Implicit cognition and substance use: a meta-analysis

A decade on: Reflecting on the limitations of the first meta-analysis of the Implicit Relational Assessment Procedure's (IRAP) criterion validity in the clinical domain

Hussey (in press) recently conducted a detailed critical reanalysis of Vahey, Nicholson and Barnes-Holmes' (2015) meta-analysis. Its stated purpose was to (a) examine the extent to which Vahey et al.'s (2015) meta-analysis contains errors; and (b) to test how computationally reproducible it is by current standards of best practice. Hussey identified a small number of minor numerical errors, but crucially was unable to exactly replicate the original meta-effect of r‾ = .45. Six different variations of the meta-analysis reported by Vahey et al. were used and obtained meta-effects that deviated from the original by Δr‾ = .01-.02. Hussey also reported corresponding 95% credibility intervals that were all of zero width. These discrepancies prompted the present authors to conduct a detailed audit of the original meta-analysis. This revealed one minor transposing error in addition to three identified by Hussey. Once corrected this resulted in a marginally increased Hunter and Schmidt meta-analytic effect of r‾ = .46 without a credibility interval, and a Hedges-Vevea meta-effect of r‾ = .47 with 95% confidence interval (.40, .54). This correction was too small to have any bearing on Vahey et al.'s supplementary analyses regarding publication bias or statistical power. Vahey et al. contained a much lower proportion of transposing errors than is typical of meta-analyses even still (cf. Kadlec, Sainani, & Nimphius, 2023; Lakens et al., 2016; Lakens et al., 2017). Nonetheless, Hussey highlighted important ambiguities about the theoretical and practical meaning of the meta-effect reported by Vahey et al. We clarify our position on these matters in summary, and in so doing explain why we believe that the wider IRAP literature would undoubtedly benefit from increased adoption of contemporary open science standards.

Progress on theory of planned behavior research: advances in research synthesis and agenda for future research

The theory of planned behavior is a social cognition theory that has been widely applied to identify the psychological determinants of intentions and behavior in health contexts. Our 2015 meta-analysis of theory applications in chronic illness contributed to a burgeoning evidence base comprising syntheses supporting theory predictions in health behavior. In this review, we identify limitations of prior meta-analyses of theory applications in health behavior and highlight salient evidence gaps, summarize how recent meta-analyses of the theory have addressed some of the limitations, outline outstanding research questions, and suggest future research syntheses, including those currently in progress, to resolve them. We point to recent and ongoing meta-analyses addressing theory hypotheses and assumptions not tested in previous syntheses, such as perceived behavioral control moderating effects and indirect effects of environmental (e.g., sociostructural variables) and intrapersonal (e.g., personality traits) determinants on health behavior mediated by theory constructs. We also highlight meta-analyses examining behavioral effects of constructs representing extended processes (e.g., habit, implicit cognition) in the context of the theory. Further, we summarize recent meta-analyses addressing directional and causal inferences in theory effects, including meta-analyses of longitudinal studies and experimental and intervention research. We also highlight attempts to test the mechanisms of action of interventions based on the theory including the change meta-analysis method and mediation analyses. We conclude by summarizing the advances that recent meta-analyses of the theory have made to the evidence base of health behavior determinants and interventions and highlighting suggestions for meta-analyses that will further progress the evidence base.

Relating distractor suppression to problematic drinking behavior

BACKGROUND

Impaired cognitive control has been linked to weakened self-regulatory processes underlying compulsive substance intake. Previous research has provided evidence for impaired task performance in substance-abusing groups during Stroop and Go/No-Go tasks. Mechanisms of distractor suppression in visual search might also involve overlapping regulatory components that support goal-directed behavior by resolving the attentional competition between distractors and the target of search. However, the efficiency of learning-dependent distractor suppression has not been examined in the context of drug abuse and a direct comparison between cognitive control and distractor suppression is lacking.

