornographic cues in individuals with problematic pornography use (PPU). Since attentional bias can occur without conscious awareness, the purpose of this study was to use electroencephalography to examine whether individuals with a high tendency for PPU exhibit attentional bias at the level of the preconscious processing. Event-related potentials (ERPs) were recorded while male participants with high (n = 24) and low (n = 23) levels of subclinical PPU performed a masked version of the dot-probe task measuring attentional bias toward subliminally presented pornographic stimuli. Behavioral data revealed that participants from both groups with high and low tendencies for PPU reacted faster to probes replacing pornographic images than to probes replacing neutral images. ERPs revealed that individuals with a high tendency for PPU exhibited larger probe-locked P1 amplitudes following masked pornographic images (valid condition) compared with masked neutral images (invalid condition). Additionally, PPU symptom severity correlated positively with the P1 amplitude difference between valid and invalid conditions. These results highlight the automaticity of attentional capture by pornographic stimuli and support the hypothesis of an addiction-related attentional bias during preconscious processes. The implication of these findings for understanding the clinical phenomenon of out-of-control addictive behavior are discussed.

Metadehumanization, fundamental needs and coping strategies: A comparison of drinkers at low versus high risk of alcohol use disorder

The interpersonal difficulties documented in chronic excessive drinking might foster the progression toward severe alcohol use disorder (SAUD). Characterizing these interpersonal difficulties and their commonalities with patients already presenting a diagnosed SAUD is needed to develop targeted prophylactic interventions. Patients with SAUD present metadehumanization (i.e., the perception of being considered as less than human by others), which is associated with deleterious consequences (e.g., reduced fundamental needs satisfaction, increased negative emotions, reduced self-esteem, disrupted coping strategies) involved in the persistence of this disorder. No study has investigated metadehumanization among individuals not diagnosed with SAUD but at high risk of alcohol use disorder. We measured metadehumanization, emotions, self-esteem, coping strategies, and fundamental needs threat among such high-risk drinkers (N = 86; AUDIT score higher than 15), and matched low-risk drinkers (N = 100, AUDIT score <8). Compared to low-risk drinkers, high-risk drinkers felt more dehumanized and reported increased fundamental needs threat, negative emotions, anxiety, depression, and more frequent use of both adaptive and maladaptive coping strategies, including alcohol use. Mediation analyses controlling for anxiety/depression revealed that the differences in emotions and coping strategies were explained by metadehumanization and fundamental needs threat. Despite not being diagnosed with SAUD and being untreated, high-risk drinkers are more similar to patients with SAUD than to low-risk drinkers. In view of its links with factors favoring SAUD, metadehumanization should be considered in experimental studies among high-risk drinkers and treated by specific interventions.

Exploring Attentional Bias toward Alcohol Content: Insights from Eye-Movement Activity

INTRODUCTION

Attentional bias (AB) is an implicit selective attention toward processing disorder-significant information while neglecting other environmental cues. Considerable empirical evidence highlights the clinical implication of AB in the onset and maintenance of substance use disorder. An innovative method to explore direct measures of AB relies on the eye-movement activity using technologies like eye-tracking (ET). Despite the growing interest regarding the clinical relevance of AB in the spectrum of alcohol consumption, more research is needed to fully determine the AB patterns and its transfer from experimental to clinical applications. The current study consisted of three consecutive experiments. The first experiment aimed to design an ad-hoc visual attention task (VAT) consisting of alcohol-related and neutral images using a nonclinical sample (n = 15). The objective of the second and third experiments was to analyze whether the effect of type of image (alcohol-related vs. neutral images) on AB toward alcohol content using the VAT developed in the first experiment was different for type of drinker (light vs. heavy drinker in the second experiment [n = 30], and occasional social drinkers versus alcohol use disorder (AUD) patients in the third experiment [n = 48]).

METHODS

Areas of interest (AOIs) within each type of image (neutral and alcohol-related) were designed and raw ET-based data were subsequently extracted through specific software analyses. For experiment 1, attention maps were created and processed for each image. For experiments 2 and 3, data on ET variables were gathered and subsequently analyzed through a two-way ANOVA with the aim of examining the effects of the type of image and drinker on eye-movement activity.

RESULTS

There was a statistically significant interaction effect between type of image and type of drinker (light vs. heavy drinker in experiment 2, F(1, 56) = 13.578, p < 0.001, partial η2 = 0.195, and occasional social drinker versus AUD patients in the experiment 3, F(1, 92) = 35.806, p < 0.001, partial η2 = 0.280) for "first fixation" with large effect sizes, but not for "number of fixations" and "dwell time." The simple main effect of type of image on mean "first fixation" score for AUD patients was not statistically significant.

CONCLUSION

The data derived from the experiments indicated the importance of AB in sub-clinical populations: heavy drinkers displayed an implicit preference for alcohol-related images compared to light drinkers. Nevertheless, AB fluctuations in patients with AUD compared to the control group were found. AUD patients displayed an early interest in alcohol images, followed by an avoidance attentional processing of alcohol-related images. The results are discussed in light of recent literature in the field.

Effect of body-related information on food attentional bias in women with body weight dissatisfaction

Women with body weight dissatisfaction (BWD) have long-term negative assessments of their body weight, which are often associated with poor eating behavior. In this study, we investigated the effect of body-related information on the food cue processing and attention of women with BWD. Sixty-eight women were recruited and assigned to either a BWD (NPSS-F > 2) (n = 32) or a no body weight dissatisfaction (NBWD) group (NPSS-F < 1) (n = 36). We measured attentional bias to food cues (high- and low-calorie) with a food probe task after exposure to body-related information and recorded eye tracking data. Body-related images were presented prior to a pair of stimulus images (food-neutral or neutral-neutral). Body-related information and food type were repeated measure factors in our study. Our results showed that the first fixation duration bias for high-calorie foods was significantly longer than for low-calorie foods after exposure to overweight cues in the BWD group. Compared with the NBWD group, the BWD group showed longer first fixation duration bias for high-calorie foods after exposure to overweight cues. The direction for high-calorie foods was significantly more often than that for low-calorie foods in the BWD group after exposure to body-related information. Our findings suggest that compared to women with NBWD, women with BWD may be more susceptible to body-related information, resulting in increased attention to high-calorie foods.

Blunted neural reward response to alcohol and greater alcohol motivation in binge drinkers in a randomized clinical experiment

BACKGROUND

Alcohol stimulates cerebral blood flow (CBF) in brain reward regions. However, neural processes that support sustained alcohol motivation after the first drink are not well understood.

METHODS

Using a novel placebo-controlled, randomized, crossover experiment, 27 individuals who binge drink (BD; 15 M, 12 F) and 25 social drinkers (SD; 15 M, 10 F) underwent a behavioral test of self-motivated alcohol consumption using an Alcohol Taste Test (ATT) involving alcoholic and nonalcoholic beer on separate days. The test was followed immediately by perfusion functional magnetic resonance imaging (fMRI). On both days, participants then engaged in a post-scan ATT with placebo beer to assess sustained alcohol self-motivation without active alcohol effects. Linear mixed effects models were used to examine the effects of drinking group on the placebo-controlled effect of initial alcohol motivation on brain perfusion (whole brain corrected p < 0.001, cluster corrected p < 0.025) and on the relationship between placebo-controlled brain perfusion and sustained alcohol motivation.

RESULTS

Initial alcohol self-motivation in the alcohol relative to placebo session led to markedly decreased activation in the medial orbitofrontal cortex (OFC) and the ventral striatum in BD relative to SD, indicative of neural reward tolerance. The BD group also showed an enhanced neural response in behavioral intention regions of the supplementary motor area (SMA) and inferior frontal gyrus (IFG) regions. Moreover, there was greater sustained alcohol motivation in BD than SD in the post-scan ATT in the alcohol relative to placebo session. Correspondingly, only in BD and only in the alcohol session, lower alcohol-induced OFC response correlated with concurrent sensitized SMA response, and each predicted the subsequent sustained higher alcohol motivation in the post-scan ATT.

