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Reichl D, Enewoldsen N, Müller A, Steins-Loeber S. Pilot testing of an adaptive, individualized inhibitory control training for binge drinking: first evidence on feasibility, acceptance, and efficacy. PSYCHOLOGICAL RESEARCH 2022; 87:1267-1283. [PMID: 35994096 PMCID: PMC9395788 DOI: 10.1007/s00426-022-01725-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/04/2022] [Indexed: 11/28/2022]
Abstract
Background Deficits in inhibitory control seem to promote habit behavior and therefore play an important role in the development and maintenance of addictive diseases. Although several training approaches have been suggested, there is a considerable lack of knowledge about the best way to improve inhibitory control. Based on a literature review regarding shortcomings of existing trainings, an individualized, adaptive inhibitory control training was developed. We aimed to assess feasibility and acceptance of this training and to provide preliminary results on its efficacy regarding inhibitory control and binge drinking. Methods Sixty-one individuals (30 female) with binge drinking behavior were randomly allocated to either an experimental group receiving three sessions of the inhibitory control training or a waitlist control group receiving no training. Before and after the training, the participants performed a Go/NoGo task to assess inhibitory control (commission errors and false reaction time), completed a questionnaire on drinking-related self-control, and reported drinking behavior. Results Although the training was feasible and accepted by participants, it did not affect self-control over drinking, inhibitory control or drinking behavior. The relationship between session number and false reaction time was linear for alcohol stimuli, but squared for neutral stimuli. Conclusion Although our findings have to be interpreted in the light of some shortcomings, they demonstrate that further research is needed to enhance our understanding of how to improve inhibitory control and which factors might moderate this process. Supplementary Information The online version contains supplementary material available at 10.1007/s00426-022-01725-4.
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Affiliation(s)
- Daniela Reichl
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University Bamberg, Markusplatz 3, 96047, Bamberg, Germany.
| | - Niklas Enewoldsen
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University Bamberg, Markusplatz 3, 96047, Bamberg, Germany
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Almeida-Antunes N, Vasconcelos M, Crego A, Rodrigues R, Sampaio A, López-Caneda E. Forgetting Alcohol: A Double-Blind, Randomized Controlled Trial Investigating Memory Inhibition Training in Young Binge Drinkers. Front Neurosci 2022; 16:914213. [PMID: 35844233 PMCID: PMC9278062 DOI: 10.3389/fnins.2022.914213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Binge Drinking (BD) has been associated with altered inhibitory control and augmented alcohol-cue reactivity. Memory inhibition (MI), the ability to voluntarily suppress unwanted thoughts/memories, may lead to forgetting of memories in several psychiatric conditions. However, despite its potential clinical implications, no study to date has explored the MI abilities in populations with substance misuse, such as binge drinkers (BDs). Method This study—registered in the NIH Clinical Trials Database (ClinicalTrials.gov identifier: NCT05237414)—aims firstly to examine the behavioral and electroencephalographic (EEG) correlates of MI among college BDs. For this purpose, 45 BDs and 45 age-matched non/low-drinkers (50% female) will be assessed by EEG while performing the Think/No-Think Alcohol task, a paradigm that evaluates alcohol-related MI. Additionally, this work aims to evaluate an alcohol-specific MI intervention protocol using cognitive training (CT) and transcranial direct current stimulation (tDCS) while its effects on behavioral and EEG outcomes are assessed. BDs will be randomly assigned to one MI training group: combined [CT and verum tDCS applied over the right dorsolateral prefrontal cortex (DLPFC)], cognitive (CT and sham tDCS), or control (sham CT and sham tDCS). Training will occur in three consecutive days, in three sessions. MI will be re-assessed in BDs through a post-training EEG assessment. Alcohol use and craving will be measured at the first EEG assessment, and both 10-days and 3-months post-training. In addition, behavioral and EEG data will be collected during the performance of an alcohol cue reactivity (ACR) task, which evaluates attentional bias toward alcoholic stimuli, before, and after the MI training sessions. Discussion This study protocol will provide the first behavioral and neurofunctional MI assessment in BDs. Along with poor MI abilities, BDs are expected to show alterations in event-related potentials and functional connectivity patterns associated with MI. Results should also demonstrate the effectiveness of the protocol, with BDs exhibiting an improved capacity to suppress alcohol-related memories after both combined and cognitive training, along with a reduction in alcohol use and craving in the short/medium-term. Collectively, these findings might have major implications for the understanding and treatment of alcohol misuse. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [NCT05237414].