METHOD

A total of 84 participants were assigned either to the heavy drinking group (ALC, n = 42) or the control group (CTL, n = 42) based on self-reported substance use. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) and Barratt Impulsiveness Scale (BIS). After that, participants completed a computerized version of the Stroop task, Go/No-go task, and a visual search task measuring learning-dependent distractor suppression.

RESULTS

The Stroop effect and the frequency of no-go errors did not differ between groups. However, learned distractor suppression was significantly blunted in the ALC group compared to the control group. Across participants, performance on the Stroop and Go/No-go task were correlated, while the magnitude of distractor suppression was related to neither.

CONCLUSIONS

Our findings support a divergence of mechanistic processes underlying cognitive control and attentional control, and demonstrate impaired learning-dependent distractor suppression in heavy drinkers relative to a control group. Impaired distractor suppression offers new insight into why drug cues can be difficult to ignore.

Combining Motivational Interviewing and Cognitive Bias Modification Training for Substances in Detained Youth

Objective

Motivation is considered a key factor in successful treatment. Unfortunately, detained youth typically show lower motivation for treatment and behavioral change. This pilot study examined the effects of a brief Motivational Interviewing (MI) protocol in conjunction with a Cognitive Bias Modification (CBM) intervention aimed at reducing substance use in detained youth.

Method

An MI protocol for adult parolees was adapted for adolescents. A total of 52 detained youth received the MI intervention, aimed at enhancing their insights into their substance use and its potential relation with their offenses, plus substance use treatment. These youth were matched with controls from similar populations who received the same CBM without MI.

Results

Changes in motivation over time were examined with a repeated-measures analysis of variance. Results showed no change in motivation over time, nor a significant effect of condition (MI vs no MI).

Conclusion

Although application of the MI protocol was feasible, no effect was found on motivation, in contrast to the original adult-focused protocol. Certain core facets of the original protocol, such as client reflection on their history of substance use, may be less applicable to detained youth whose use history is relatively brief. The severity of their substance use behavior should also be taken into account in any future applications.

Masked liking of pornography: implicit associations in men with compulsive sexual behavior

Background

Compulsive Sexual Behavior Disorder is a new category in the 11th version of the International Classification of Diseases and is showing neuropsychological similarities to substance dependencies and behavioral addictions.

Aims

This experimental study aims to further our knowledge on implicit associations in Compulsive Sexual Behavior (CSB) with a clinical sample.

Methods

Participants completed an Implicit Association Test modified with pornographic pictures. In addition, problematic sexual behavior and sensitivity toward sexual excitation were assessed.

Outcomes

We collected data on implicit associations from 47 heterosexual men with CSB (age, M = 36.51, SD = 11.47) and a control group of 38 men without the condition (age: M = 37.92, SD = 12.33).

Results

Results show significantly more positive relationships between implicit associations of pornographic pictures with positive emotions, as well as with problematic sexual behavior and sensitivity toward sexual excitation, in men with CSB vs. men without CSB. Furthermore, implicit associations, sexual excitation, and sexual inhibition due to threat of performance consequences differentiated significantly between groups using a binary stepwise logistic regression analysis. The findings are in line with those of previous subclinical investigations and support the assumption of pronounced positive implicit associations in CSB. Moreover, as suggested by the I-PACE model of addictive behaviors, implicit associations may be crucial to the maintenance of behavioral addictions.

Clinical implications

Implicit associations could be addressed in therapy to illustrate cognitive processes of those affected and as an outcome measure in research on treatment efficiency.

Strengths & limitations

The present study is the first to investigate implicit associations in CSB in a clinical sample. Findings are limited to heterosexual men.

Conclusion

Findings can be seen in accordance with a proposed classification of CSB as a behavioral addiction.