CONCLUSIONS

Alcohol-related OFC tolerance may play an important role in sustained alcohol motivation. Furthermore, both specific alcohol-related neural reward tolerance and premotor sensitization responses may contribute to escalating alcohol motivation to drive excessive alcohol intake, even in individuals without alcohol use disorder.

Approach-Bias Retraining and Other Training Interventions as Add-On in the Treatment of AUD Patients

In the past two decades, a variety of cognitive training interventions have been developed to help people overcome their addictive behaviors. Conceptually, it is important to distinguish between programs in which reactions to addiction-relevant cues are trained (varieties of cognitive bias modification, CBM) and programs in which general abilities are trained such as working memory or mindfulness. CBM was first developed to study the hypothesized causal role in mental disorders: by directly manipulating the bias, it was investigated to what extent this influenced disorder-relevant behavior. In these proof-of-principle studies, the bias was temporarily modified in volunteers, either temporarily increased or decreased, with corresponding effects on behavior (e.g., beer consumption), in case the bias was successfully manipulated. In subsequent clinical randomized controlled trials (RCTs), training (away from the substance vs. sham training) was added to clinical treatment. These studies have demonstrated that CBM, as added to treatment, reduces relapse with a small effect of about 10% (similar effect size as for medication, with the strongest evidence for approach-bias modification). This has not been found for general ability training (e.g., working memory training), although effects on other psychological functions have been found (e.g., impulsivity). Mindfulness also has been found to help people overcome addictions, and different from CBM, also as stand-alone intervention. Research on (neuro-)cognitive mechanisms underlying approach-bias modification has pointed to a new perspective in which automatic inferences rather than associations are influenced by training, which has led to the development of a new variety of training: ABC training.

In people who drink more, facets of theory of mind may be impaired by alcohol stimuli

BACKGROUND

Theory of mind (ToM) - the ability to understand others' beliefs, mental states, and knowledge - is an important part of successful social interaction. There is a growing (albeit mixed) evidence base suggesting that individuals with substance use disorder or who are intoxicated (relative to sober controls) perform worse on a number of ToM tasks. The aim of this study was to explore the hitherto little explored notion that ToM-related capabilities such as the ability to see the world from another person's perspective (termed Visual Perspective Taking; VPT), may be impacted by alcohol-related stimuli.

METHOD

In this pre-registered study, 108 participants (M age = 25.75, SD age = 5.67) completed a revised version of the director task where they followed the instructions of an avatar to move both alcohol beverages and soft drinks that were mutually visible (target objects) while avoiding those only visible to the participant (distractor items).

RESULTS

Contrary to predictions, accuracy was lower when the target drink was alcohol and the distractor was a soft drink, although higher AUDIT scores were associated with significantly lower accuracy when alcohol drinks were the distractor items.

CONCLUSIONS

There may be some contexts when being able to see alcohol beverages makes it harder to take another person's perspective. It also appears that poorer VPT and perhaps ToM capacity may be evident in individuals who consume more alcohol. Future research is warranted to examine how alcohol beverages, alcohol consumption behaviours, and intoxication interact to impact VPT capacity.

Does alcohol automatically capture drinkers' attention? Exploration through an eye-tracking saccadic choice task

RATIONALE

Dominant theoretical models postulate the presence of an automatic attentional bias (AB) towards alcohol-related stimuli in alcohol use disorder, such AB constituting a core feature of this disorder. An early alcohol AB has been documented in subclinical populations such as binge drinking (i.e., a drinking pattern prevalent in youth and characterized by repeated alternation between alcohol intoxications and withdrawals, generating cerebral consequences). However, the automatic nature of AB remains to be established.

OBJECTIVES

We investigated the automatic nature of AB in binge drinkers through the saccadic choice task. This eye-tracking paradigm consistently highlights the extremely fast and involuntary saccadic responses elicited by faces in humans, relative to other object categories. Through an alcohol-related adaptation of the saccadic choice task, we tested whether the early and automatic capture of attentional resources elicited by faces can also be found for alcohol-related stimuli in binge drinkers, as predicted by theoretical models.

METHODS

Forty-three binge drinkers and 44 control participants performed two versions of the saccadic choice task. In the original version, two images (a face, a vehicle) were displayed on the left and right side of the screen respectively. Participants had to perform a saccade as fast as possible towards the target stimulus (either face or vehicle). In the alcohol-related version, the task was identical, but the images were an alcoholic beverage and a non-alcoholic stimulus.

RESULTS

We replicated the automatic attraction towards faces in both groups, as faces generated higher saccadic accuracy, speed, and amplitude than vehicles, as well as higher corrective saccade proportion. Concerning the alcohol-related adaptation of the task, groups did not differ for the accuracy, speed, and amplitude of the first saccade towards alcohol. However, binge drinkers differed from controls regarding the proportion of corrective saccade towards non-alcoholic stimuli after an error saccade towards alcohol, suggesting the presence of an alcohol disengagement bias specific to binge drinkers.

CONCLUSIONS

Alcohol-related AB in binge drinkers is not characterized by an early and automatic hijacking of attention towards alcohol. This AB rather relies on later and more controlled processing stages, namely a difficulty to disengage attentional resources from alcohol-related stimuli.

Differences in attentional bias to smoking-related, affective, and sensation-seeking cues between smokers and non-smokers: an eye-tracking study

RATIONALE

One of the behavioural features of tobacco use disorder is the presence of attentional bias (AB) to smoking-related stimuli. However, much of the research investigating these associations have been limited to the use of reaction-based indices.

OBJECTIVES

We aimed to investigate differences in AB to smoking, affective, and sensation-seeking cues in smokers and non-smokers using novel, free-viewing, eye-tracking technology. Secondary aims included investigating impulsivity-by-group interaction effects on AB to sensation-seeking cues.

METHODS

Participants were either otherwise-healthy smokers of at least 8 cigarettes per day or otherwise-healthy non-smokers (< 100 cigarettes in their lifetime and no smoking in the past year). AB was measured using a free-viewing, eye-tracking system. Participants were presented a series of slides divided into 3 themes: smoking, affective, and sensation-seeking. Each slide contained 4 images (1 theme-related, 1 neutral, 2 competitive). Primary outcome measure was the difference in the proportion of time spent viewing the theme-related cue to neutral cue. Impulsivity was measured using a monetary delayed discounting task.

RESULTS

The sample consisted of 50 smokers (41 ± 12 years old) and 50 age- and sex-matched non-smokers (40 ± 14 years old). Smokers spent over 2 times longer looking at smoking-related images than non-smokers (F = 25.50, p < 0.001). As well, greater impulsivity was significantly associated with increased AB to sensation-seeking cues (R² = 0.059, F = 2.98, p = 0.04) in smokers but not non-smokers. No differences were found on AB to affective cues.

CONCLUSION

The eye-tracking procedure is a sensitive tool for assessing AB in smokers compared to non-smokers to both smoking and sensation-seeking cues.