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Affiliation(s)
- Natália Almeida-Antunes
- Psychological Neuroscience Laboratory, Psychology Research Center, University of Minho, Braga, Portugal
| | - Margarida Vasconcelos
- Psychological Neuroscience Laboratory, Psychology Research Center, University of Minho, Braga, Portugal
| | - Alberto Crego
- Psychological Neuroscience Laboratory, Psychology Research Center, University of Minho, Braga, Portugal
| | - Rui Rodrigues
- Psychological Neuroscience Laboratory, Psychology Research Center, University of Minho, Braga, Portugal
| | - Adriana Sampaio
- Psychological Neuroscience Laboratory, Psychology Research Center, University of Minho, Braga, Portugal
| | - Eduardo López-Caneda
- Psychological Neuroscience Laboratory, Psychology Research Center, University of Minho, Braga, Portugal
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Reichl D, Enewoldsen N, Weisel KK, Fuhrmann L, Lang C, Saur S, Berking M, Zink M, Ahnert A, Falkai P, Kraus T, Hillemacher T, Müller FN, Kornhuber J, Bönsch D, Kerkemeyer L, Steins-Loeber S. Association of impulsivity with quality of life and well-being after alcohol withdrawal treatment. J Clin Psychol 2022; 78:1451-1462. [PMID: 35045188 DOI: 10.1002/jclp.23316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/12/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Impulsivity is related to a higher risk of relapse in alcohol use disorders. However, besides drinking behavior, other recovery outcomes like physical and mental health-related quality of life are at least as important. The present study aimed to fill a research gap regarding the association of different impulsivity facets with health-related quality of life and well-being in alcohol use disorder. METHODS Individuals with a primary alcohol use disorder diagnosis (n = 167) were interviewed with standardized self-report measures at the progressed stage of their withdrawal treatment and 6 weeks thereafter. Multiple regression models were calculated to examine the association of impulsivity, craving, and drinking patterns with health-related quality of life and well-being 6 weeks after withdrawal treatment, as well as the predictive role of impulsivity assessed during withdrawal for these two outcomes. RESULTS Craving was associated with health-related quality of life and well-being 6 weeks after withdrawal. Likewise, non-planning and attentional impulsivity were associated with well-being 6 weeks after withdrawal. Motor impulsivity during withdrawal treatment predicted health-related quality of life 6 weeks thereafter. CONCLUSION Impulsivity seems to be negatively related to health-related quality of life and well-being in the first weeks after alcohol withdrawal treatment, probably to a higher extent than drinking patterns, but differentiating between its facets seems to be important. These findings emphasize the importance of treatment approaches aiming at reduced impulsivity in the early recovery process.