Food for thought: The impact of short term fasting on cognitive ability

Growing evidence suggests that resource scarcity can severely impede individuals' cognitive capacity, resulting in sub-optimal decision making. Few experimental studies investigate whether food deprivation as a form of resource scarcity influences decisions in other non-hunger related domains. We examine the effect of short term fasting on cognitive capacity by exogenously manipulating individuals' fasting time in a laboratory experiment. Participants were randomly assigned to one of three treatments: 1) 3-hour fast; 2) 12-hour fast; and 3) control, in which participants were not required to fast and consumed a protein shake upon arriving to the lab. Following the manipulation, participants completed the Raven's Progressive Matrices test which measures cognitive function. Although we find null treatment effects on cognitive ability, our results provide evidence that short term fasting does not directly inhibit cognition.

The development of an implicit measure of treatment expectations

In three preregistered studies, we investigated whether implicit treatment expectations, using a relational implicit measure (the MT-PEP), vary between participants provided opposing information about novel medical treatments (Studies 1 and 2) or who responded based on normative beliefs toward common over-the-counter drugs (Study 3). The studies revealed large Cohen's d effect sizes of both novel and well-known treatment information within the implicit measure. The studies also provide evidence of convergent validity, with MT-PEP scores associated with explicit beliefs about medicine and over-the-counter drug familiarity. Implicit treatment expectations can be assessed and offer a novel tool for the intersection of social psychology and medicine.

Implicit beliefs and automatic associations in smoking

BACKGROUND AND OBJECTIVES

Dual process models of addiction suggest that controlled, goal-directed processes prevent drug-use, whereas impulsive, stimulus-driven processes promote drug-use. The most frequently used measure of automatic smoking-related processes, the implicit association test (IAT), has yielded mixed results. We examine the validity of two alternative implicit measures: 1) the affect misattribution procedure (AMP), a measure of automatic evaluations, and 2) the relational responding task (RRT), a measure of implicit beliefs.

METHODS

Smokers and non-smokers performed smoking-related versions of the AMP and the RRT and filled in questionnaires for smoking dependence. Smokers participated in two sessions: once after they just smoked, and once after being deprived for 10 h. Smokers also kept a smoking diary for a week after the second session.

RESULTS

We found significant differences between smokers and non-smokers on the RRT, t (86) = 2.86, p = .007, d = 0.61, and on the AMP, F (1, 85) = 6.22, p = .015, pƞ2 = 0.07. Neither the AMP nor the RRT were affected by the deprivation manipulation. Smoking dependence predicted smoking behavior in the following week; the AMP and RRT did not explain additional variance.

LIMITATIONS

Possibly, our manipulation was not strong enough to affect the motivational state of participants in a way that it changed their implicit cognitions. Future research should examine the sensitivity of implicit measures to (motivational) context.

CONCLUSIONS

We found limited evidence for the validity of the smoking-AMP and the smoking-RRT, highlighting the need for a critical view on implicit measures.

The effectiveness of cognitive bias modification in reducing substance use in detained juveniles: An RCT

BACKGROUND AND OBJECTIVE

Young offenders show high levels of substance use. Treatment programs within detention settings are less effective. Cognitive bias modification (CBM) is a promising supplement to substance use treatment. This study tests the effectiveness of CBM in young offenders to reduce cannabis and alcohol use, and delinquent recidivism.

METHOD

A randomized controlled trial added CBM to treatment as usual (TAU), among 181 youth in juvenile detention centers. In a factorial design, participants were randomly assigned to either active- or sham-training for two varieties of CBM, targeting attentional-bias (AtB) and approach-bias (ApB) for their most used substance. Substance use was measured with the Alcohol and Cannabis Use Disorder Identification Tests. Delinquent recidivism was measured with the International Self-Report Delinquency (ISRD) survey.

RESULTS

At pretest, participants showed AtB but no ApB for both substances. For alcohol, a decrease was found in AtB in the active-training group. For cannabis, a decrease was found in AtB for both active- and sham-training groups. Regardless of condition, no effects were found on substance use or ISRD scores at follow-up.