A Systematic Review of Eye-Tracking Studies of Gambling-Related Attentional Biases

Previous research has identified attentional biases towards addiction-related stimuli, including gambling-related stimuli. Eye-tracking is considered the gold standard methodology for measuring attentional biases, yet no review to date has examined its use in measuring gambling-related attentional biases. This systematic review synthesized the literature using eye-tracking to examine attentional biases among people who gamble. We reviewed articles from Web of Science and PubMed that were published from 1990 to 2021. A total of 11 articles were included, with sample sizes ranging from 38 to 173 participants. Of these studies, seven examined attentional biases for gambling-related visual stimuli. These seven studies provided support that gambling can result in the development of an attentional bias for gambling-related stimuli. With respect to correlates of gambling-related attentional biases, there were mixed results. Some studies identified significant positive associations between gambling-related attentional biases and psychosocial variables, such as problem gambling severity, gambling expectancies, gambling cravings, gambling motives, depressive symptom severity, alcohol use severity, daily stress, affective impulsivity, and immersion. Four studies examined attentional biases for responsible gambling messaging and advertisements, finding that both people who do and do not gamble attend less to responsible gambling messaging compared to other types of information such as the betting odds. Research using eye-tracking to examine attentional biases among people who gamble is in its infancy. Yet, the preliminary results support the identification of attentional biases using the gold-standard methodology. Further studies are needed to examine the correlates and potential clinical utility of assessing gambling-related attentional biases using eye-tracking.

Body mass index and attention bias of food cues in women: a mediation model of body weight dissatisfaction

Food attention bias could be used to indicate diet-related diseases in individuals with obesity. The purpose of this study is to explore the relationship between body mass index (BMI) and food attention bias, and the mediating role of body weight dissatisfaction (BWD) on this relationship in women. Seventy-five participants were recruited to complete a visual dot task with eye tracking. The results showed that BMI would positively predict response latency and duration bias on high-calorie foods; the relationship between BMI and response latency of high-calorie food was a complete mediation of BWD; the relationship between BMI and duration bias of high-calorie food was a complete mediation of BWD; and BWD positively predicts response latency and duration bias on high-calorie foods. These findings suggest a positive relationship between BMI and food attention bias, and the effect of a complete mediation of BWD in women.

Attentional bias in alcohol drinkers: A systematic review of its link with consumption variables

In severe alcohol use disorder (SAUD), attentional bias refers to the preferential allocation of attentional resources toward alcohol-related cues. Dominant models consider that this bias plays a key role in the emergence and maintenance of SAUD. We evaluate the available experimental support for this assumption through a systematic literature review, providing a critical synthesis of studies exploring the links between alcohol consumption and attentional bias. Using PRISMA guidelines, we explored three databases (PsycINFO, PubMed, Scopus) and extracted 95 papers. We assessed their methodological quality and categorized them based on the population targeted, namely patients with SAUD or subclinical populations with various drinking patterns. We also classified papers according to the measures used (i.e., behavioral or eye-tracking measures). Overall, subclinical populations present an alcohol-related bias, but many studies in SAUD did not find such bias, nor approach/avoidance patterns. Moreover, attentional bias fluctuates alongside motivational states rather than according to alcohol use severity, which questions its stability. We provide recommendations to develop further theoretical knowledge and overcome methodological shortcomings.

Inflammatory reactivity to the influenza vaccine is associated with changes in automatic social behavior

Recent evidence suggests differential patterns of social behavior following an inflammatory challenge, such that increases in inflammation may not uniformly lead to social withdrawal. Indeed, increases in inflammation have been associated with enhanced self-reported motivation to approach a specific close other, and greater neural sensitivity to positive social cues. However, no known studies have examined the association between inflammation in response to an inflammatory challenge and social behavior in humans, nor has past research examined specifically how approach and withdrawal behavior may differ based on whether the target is a close other or stranger. To address this, 31 participants (ages 18-24) received the influenza vaccine to elicit a low-grade inflammatory response. The morning before and approximately 24 h after the vaccine, participants provided a blood sample and completed a computer task assessing automatic (implicit) approach and withdrawal behavior toward a social support figure and strangers. Greater increases in the inflammatory cytokine interleukin-6 (IL-6) in response to the vaccine were associated with an increase in accuracy in avoiding strangers and a decrease in accuracy in approaching them. Increases in IL-6 were also associated with a decrease in reaction time to approach a support figure, but only when controlling for baseline IL-6 levels. There were no associations between change in IL-6 and changes in self-reported motivation to engage in social behavior with either close others, or strangers. Together, these findings reveal that increases in inflammation following the influenza vaccine are associated with automatic social behavior, especially behavior suggesting avoidance of unfamiliar social targets and ease in approaching a support figure. These data add to the growing literature suggesting that the association between inflammation and social behavior includes both social withdrawal and social approach, depending on the specific target.

When Alcohol Adverts Catch the Eye: A Psychometrically Reliable Dual-Probe Measure of Attentional Bias

Existing tasks assessing substance-related attentional biases are characterized by low internal consistency and test–retest reliability. This study aimed to assess the psychometric properties of a novel dual-probe task to measure alcohol-related attentional bias. Undergraduate students were recruited in June 2019 (N = 63; final N = 57; mean age = 20.88, SD = 2.63, 67% females). In the dual-probe task, participants were presented with simultaneous visual streams of adverts promoting either alcoholic or non-alcoholic drinks, and probes were presented in both streams. The dual-probe task measured the percentage of accurately identified probes that appeared on alcohol adverts in relation to total accuracy. The dual-probe task displayed excellent split-half reliability (M = 0.90, SD = 0.11; α = 0.90; 95% CI [0.84, 0.93]), and the derived attentional bias measure was significantly positively associated with beer drinking in a taste-test (r (57) = 0.33, p = 0.013; 95% CI [0.07, 0.54]), with habitual drinking (r (57) = 0.27, p = 0.045; 95% CI [0.01, 0.49]), and with increased craving (r (57) = 0.29, p = 0.031; 95% CI [0.03, 0.51]). Thus, the dual-probe task assessed attentional bias with excellent internal consistency and was associated with laboratory and habitual drinking measures, demonstrating initial support for the task’s utility in addiction research.

Augmented tendency to act and altered impulse control in alcohol use disorders

Action preparation relies on the operation of control processes that modulate the excitability of the corticospinal tract. On the one hand, excitatory processes prepare the motor system for the forthcoming response; the stronger these influences, the stronger the tendency to act. On the other hand, inhibitory influences allow to suppress inappropriate actions and, more generally, to ensure some sort of impulse control. Because an impairment in these processes could foster inappropriate drinking behavior, the present study aimed at evaluating the motor correlates of such excitatory and inhibitory influences in non-treatment seeking heavy drinkers (HDs) and inpatients suffering from severe alcohol use disorder (SAUDs). Besides, as cue-elicited craving might further alter these processes, we also assessed the impact of an alcohol-related exposure. To do so, 15 healthy controls (HCs), 15 HDs and 15 SAUDs performed a choice reaction time task after having been immersed in a neutral or an alcohol-related environment, using virtual reality videos. Importantly, single-pulse transcranial magnetic stimulation was applied over the left and the right primary motor cortex during the task to elicit motor-evoked potentials in a set of hand muscles allowing us to specifically probe the impact of excitatory and inhibitory processes on motor activity. Our data indicate that excitatory influences are particularly high in both HDs and SAUDs, especially in the dominant hand, an effect that was not observed in HCs. By contrast, inhibitory influences were found to be perfectly normal in HDs, while they were lacking in SAUDs. Furthermore, the alcohol-related exposure enhanced the level of self-reported craving, but this effect only arose in HDs and did not significantly alter the strength of excitatory and inhibitory influences. Overall, although these results have to be taken with caution due to the small sample sizes, this study suggests that enhanced excitatory processes characterize both HDs and SAUDs, while weaker inhibitory influences only concern SAUDs. Hence, an abnormally strong tendency to act could represent a common feature of hazardous drinking, leading individuals to excessive alcohol consumption, whereas deficient impulse control would be a hallmark of more severe forms of AUD, potentially due to the chronic neurotoxic effects of alcohol. Finally, although an alcohol-related exposure does not seem to affect excitatory and inhibitory processes at play during action preparation per se, future works should evaluate changes in corticospinal excitability during the preparation of responses specifically targeting alcohol-related cues.