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Affiliation(s)
- Daniela Reichl
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University, Bamberg, Germany
| | - Niklas Enewoldsen
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University, Bamberg, Germany
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany
| | - Lukas Fuhrmann
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany.,Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirksklinikum Ansbach, Ansbach, Germany
| | - Catharina Lang
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany
| | - Sebastian Saur
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen, Germany
| | - Mathias Zink
- Klinik für Psychiatrie, Sucht, Psychotherapie und Psychosomatik, Klinikum am Europakanal, Erlangen, Germany
| | - Andreas Ahnert
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirksklinikum Ansbach, Ansbach, Germany
| | - Peter Falkai
- Klinik für Psychiatrie und Psychotherapie, LMU-Klinikum, München, Germany
| | - Thomas Kraus
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Frankenalb-Klinik Engelthal, Engelthal, Germany
| | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nürnberg, Germany
| | - Felix-N Müller
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nürnberg, Germany
| | - Johannes Kornhuber
- Psychiatrische und Psychotherapeutische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Dominikus Bönsch
- Krankenhaus für Psychiatrie, Psychotherapie und Psychosomatische Medizin, Bezirkskrankenhaus Lohr, Lohr am Main, Germany
| | - Linda Kerkemeyer
- Institute for Applied Health Services Research (inav), Berlin, Germany
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University, Bamberg, Germany
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Ghin F, Beste C, Stock AK. Neurobiological mechanisms of control in alcohol use disorder - moving towards mechanism-based non-invasive brain stimulation treatments. Neurosci Biobehav Rev 2021; 133:104508. [PMID: 34942268 DOI: 10.1016/j.neubiorev.2021.12.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 12/13/2022]
Abstract
Alcohol use disorder (AUD) is characterized by excessive habitual drinking and loss of control over alcohol intake despite negative consequences. Both of these aspects foster uncontrolled drinking and high relapse rates in AUD patients. Yet, common interventions mostly focus on the phenomenological level, and prioritize the reduction of craving and withdrawal symptoms. Our review provides a mechanistic understanding of AUD and suggests alternative therapeutic approaches targeting the mechanisms underlying dysfunctional alcohol-related behaviours. Specifically, we explain how repeated drinking fosters the development of rigid drinking habits and is associated with diminished cognitive control. These behavioural and cognitive effects are then functionally related to the neurobiochemical effects of alcohol abuse. We further explain how alterations in fronto-striatal network activity may constitute the neurobiological correlates of these alcohol-related dysfunctions. Finally, we discuss limitations in current pharmacological AUD therapies and suggest non-invasive brain stimulation (like TMS and tDCS interventions) as a potential addition/alternative for modulating the activation of both cortical and subcortical areas to help re-establish the functional balance between controlled and automatic behaviour.
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Affiliation(s)
- Filippo Ghin
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany; University Neuropsychology Center, Faculty of Medicine, TU Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany; University Neuropsychology Center, Faculty of Medicine, TU Dresden, Germany
| | - Ann-Kathrin Stock
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany; University Neuropsychology Center, Faculty of Medicine, TU Dresden, Germany; Biopsychology, Faculty of Psychology, TU Dresden, Dresden, Germany.
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The transcranial direct current stimulation over prefrontal cortex combined with the cognitive training reduced the cue-induced craving in female individuals with methamphetamine use disorder: A randomized controlled trial. J Psychiatr Res 2021; 134:102-110. [PMID: 33383492 DOI: 10.1016/j.jpsychires.2020.12.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/13/2020] [Accepted: 12/19/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Craving and cognitive deficits are potential treatment targets for methamphetamine use disorder (MUD). Previous studies implied that transcranial direct current stimulation (tDCS) and cognitive training respectively improve these symptoms, but the combined effect is unknown. In this study, we investigated the combined effects of tDCS over dorsolateral prefrontal cortex (DLPFC) and computerized cognitive addiction therapy (CCAT) on cue-induced craving and cognitive functions among female individuals with MUD. METHODS Seventy-five patients with MUD were randomly assigned to three groups: CCAT + tDCS group, CCAT + sham tDCS group and the control group. The former two groups received 20 sessions of cognitive training combined 1.5 mA active/sham tDCS over DLPFC (20min/session, 5times/week), while the control group received usual care which includes routine medical care, health education, physical exercises and psychological support related to relapse prevention. The cue-induced craving and cognitive functions were tested at the baseline, the end of 2nd week and 4th week. RESULTS The CCAT + tDCS group showed a significant reduction in cue-induced craving after 4-week intervention. Moreover, the craving score of the real CCAT + tDCS group was significantly lower than that of the CCAT + sham tDCS group and that of the control group at the end of 4th week. A significant improvement in accuracy of TWOB task was only observed in the CCAT + tDCS group at the end of 4th week when compared to baseline. Unexpectedly, participants who received CCAT plus active or sham tDCS did not change their discounting, whereas those in the control group performed more impulsively over time. CONCLUSIONS The study found that the intervention of tDCS over DLPFC combined with CCAT may have potential benefit in improving treatment outcome in patients with MUD. More research is needed to explore the underlying mechanism.
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