LIMITATIONS

The sample is judicial, not clinical, as is the setting. TAU and participant goals are not necessarily substance related.

CONCLUSIONS

Young offenders show a significant attentional-bias towards substance cues. CBM changed attentional-biases but not substance use. Combining CBM with a motivational intervention is advised. Follow-up research should better integrate CBM with running treatment programs. New developments regarding CBM task design could be used that link training better to treatment.

Nicotine-related interpretation biases in cigarette smoking individuals

Addictive behaviors are characterized by information processing biases, including substance-related interpretation biases. In the field of cigarette smoking, such biases have not been investigated yet. The present study thus adopted an open-ended scenario approach to measure smoking-related interpretation biases. Individuals who smoke, those who ceased smoking, and those without a smoking history (total sample N = 177) were instructed to generate spontaneous continuations for ambiguous, open-ended scenarios that described either a smoking-related or neutral context. Overall, people who smoke generated more smoking-related continuations in response to smoking-relevant situations than non-smoking individuals or people who had stopped smoking, providing evidence for a smoking-related interpretation bias. When differentiating for situation type within smoking-relevant scenarios, smoking individuals produced more smoking-related continuations for positive/social and habit/addictive situations compared to negative/affective ones. Additionally, the tendency to interpret habit/addictive situations in a smoking-related manner was positively associated with cigarette consumption and levels of nicotine dependence. Exploratory analyses indicated that other substance-related continuations were correlated with their respective behavioral counterparts (e.g., the level of self-reported alcohol or caffeine consumption). The present study is the first to demonstrate smoking-related interpretation biases in relation to current cigarette smoking. Future studies should investigate the causal role of such biases in the initiation and/or maintainance of nicotine addiction and the merit of Interpretation-Bias-Modification training to support smoking cessation.

Attentional bias modification in male college smokers: The changes of facilitated attention, difficulty in disengagement and the transfer effects of training

BACKGROUND

Attentional bias modification (ABM) has been used to modify the attentional bias (AB) towards smoking-related cues. Still, the effects of ABM are extensively controversial. The present study aimed to investigate the effects of ABM on AB and its two sub-processes named facilitated attention and difficulty in disengagement at two different stimulus durations, as well as test whether the effects of ABM could transfer to new measures of AB.

METHOD

Forty-six male college smokers were allocated to either ABM group using a modified visual probe task (n = 24), or the corresponding placebo training (PT) group (n = 22). Participants performed three sessions of training in one week. The pre- and post-training AB and its sub-processes were measured using visual probe task. Cue-target task and pictorial Stroop task were used for testing the transfer effects of ABM.

RESULTS

The AB in ABM group was significantly decreased compared with the PT group. Specifically, the facilitated attention was significantly reduced at 200 ms stimulus duration, while the difficulty in disengagement was significantly decreased at 500 ms stimulus duration. The benefit of ABM training could transfer to the cue-target task, but not to the pictorial Stroop task. Meanwhile, no effects of ABM were observed on smoking craving and nicotine dependence.

CONCLUSIONS

These findings suggested that the stimulus duration is a crucial factor for the efficacy of ABM on the facilitated attention and the difficulty in disengagement in male college smokers and detected the transfer effects between different measures of AB to some extent. Future studies need to further explore the influence mechanism in distinct stimulus durations.

The nomological network of drinker identity: A scoping review

BACKGROUND

Despite the growing interest in the construct of drinker identity and empirical evidence for its role in drinking behavior, there is a paucity of papers that evaluate and integrate the results of studies on drinker identity, leaving a gap in our knowledge of the importance of the drinker identity construct. The current paper addresses this gap by reviewing and integrating the results of the studies of drinker identity.

METHODS

The scoping review identified, retrieved, and evaluated the existing literature regarding drinker identity. English language studies from EBSCOHost, PubMed, ScienceDirect, and Scopus databases were reviewed. Studies were included in the review if they were data-based studies or theoretical publications with drinker identity as the primary topic published in peer-reviewed journals. Studies were reviewed and coded based on their reported methodology and findings and codes were used to integrate and present findings.