Relationships between Attentional Bias and craving in Alcohol Use Disorder: Role of metacognitions

Researchers have claimed that craving and Attentional Bias (AB) towards alcohol-related cues can be explained by a common incentive-salience mechanism. However, the exact relationship between AB and craving is a matter of debate. The aim of this study was to show that metacognitions moderate the effect of AB on craving. A sample of 38 alcohol abusers undergoing post-withdrawal treating in a hospital setting completed the visual Dot Probe Detection Task (DPDT), while both pre- and post-task measures of craving were recorded. Our results confirmed significant effects of both exposure to pictures of alcohol, and metacognitions, on craving; in particular, the interaction Metacognition * DPDT was significant. Although we initially confirmed a significant main effect of AB on craving, it became non-significant when adjusted for inter-subject variance, and metacognitions. The effect of the interaction AB * Metacognition on craving was not significant. Our findings support the hypothesis that craving and AB share variance, but the relationship appears to be spurious, and caused by confounding factors. We discuss these results with reference to the metacognitive model of addiction.

Initial orientation vs maintenance of attention: Relationship with the severity of dependence and therapeutic outcome in a sample of cocaine use disorder patients

The visual probe paradigm allows for evaluating attentional bias (AB), distinguishing between approach vs avoidance patterns of attention and assessing two different processes when the exposure time to images is manipulated: initial orienting and maintenance of attention. The present study aimed to analyze the predictive capacity of these two processes for substance use disorder severity and therapeutic outcomes of patients with cocaine use disorder in treatment. The sample consisted of 70 outpatients who were starting treatment at a public service. AB was evaluated using a task based on the visual probe (VP) paradigm with images presented under two conditions: 200 ms vs 1000 ms. Cocaine and alcohol use disorder severity, craving, retention in treatment and relapse in consumption were recorded. Cocaine AB in the 1000 ms condition was negatively correlated with the cocaine use disorder severity (r = -0.26), whilst a positive correlation was found between cocaine craving and cocaine AB (r = 0.29). Alcohol use disorder severity negatively correlated with cocaine AB in the 200 ms condition (r = -0.24). Logistic regression analysis revealed that, after controlling for gender, age, and substance use disorder severity, cocaine AB in the 200 ms condition predicted dropout and relapse. Our results suggest that patients who adhere to treatment and remain abstinent tend to show avoidance in the 200 ms condition, with effect sizes of r = 0.29 and 0.30 respectively. The results suggest that training in avoidance strategies could be a valuable way of maintaining adherence and abstinence, as well as improving control of craving.

Event-related brain response to visual cues in individuals with Internet gaming disorder: relevance to attentional bias and decision-making

This study investigated attentional bias toward game-related cues in Internet gaming disorder (IGD) using electrophysiological markers of late positive potential (LPP) and identifying the sources of LPP. In addition, the association between LPP and decision-making ability was investigated. The IGD (n = 40) and healthy control (HC; n = 39) participants viewed a series of game-related and neutral pictures, while their event-related potentials (ERPs) were recorded. LPPs were calculated as the mean amplitudes between 400 and 700 ms at the centro-parietal (CP3, CP1, Cpz, CP2, and CP4) and parietal (P3, P1, Pz, P2, and P4) electrode sites. The source activations of LPP were estimated using standardized low-resolution brain electromagnetic tomography (sLORETA). In addition, decision-making ability was evaluated by the Cambridge Gambling Task. Higher LPP amplitudes were found for game-related cues in the IGD group than in the HC group. sLORETA showed that the IGD group was more active in the superior and middle temporal gyri, which are involved in social perception, than in the HC group, whereas it was less active in the frontal area. Individuals with IGD have deficits in decision-making ability. In addition, in the HC group, the lower the LPP when looking at the game-related stimuli, the better the quality of decision-making, but not in the IGD group. Enhanced LPP amplitudes are associated with emotional arousal to gaming cues and decision-making deficits in IGD. In addition, source activities suggest that patients with IGD perceive game-related cues as social stimuli. LPP can be used as a neurophysiological marker of IGD.

Vicarious racial discrimination, racial identity, and alcohol-related outcomes among Black young adults: An experimental approach

Objective: Racial discrimination is a known risk factor for alcohol-related outcomes among young Black American adults. However, vicarious racial discrimination's associations with alcohol-related outcomes and the role of racial identity in these associations remain unknown. This within-subject experiment study tested whether associations of vicarious racial discrimination with alcohol craving and attentional bias differed by three components of racial identity (centrality, private regard, and public regard). Method: Black young adult, at-risk drinkers (N = 51; Mage = 21 [SD = 3.02]; 60% female) completed two vicarious racial discrimination conditions (manipulated by video) followed by alcohol craving and attentional bias tasks. Results: Associations of vicarious discrimination with alcohol craving were exacerbated by high centrality and buffered by high private regard, but did not differ by public regard. No associations of vicarious discrimination with alcohol attention bias were found. Conclusion: Findings highlight the important role of Black racial identity in within-group differences in the impact of vicarious racial discrimination on select implicit indicators of alcohol risk among Black young adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effects of Acute Alcohol Consumption on Food Intake and Pictorial Stroop Response to High-Calorie Food Cues

AIMS

We examined (a) the effect of an acute dose of alcohol on the consumption of energy-dense food and (b) on cognitive bias towards high-energy-dense food cues and (3) whether the effect of an acute dose of alcohol on the consumption of energy-dense food would be mediated by cognitive bias towards high-energy-dense food cues.

METHODS

Heavy social drinkers (n = 40) abstained from drinking for 12 hours before testing. On the test day, participants completed pre-challenge measures of alcohol and food craving, and cognitive bias towards alcohol in a placebo-controlled, double-blind design. Participants performed post-challenge measures of alcohol and food craving, ad lib energy-dense food consumption and cognitive bias.

RESULTS

We did not observe any of the hypothesized interactions between challenge condition, consumption of energy-dense food and cognitive bias towards high-energy-dense food cues.

CONCLUSIONS

Our data suggest that acute alcohol consumption does not influence the consumption of energy-dense food or cognitive bias towards high-energy-dense food cues. These findings may reflect that alcohol does not increase the appetitive value of food and food-related cues or that the measures used in this study were not sensitive to detect an effect. Further research is required to determine whether alcohol at higher doses and/or food cues that are frequently paired with alcohol intake stimulates changes in food intake and the reward value of food cues.

The Effects of Alcohol Hangover on Response Inhibition and Attentional Bias towards Alcohol-Related Stimuli

Alcohol hangover is associated with the development of alcohol use disorders, yet few studies have examined the influence of hangover on cognitive processes that may contribute towards future alcohol consumption such as response inhibition and attentional bias towards alcohol-related stimuli. Therefore, the current study aimed to explore the effects of hangover on these processes. In total, 37 adult drinkers who reported regularly engaging in heavy episodic drinking and experiencing a hangover at least once in the previous month took part in this within-subjects, "naturalistic" crossover study. Participants completed Go/No-Go (assessing response inhibition) and Visual Dot Probe (attentional bias) tasks in a hangover condition (morning following alcohol consumption) and a no-hangover condition (no alcohol consumption for at least 24 h). Participants also completed measures of hangover severity, mood, and perceived mental effort. Results indicated impaired response inhibition during hangover compared to the no-hangover condition (p < 0.001, d = 0.89), but no difference in attentional bias scores between conditions. Participants reported expending greater mental effort to complete tasks (p < 0.001, d = 1.65), decreased alertness (p < 0.001, d = 3.19), and reduced feelings of tranquillity (p < 0.001, d = 1.49) in the hangover versus no-hangover condition. Together, these findings suggest that alcohol hangover is associated with impaired response inhibition and lower mood. However, problems with recording eye-tracking data on the Visual Dot Probe task used in the present study may limit the reliability of our attentional bias findings.