RESULTS

This review advances this line of research in four ways. First, the operationalization of drinker identity is evaluated by examining the theoretical frameworks defining the construct. Second, the conceptualization and measurement of drinker identity is assessed, with suggestions for future measurement research. Third, an integrated framework of predictors, outcomes, moderators, and mediators is presented. Finally, the research gaps, future recommendations, and clinical implications are discussed.

CONCLUSIONS

There is a need for continued research, specifically research which aims to standardize and improve measurement of drinker identity, considers longitudinal and developmental processes, and broadens the research samples and settings.

Same same, but different: A psychometric examination of three frequently used experimental tasks for cognitive bias assessment in a sample of healthy young adults

Cognitive bias research draws upon the notion that altered information processing is key for understanding psychological functioning and well-being. However, little attention has been paid to the question of whether the frequently used experimental paradigms hold adequate psychometric properties. The present study examined the psychometric properties of three widely used cognitive bias tasks: the Approach-Avoidance Task (AAT), the visual dot-probe-task, and the Implicit Association Test (IAT). Approach, attentional, and association biases towards valenced stimuli were repeatedly measured at five different time points in a sample of 79 healthy young adults. Two different devices were used for assessment: a personal computer (PC) and a touchscreen-based tablet. Reliability estimates included internal consistency and temporal stability. Validity was inferred from convergence across different behavioral tasks and correlations between bias scores and self-reported psychological traits. Reliability ranged widely amongst tasks, assessment devices, and measurement time points. While the dot-probe-task appeared to be completely unreliable, bias scores obtained from the PC-based version of the AAT and both (PC and touchscreen) versions of the IAT showed moderate reliability. Almost no associations were found across information processing tasks or between implicit and explicit measures. Cognitive bias research should adopt a standard practice to routinely estimate and report psychometric properties of experimental paradigms, investigate feasible ways to develop more reliable tools, and use tasks that are suitable to answer the precise research question asked.

Measuring attentional bias in smokers during and after psychosocial stress induction with a Trier Social Stress Test in virtual reality via eye tracking

Introduction

Attentional bias (AB) is considered an important factor not only in the etiology of addiction, but also with respect to relapse. However, evidence for the predictive ability of AB for relapse is not robust. One reason for this might be fluctuations of AB due to stress. Therefore, the current study investigated whether AB was present during and after stress induction and whether AB was enhanced by stress induction.

Methods

A Virtual Reality (VR) adaptation of the Trier Social Stress Test (VR-TSST) was used to induce psychosocial stress in smokers (n = 34) and non-smokers (n = 37) followed by a novel free-viewing task in VR. Eye tracking data was recorded to examine gaze behavior to smoking-related and neutral stimuli presented in the VR-TSST and the free-viewing task.

Results

Stress ratings increased significantly from baseline to post VR-TSST in smokers and non-smokers. During the VR-TSST we observed, more frequent, longer, and earlier fixations on smoke-related compared with neutral stimuli without significant group differences. However, in the free-viewing task following the stress induction, a specific AB of smokers in terms of earlier and longer fixations on smoke stimuli was found.

Conclusion

Results indicate that AB is not a persistent trait in smokers, but is context dependent. It is suggested that emotional learning processes such as smoking in the context of relief after stress may contribute to changes of AB both in terms of increased initial attention and deeper stimulus processing. Additionally, the potential of the VR-TSST to induce psychosocial stress could be replicated.