Meta-analysis of grey matter changes and their behavioral characterization in patients with alcohol use disorder

Alcohol Use Disorder (AUD) is associated with reductions in grey matter (GM) volume which can lead to changes in numerous brain functions. The results of previous studies on altered GM in AUD differ considerably in the regions identified. Three meta-analyses carried out between 2014 and 2017 yielded different results. The present study includes the considerable amount of newer research and delivers a state-of-the art meta-analysis in line with recently published guidelines. Additionally, we behaviorally characterized affected regions using fMRI metadata and identified related brain networks by determining their meta-analytic connectivity patterns. Twenty-seven studies with 1,045 AUD patients and 1,054 healthy controls were included in the analysis and analyzed by means of Anatomical Likelihood Estimation (ALE). GM alterations were identified in eight clusters covering different parts of the cingulate and medial frontal gyri, paracentral lobes, left post- and precentral gyri, left anterior and right posterior insulae and left superior frontal gyrus. The behavioral characterization associated these regions with specific cognitive, emotional, somatosensory and motor functions. Moreover, the clusters represent nodes within behaviorally relevant brain networks. Our results suggest that GM reduction in AUD could disrupt network communication responsible for the neurocognitive impairments associated with high chronic alcohol consumption.

Alcohol attention bias in 14-16 year old adolescents: an eye tracking study

RATIONALE

Theoretical models regarding the automaticity of attentional processes highlight a progression of attentional bias style from controlled to automatic in drinking populations as alcohol use progresses. Previous research has focused on older adolescent and adult drinking populations at later stages in their drinking career.

OBJECTIVES

The aim of this study was to investigate alcohol attention bias in 14-16-year-old adolescent social drinkers and abstainers.

METHODS

Alcohol attention bias was measured in social drinking and abstaining groups in an eye-tracking paradigm. Questionnaires measured alcohol use, expectancies, exposure and socially desirable response styles.

RESULTS

Social drinkers fixated to alcohol stimuli more frequently and spent a larger proportion of their fixation time attending to alcohol stimuli compared to non-drinkers. Groups displayed differences in their style of attentional processing of alcohol-related information, with heavy drinkers fixating significantly longer to alcohol information across alcohol stimulus presentation and exhibiting a delayed disengagement style of alcohol attention bias that differentiated them from light drinking and abstaining peers. All social drinkers fixated significantly more than abstainers in the latter half of alcohol stimulus presentation.

CONCLUSION

Alcohol attention bias was present in this adolescent sample. Drinking subgroups are defined from abstaining peers by unique features of their attentional bias that are controlled in nature. These findings are comparable to those in other adolescent and adult social drinking populations. The identification of specific attentional bias features according to drinking subpopulations has implications for our theoretical understanding of developing alcohol attention bias and problematic drinking behaviours, as well as at-risk identification and early intervention.

Attentional Bias to High-Calorie Food in Binge Eaters With High Shape/Weight Concern

Individuals with high shape/weight concern (SWC) place disproportionate emphasis on shape and weight in evaluating their self-worth, making them more vulnerable to body-related cues. Binge eaters (BE), who are obsessed with devouring high-calorie foods, would show severe symptomatology, especially when they have clinically high SWC. The present study attempted to elucidate how SWC influences binging based on attentional patterns toward high-calorie food cues. A total of 120 participants were selected and divided into four groups: (1) BE with high SWC, (2) BE with low SWC, (3) healthy controls (HC) with high SWC, and (4) HC with low SWC. BE and SWC status were respectively determined using the Eating Disorder Diagnostic Scale (DSM-5) and the Eating Disorder Examination Questionnaire. All participants completed the same free-viewing task, measuring initial fixation latency and total fixation duration. BE with high SWC showed attentional bias toward high-calorie food cues in terms of significantly faster initial fixation latency and longer total fixation duration, whereas BE with low SWC and the HC groups did not show any differences. The results revealed that SWC level makes unique contributions to BE's initial orienting bias toward and difficulty disengaging from high-calorie food cues. This may indicate that BE with high SWC merely worry about eating high-calorie food in a cognitive way, but not controlling actual binging behavior. The current study of attentional bias elucidated the role of SWC as a potential maintenance factor of being concerned and binging in BE.

Eye tracking of smoking-related stimuli in tobacco use disorder: A proof-of-concept study combining attention bias modification with alpha-transcranial alternating current stimulation

BACKGROUND

Tobacco use disorder (TUD) is characterized by the presence of an attentional bias (AB) towards smoking-related stimuli. We investigated whether combining an AB modification paradigm (ABM) with transcranial alternating current stimulation (tACS) applied over the dorsolateral prefrontal cortex (DLPFC) reduces the AB towards smoking-related stimuli, as well as craving level and impulsive choices.

METHODS

In a sham-controlled, crossover preliminary study, 19 subjects with TUD received two stimulation arms: 1) active tACS (10 Hz, 2 mA, 30 min) combined with ABM and 2) sham tACS combined with ABM, in a randomized order, separated by one week. AB towards smoking cues during passive observation of smoking and neutral cues was assessed with an eye-tracking device and reactions times at a visual-probe task. Craving level was measured with the Questionnaire of Smoking Urges. Impulsive choices were assessed with the delay discounting task.

RESULTS

Active tACS combined with ABM reduced the amount of time spent looking at smoking-related pictures (p = 0.03), prevented the increase of self-reported desire to smoke (p = 0.026), and reduced the proportion of impulsive choices (p = 0.049), compared to sham tACS combined with ABM. No significant effects were reported on other craving dimensions and on AB based on reaction times.

CONCLUSIONS

These preliminary findings suggest that combining tACS with ABM may help smokers who wish to quit by reducing the desire to smoke, attention to smoking-cues, and impulsive decision-making.

Where's the wine? Heavy social drinkers show attentional bias towards alcohol in a visual conjunction search task

BACKGROUND AND AIMS

Research indicates that high consumers of alcohol exhibit attentional bias (AB) towards alcohol-related cues, suggestive of a cognitive mechanism that might drive substance seeking. Many tasks that measure AB (e.g. visual probe, addiction Stroop), however, are limited by their reliance on non-appetitive control cues, the serial presentation of stimuli and their poor internal reliability. The current study employed a visual conjunction search (VCS) task capable of presenting multiple alcoholic and non-alcoholic appetitive cues simultaneously to assess whether social drinkers attend selectively to alcoholic stimuli. To assess the construct validity of this task, we examined whether alcohol consumption and related problems, subjective craving and drinking motives predict alcohol-specific AB.

DESIGN AND SETTING

A VCS task was performed in a laboratory setting, which required participants to detect the presence of appetitive alcoholic (wine, beer) and non-alcoholic (cola, lemonade) targets within arrays of matching and non-matching distractors.

PARTICIPANTS

Data from 99 participants were assessed [mean_age  = 20.77, standard deviation (SD) = 2.98; 64 (65%) females], with 81.8% meeting the threshold for harmful alcohol consumption (mean_AUDIT  = 12.89, SD = 5.79).

MEASUREMENTS

Self-reports of alcohol consumption and related problems [Alcohol Use Disorders Identification Test (AUDIT)], subjective craving (Alcohol Craving Questionnaire Short Form) and drinking motives (Drinking Motives Questionnaire Short Form) were obtained, and the VCS task measured response times for the correct detection of alcoholic and non-alcoholic targets.

FINDINGS

Participants were significantly quicker to detect alcoholic relative to non-alcoholic appetitive targets (P < 0.001, d_z  = 0.41), which was predicted positively by AUDIT scores (P = 0.013, R²  = 0.06%). The VCS task achieved excellent reliability (α > 0.79), superior to other paradigms.

CONCLUSIONS

The visual conjunction search task appears to be a highly reliable method for assessing alcohol-related attentional bias, and shows that heavy social drinkers prioritize alcoholic cues in their immediate environment.

Behavioral, neurobiological, and neurochemical mechanisms of ethanol self-administration: A translational review

Alcohol use disorder has multiple characteristics including excessive ethanol consumption, impaired control over drinking behaviors, craving and withdrawal symptoms, compulsive seeking behaviors, and is considered a chronic condition. Relapse is common. Determining the neurobiological targets of ethanol and the adaptations induced by chronic ethanol exposure is critical to understanding the clinical manifestation of alcohol use disorders, the mechanisms underlying the various features of the disorder, and for informing medication development. In the present review, we discuss ethanol's interactions with a variety of neurotransmitter systems, summarizing findings from preclinical and translational studies to highlight recent progress in the field. We then describe animal models of ethanol self-administration, emphasizing the value, limitations, and validity of commonly used models. Lastly, we summarize the behavioral changes induced by chronic ethanol self-administration, with an emphasis on cue-elicited behavior, the role of ethanol-related memories, and the emergence of habitual ethanol seeking behavior.

Craving is everything: An eye-tracking exploration of attentional bias in binge drinking

BACKGROUND

Attentional bias towards alcohol-related stimuli is a core characteristic of severe alcohol use disorders (AUD), directly linked to clinical variables (e.g. alcohol consumption, relapse). Nevertheless, the extent of this bias in subclinical populations remains poorly documented. This is particularly true for binge drinking, an alcohol consumption pattern highly prevalent in youth, characterised by an alternation between excessive intakes and withdrawal periods.

AIMS

We used eye-tracking to: (a) measure attentional bias in binge drinking, (b) determine its time course by dissociating early/late processing stages, (c) clarify its specificity for alcohol-related stimuli compared to other appetitive stimulations and (d) explore its modulation by current craving intensity.

METHODS

Binge drinkers (n=42) and matched controls (n=43) performed a visual probe task, requiring visual targets preceded by pairs of pictures to be processed, with three conditions (i.e. alcohol vs. soft drink, alcohol vs. high-calorie food, high-calorie food vs. low-calorie food).

RESULTS

No group difference was observed for early processing (i.e. first area of interest visited). Dwell times highlighted a bias towards soft drinks and healthy food among controls, without any global bias towards alcohol in binge drinkers. Centrally, a comparison of binge drinkers with low versus high current craving intensity indicated that binge drinking was associated with a bias towards alcohol and high-calorie food only in the presence of a high craving towards these stimuli.

CONCLUSION

Attentional bias towards alcohol reported in severe AUD is only found in binge drinkers in the presence of high craving and is generalised to other appetitive cues.

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

RATIONALE

Cue avoidance training (CAT) reduces alcohol consumption in the laboratory. However, the neural mechanisms that underlie the effects of this intervention are poorly understood.

OBJECTIVES

The present study investigated the effects of a single session of CAT on event-related and readiness potentials during preparation of approach and avoidance movements to alcohol cues.

METHODS

Heavy drinking young adults (N = 60) were randomly assigned to complete either CAT or control training. After training, we recorded participants' event-related and motor readiness potentials as they were preparing to respond.

RESULTS

In the CAT group, N200 amplitude was higher when preparing to approach rather than avoid alcohol pictures. In the control group, N200 amplitudes did not differ for approach and avoidance to alcohol pictures. Regarding the late positive potential (LPP), in the CAT group, the negativity of this was blunted when preparing to avoid alcohol pictures relative to when preparing to avoid control pictures. In the control group, the negativity of the LPP was blunted when preparing to approach alcohol pictures relative to when preparing to approach control pictures. There were no effects on motor readiness potentials. Behavioural effects indicated short-lived effects of training on reaction times during the training block that did not persist when participants were given time to prepare their motor response before executing it during the EEG testing block.

CONCLUSIONS

After a single session of CAT, the enhanced N200 when approaching alcohol cues may indicate the engagement of executive control to overcome the associations learned during training. These findings clarify the neural mechanisms that may underlie the effects of CAT on drinking behaviour.

Predictive cues and spatial attentional bias for alcohol: Manipulations of cue-outcome mapping

Previous studies suggest that cues predicting the outcome of attentional shifts provide a measure of anticipatory alcohol-related attentional bias that is correlated with risky drinking and has high reliability. However, this is complicated by potential contributions of visual features of cues to reliability, unrelated to their predictive value. Further, little is known of the sensitivity of the bias to variations in cue-outcome mapping manipulations, limiting our theoretical and methodological knowledge: Does the bias robustly follow varying cue-outcome mappings, or are there automatic cue-related associative processes involved? The current studies aimed to address these issues. Participants performed variations of the cued Visual Probe Task (cVPT) in which cues were non-predictive; in which there were multiple cue pairs, used simultaneously and serially; and in which the cue-outcome mapping was reversed. The major findings were, first, that previously found reliability cannot be attributed to aspects of the cues not related to outcome-prediction; second, that reliability of the bias does not survive deviations from a simple, consistent cue-outcome mapping; third, that all predictive versions of the task showed a bias towards alcohol; fourth, that the bias did not simply follow awareness of the cue-outcome mapping; and finally, that only in the case of simultaneous multiple cue pairs, an association with risky drinking was replicated. The results provide support for the reliability of the anticipatory attentional bias for alcohol, suggest that relatively persistent associative processes underlie the bias in the alcohol context, and provide a foundation for future work using the cVPT.

Evidence for incentive salience sensitization as a pathway to alcohol use disorder

The incentive salience sensitization (ISS) theory of addiction holds that addictive behavior stems from the ability of drugs to progressively sensitize the brain circuitry that mediates attribution of incentive salience (IS) to reward-predictive cues and its behavioral manifestations. In this article, we establish the plausibility of ISS as an etiological pathway to alcohol use disorder (AUD). We provide a comprehensive and critical review of evidence for: (1) the ability of alcohol to sensitize the brain circuitry of IS attribution and expression; and (2) attribution of IS to alcohol-predictive cues and its sensitization in humans and non-human animals. We point out gaps in the literature and how these might be addressed. We also highlight how individuals with different alcohol subjective response phenotypes may differ in susceptibility to ISS as a pathway to AUD. Finally, we discuss important implications of this neuropsychological mechanism in AUD for psychological and pharmacological interventions attempting to attenuate alcohol craving and cue reactivity.

Alcohol usage predicts holistic perception: A novel method for exploring addiction

Holistic perception is a special form of automatic and experience dependent processing that prioritises objects of interest through the visual system. We therefore speculated that higher levels of alcohol consumption may be associated with enhanced holistic perception for alcohol cues. In our first experiment, we confirmed this hypothesis by showing that increasing regular alcohol usage was associated with greater holistic perception of alcohol, but not non-alcohol, cues. We replicated this finding in a second experiment, but confirmed drink-specific holistic perception for lager cues was not predicted by experience with that drink, but general alcohol usage. In our final experiment when alcohol images were absent from the task, higher levels of alcohol consumption predicted decreased holistic perception for non-rewarding cues. Alcohol use is therefore linked to inverse alterations in holistic perception for alcohol versus non-alcohol cues, with the latter's effects context dependent. We hypothesise that such inverse relationships may be due to limited cortical resources becoming reutilised for alcohol cues at the expense of other stimuli. Future work will be required to determine holistic perception's role in maintaining addiction, its predictive value in successful abstinence, and its relationship with characteristics of addiction such as cue reactivity, attentional biases and personality traits.

Co-designing a Mobile Gamified Attention Bias Modification Intervention for Substance Use Disorders: Participatory Research Study

Background

Advances in experimental psychology have highlighted the need to modify underlying automatic cognitive biases, such as attentional biases. The effectiveness of bias modification has been well studied for substance use disorders. With recent advances in technology, it is now possible to work outside the laboratory with Web-based and mobile-based attention bias interventions. Gamification technologies might also help diminish the repetitiveness of the task and increase the intrinsic motivation to train. The inconsistent findings of the impact of gaming on the effectiveness of mobile interventions call for further work to better understand the needs of patients (users) and health care professionals.

Objective

The aim of this study was to involve patients, together with health care professionals, in the design of a gamified mobile attention bias modification intervention for substance use disorders.

Methods

The participatory design research method adopted is that of a user-oriented design approach in the form of a future workshop. In the first phase of the workshop, participants shared their critique of an attention bias modification intervention. In the second phase of the workshop, participants were asked to brainstorm features. Participants were also shown gamification approaches and asked to consider if gaming elements could enhance the existing app. In the last phase, participants were asked to sketch a new prototype.

Results

Three co-design workshops were conducted with health care professionals, inpatients, and outpatients. There were 20 participants, consisting of 10 health care professionals and 10 patients. When asked to identify the limitations in the existing app, common issues identified were those of the design, visual probe task, and the included images. Outpatients were also concerned with the safety of administration of the intervention. In the brainstorming sessions, health care professionals made recommendations as to how the stimulus, the mechanism of responding, and the presentation of the scores could be enhanced. Inpatient participants recommended the addition of functionalities, such as information on the harms associated with the substance use, and for there to be enhancements in the design, images, and task. Outpatient participants perceived a need to improve the images and presentation of the results and recommended the inclusion of gaming features. There were differences in opinion on the inclusion of gaming features, as only health care professionals endorsed their inclusion. In the last phase of the workshop, participants were tasked with the conceptualization of prototypes, and the commonality in the design was for a gradual shortening of the interval for stimulus/image presentation.

Conclusions

The results from this research will guide the development of an app that meets the specific needs of patients and is still based on a pre-existing validated task paradigm.  

Conflicting rewards: effects of task goals on attention for alcohol cues

Research has shown that temporary task goals capture more attention than negative, threatening cues, even in anxious individuals. In the current study, we investigated whether temporary task goals would also capture more attention than alcohol-related cues. In Experiment 1, 59 hazardous drinkers performed both a modified dot-probe and a flanker task in which temporary goal- and alcohol-relevant stimuli were presented together. Results of the dot-probe task confirmed an attentional bias towards goal-relevant stimuli in the presence of alcohol cues. This effect was absent in a modified flanker task, although there was a general slowing when the targets appeared on top of goal-relevant stimuli, suggesting that goal-related backgrounds captured more attention than alcohol backgrounds. In Experiment 2, we replicated the dot-probe procedure in 29 hazardous drinkers who had been exposed to a prime dose of alcohol prior to performing the task. Our findings indicate that temporary goal stimuli are more salient than alcohol cues, which might lead the way to novel clinical applications.

Same, same but different: Attention bias for food cues in adults and adolescents with anorexia nervosa

OBJECTIVE

Attention processing for food may be biased in people with Anorexia Nervosa (AN). However, previous studies have had inconsistent results. This is likely to be due to indirect assessment of attention, which does not inform on the underlying attention processes, and/or the heterogeneity of participants across studies, testing either adults or adolescents with AN, that is, people at very different developmental and illness stages.

METHOD

Eye-tracking was employed as a direct assessment of attention during a visual probe task with food versus non-food pictures. Attention bias for food was measured in 39 adults and 34 adolescents with AN and in 53 adults and 31 adolescents without AN.

RESULTS

All participants had a direction bias for food, specifically for high-calorie food. However, adults with AN subsequently avoided maintaining attention on food versus non-food cues, compared to adults without AN. Adolescents with or without AN demonstrated increased attention maintenance on food versus non-food cues, and, contrary to our hypothesis, did not differ in their attention bias for food cues. Accordingly, adults with AN differed significantly from adolescents with AN in attention maintenance for food cues: while adolescents with AN showed significantly increased attention maintenance on food stimuli, adults avoided maintaining attention on food cues.

DISCUSSION

Adults with AN may apply attention strategies to facilitate restrictive eating. This strategy is absent in adolescents with AN. This difference in food-related attention bias between adolescents and adults with AN suggests that attention biases develop over time as the illness progresses.

Preliminary support for the role of alcohol cues in food cravings and attentional biases

This study examined whether alcohol odors, in isolation or when combined with pictures, would influence food attentional biases and cravings. Participants' cravings and attentional biases to food and alcohol pictures were assessed after exposure to alcohol or water odors ( n = 77; mean age = 30.84 years, 51.9% female, 83.1% Caucasian). Food attentional biases were increased by alcohol odors, but food cravings were increased only by a combination of alcohol odors and food pictures. These effects were related with self-reported problematic food consumption. These findings support a research program for further examining the effect of alcohol cues on problematic food consumption.

Pupillary reactivity to alcohol cues as a predictive biomarker of alcohol relapse following treatment in a pilot study

RATIONALE

Identifying the predictors of relapse in detoxified alcohol-dependent patients is crucial for effective surveillance procedures and the optimization of treatment. Physiological measures such as functional MRI activity and heart rate variability have been shown as potential markers of relapse prediction.

OBJECTIVES

Our aim was to assess differential pupillary reactions to alcohol-related cues as an objective physiological candidate predictor of relapse.

METHODS

We examined the relationship between cue-elicited pupillary reactions to alcohol stimuli and luminance-controlled neutral stimuli in 21 detoxified alcohol-dependent patients and subsequent relapse outcome at a 4-month follow-up.

RESULTS

Differential pupillary dilation to alcohol stimuli as compared to neutral stimuli at 150 to 250 ms after stimulus onset substantially improved the model prediction of relapse outcome (additional 27% of variance) beyond that achieved from five standardized questionnaires on alcohol craving, alcohol use, problematic use severity, depressive tendencies, and duration of abstinence (47% of variance). In contrast, alcohol craving did not improve relapse model prediction.

CONCLUSIONS

This pilot study shows that alcohol-dependent patients with greater pupillary dilation to alcohol stimuli are more vulnerable to relapse, and that pupillometry presents as an important tool for addiction science.

A Neurophysiological and Behavioral Assessment of Interventions Targeting Attention Bias and Sense of Control in Binge Drinking

Attention bias modification (ABM) can decrease the selective visual attention paid to alcohol-related cues but has not been found to reliably reduce alcohol craving. Here, a cognitive intervention to decrease craving by increasing sense of control (Shamloo and Cox, 2014) was used as a complement. We investigated the effects of two such interventions administered singly or in combination. Participants were 41 binge drinkers (BDs) and 10 non-binge drinkers (NBDs). BDs received either ABM, sense of control training, both interventions, or no intervention, and were compared with NBDs who received no intervention. Groups were assessed on alcohol attention bias change including both reaction times and cue-elicited ERPs (visual dot-probe task), alcohol craving change, and alcohol consumption. BDs exhibited higher attention bias scores than NBDs. ABM had no effect on BDs' behavioral or electrophysiological markers of attention bias. Sense of control training did not increase personal sense of control but protected against decreased task accuracy and against increased craving. BDs receiving the combined intervention consumed less alcohol in a bogus taste test than participants receiving no intervention. Taken together, the results suggest that ABM procedure may reduce alcohol consumption if combined with sense of control training.

Beer? Over here! Examining attentional bias towards alcoholic and appetitive stimuli in a visual search eye-tracking task

RATIONALE

Experimental tasks that demonstrate alcohol-related attentional bias typically expose participants to single-stimulus targets (e.g. addiction Stroop, visual probe, anti-saccade task), which may not correspond fully with real-world contexts where alcoholic and non-alcoholic cues simultaneously compete for attention. Moreover, alcoholic stimuli are rarely matched to other appetitive non-alcoholic stimuli.

OBJECTIVES

To address these limitations by utilising a conjunction search eye-tracking task and matched stimuli to examine alcohol-related attentional bias.

METHODS

Thirty social drinkers (Mage = 19.87, SD = 1.74) were asked to detect whether alcoholic (beer), non-alcoholic (water) or non-appetitive (detergent) targets were present or absent amongst a visual array of matching and non-matching distractors. Both behavioural response times and eye-movement dwell time were measured.

RESULTS

Social drinkers were significantly quicker to detect alcoholic and non-alcoholic appetitive targets relative to non-appetitive targets in an array of matching and mismatching distractors. Similarly, proportional dwell time was lower for both alcoholic and non-alcoholic appetitive distractors relative to non-appetitive distractors, suggesting that appetitive targets were relatively easier to detect.

CONCLUSIONS

Social drinkers may exhibit generalised attentional bias towards alcoholic and non-alcoholic appetitive cues. This adds to emergent research suggesting that the mechanisms driving these individual's attention towards alcoholic cues might 'spill over' to other appetitive cues, possibly due to associative learning.

Failed attempts to improve the reliability of the alcohol visual probe task following empirical recommendations

The visual probe task (VPT) is a computerized task used to measure attentional bias to substance-related stimuli. Little research has examined the psychometric properties of the VPT, despite concerns it demonstrates poor test-retest reliability and internal consistency. These issues can reduce confidence in inferences based on VPT performance. As such, we attempted to identify parameters under which the reliability of the alcohol VPT might be improved by applying recent empirical recommendations for outlier handling, bias calculation, and task design from the anxiety literature. We reanalyzed data from 3 previously published studies in our laboratory and 2 newly collected data sets. We compared tasks which presented images on the left/right of the screen to above/below, whether participants responded to the location or content of the probe, and whether general alcohol-related images or images personalized to the individual were used. In each VPT we also applied a priori outlier removal (2 and 3 standard deviations and median absolute difference) and data-driven outlier removal (winsorizing), in addition to calculating trial-level bias scores. Across all studies and tasks internal consistency and test-retest reliability of attentional bias measures were inadequate. There was no consistent improvement in internal consistency or test-retest reliability as a function of outlier removal methods. We were unable to demonstrate adequate reliability of the alcohol VPT, which further supports observations that these tasks may not yield reliable measures. Future research should focus on improving the reliability of these tasks or abandoning them in favor of more reliable alternatives. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Distraction towards contextual alcohol cues and craving are associated with levels of alcohol use among youth

BACKGROUND

Controlling drinking behaviour requires the ability to block out distracting alcohol cues in situations in which drinking is inappropriate or harmful. However, at present few studies have investigated whether distraction and response inhibition to contextual alcohol cues are related to alcohol use in adolescents and young adults. We aimed to investigate whether tendencies towards distraction and failures of response inhibition in the presence of contextual alcohol cues, and alcohol craving were associated with higher levels of alcohol consumption, beyond what could be explained by demographic variables.

METHODS

To test this, 108 participants (Mean age = 21.7, range = 16-27), whom were both drinkers and non-drinkers performed a modified Go/NoGo task tailored to measure distraction and response inhibition in the presence of alcohol cues relative to neutral stimuli. Alcohol craving was assessed using a visual analogue scale of craving for different types of alcohol cues. Levels of alcohol use and problematic alcohol use were assessed using a self-report measure of number of drinking days in the previous month and the Alcohol Use Disorders Identification Test. Data were analysed using sequential multiple regression using a zero-inflated negative binomial distribution model.

RESULTS

Drinking days correlated with distraction but not response inhibition to contextual alcohol cues. Sequential regression analyses revealed that the inclusion of distraction bias accounted for 11% additional variance (significant) in alcohol use, in addition to that explained by demographics alone (17%). Craving for alcohol explained an additional 30% variance (significant) in alcohol use.

CONCLUSIONS

The results reported here support the idea that both biased distraction towards alcohol cues and alcohol craving are associated with preceding drinking days, but not necessarily drinking status. Further studies are warranted that address whether cognitive distraction to alcohol-related cues cause or is an effect of alcohol use among youth.

Competing Motivations: Proactive Response Inhibition Toward Addiction-Related Stimuli in Quitting-Motivated Individuals

We examined whether addiction-related cues impact proactive inhibition (the restraint of actions in preparation for stopping) in individuals who are motivated to quit gambling or cannabis use. In Study 1, treatment-seeking individuals with cannabis use disorder and matched controls performed a stop-signal task that required them to inhibit categorizing cannabis or neutral pictures, and within varying levels of stop-signal probability. In Study 2, two groups of individuals, who applied to a voluntary self-exclusion program toward gambling, performed the stop-task following relaxation or gambling craving induction, with results compared to non-gamblers. Study 1 showed that despite being less efficient in proactive inhibition, individuals with cannabis use disorder exhibited heightened proactive inhibition toward cannabis cues. In Study 2, proactive inhibition toward gambling cues was heightened in gamblers after craving, but the degree of proactive adjustment decreased as a function of induced changes in gambling-related motivation. Present findings demonstrate that exposure to addiction-related cues can modulate proactive inhibition in individuals who are motivated to restrict their addictive behaviors.

Let's Open the Decision-Making Umbrella: A Framework for Conceptualizing and Assessing Features of Impaired Decision Making in Addiction

Decision-making impairments play a pivotal role in the emergence and maintenance of addictive disorders. However, a sound conceptualization of decision making as an umbrella construct, encompassing its cognitive, affective, motivational, and physiological subcomponents, is still lacking. This prevents an efficient evaluation of the heterogeneity of decision-making impairments and the development of tailored treatment. This paper thus unfolds the various processes involved in decision making by adopting a critical approach of prominent dual- or triadic-process models, which postulate that decision making is influenced by the interplay of impulsive-automatic, reflective-controlled, and interoceptive processes. Our approach also focuses on social cognition processes, which play a crucial role in decision making and addictive disorders but were largely ignored in previous dual- or triadic-process models. We propose here a theoretical framework in which a range of coordinated processes are first identified on the basis of their theoretical and clinical relevance. Each selected process is then defined before reviewing available results underlining its role in addictive disorders (i.e., substance use, gambling, and gaming disorders). Laboratory tasks for measuring each process are also proposed, initiating a preliminary process-based decision-making assessment battery. This original approach may offer an especially informative view of the constitutive features of decision-making impairments in addiction. As prior research has implicated these features as risk factors for the development and maintenance of addictive disorders, our processual approach sets the scene for novel and transdiagnostic experimental and applied research avenues.

Light social drinkers are more distracted by irrelevant information from an induced attentional bias than heavy social drinkers

It is well established that alcoholics and heavy social drinkers show a bias of attention towards alcohol-related items. Previous research suggests that there is a shared foundation of attentional bias, which is linked to attentional control settings. Specifically, attentional bias relates to a persistent selection of a Feature Search Mode which prioritises attentional bias-related information for selection and processing. However, no research has yet examined the effect of pre-existing biases on the development of an additional attentional bias. This paper seeks to discover how pre-existing biases affect the formation of a new, additional attentional bias. Twenty-five heavy and 25 light social drinkers, with and without a pre-existing bias to alcohol-related items, respectively, had an attentional bias towards the colour green induced via an information sheet. They then completed a series of one-shot change detection tasks. In the critical task, green items were present but task-irrelevant. Irrelevant green items caused significantly more interference for light than heavy social drinkers. This somewhat counter intuitive result is likely due to heavy drinkers having more experience in exerting cognitive control over attentional biases, something not previously observed in investigations of the effects of holding an attentional bias. Our findings demonstrate for the first time that an established attentional bias significantly modulates future behaviour.