Hazardous drinking and alcohol use disorders

Alcohol is one of the most widely consumed psychoactive drugs globally. Hazardous drinking, defined by quantity and frequency of consumption, is associated with acute and chronic morbidity. Alcohol use disorders (AUDs) are psychiatric syndromes characterized by impaired control over drinking and other symptoms. Contemporary aetiological perspectives on AUDs apply a biopsychosocial framework that emphasizes the interplay of genetics, neurobiology, psychology, and an individual's social and societal context. There is strong evidence that AUDs are genetically influenced, but with a complex polygenic architecture. Likewise, there is robust evidence for environmental influences, such as adverse childhood exposures and maladaptive developmental trajectories. Well-established biological and psychological determinants of AUDs include neuroadaptive changes following persistent use, differences in brain structure and function, and motivational determinants including overvaluation of alcohol reinforcement, acute effects of environmental triggers and stress, elevations in multiple facets of impulsivity, and lack of alternative reinforcers. Social factors include bidirectional roles of social networks and sociocultural influences, such as public health control strategies and social determinants of health. An array of evidence-based approaches for reducing alcohol harms are available, including screening, pharmacotherapies, psychological interventions and policy strategies, but are substantially underused. Priorities for the field include translating advances in basic biobehavioural research into novel clinical applications and, in turn, promoting widespread implementation of evidence-based clinical approaches in practice and health-care systems.

Implicit Cognitions, Use Expectancies and Gratification in Social-Networks-Use Disorder and Tobacco Use Disorder

Abstract: Aims: The problematic use of social networks is discussed as a further specific type of Internet-use disorders. Our project aims to clarify whether social-networks-use disorder (SNUD) is marked by characteristics of addictive behaviors by tracking behavior and investigating the relevance of 1) implicit cognitions, 2) the experiences of gratification and compensation and 3) use expectancies in SNUD compared to tobacco-use disorder. Methodology: Four groups will be examined: individuals with 1) SNUD without tobacco use, 2) risky use patterns with regard to social networks without tobacco use, 3) tobacco use disorder and 4) healthy controls. All participants first complete a laboratory examination including the Implicit Association Test (IAT) and the Approach-Avoidance task (AAT). We will use smartphone-based data tracking for 14 days following laboratory testing to record smoking and social-networks-use patterns. During this period, we further measure use expectancies and the experience of gratification and compensation by means of a smartphone-based experience sampling method (ESM). Conclusions: This is the first study to examine relevant characteristics of addictive behaviors in individuals with SNUD compared to individuals with tobacco use, using a combination of experimental psychological methods and smartphone-based measurements. We expect that this investigative approach will contribute to a deeper understanding of the processes involved in SNUD.

Understanding parental vaccine refusal: Implicit and explicit associations about vaccines as potential building blocks of vaccine beliefs and behavior

Objective

A movement of parents refusing vaccines for their children has contributed to increasingly large outbreaks of diseases that are preventable by vaccines. Research has identified multiple factors that relate to parents' vaccination behaviors (i.e., whether not they vaccinate their children), including their beliefs about vaccines' safety and utility and their trust in those who recommend vaccines. Here we examine the role of more fundamental psychological processes that may contribute to multiple vaccine-related beliefs and behaviors: cognitive associations.

Methods

Using a large sample of U.S. parents (pre-COVID-19), we investigated parents' associations between vaccines and helpfulness/harmfulness, as well as between the self and vaccines (vaccine identity), and their relation to parents' beliefs about vaccine safety and utility, trust in authorities' vaccine recommendations, and prior vaccination refusal for their children. To capture a more complete understanding of people's associations, we examined both explicit associations (measured via self-report) and implicit associations (measured by the Implicit Association Test).

Results

Both implicit and explicit associations correlated with beliefs, trust, and vaccination refusal. Results from structural equation models indicated that explicit vaccine-identity and vaccine-helpfulness associations and implicit vaccine helpfulness associations were indirectly related to vaccination refusal via their relation with vaccine beliefs.

Conclusions

Collectively, study findings suggest that vaccine associations—especially those related to helpfulness/harmfulness—may serve as psychological building blocks for parental vaccine beliefs and behaviors.

Cognitive processing features of elementary school children with mathematical anxiety: Attentional control theory-based explanation

A growing body of research suggests that mathematical anxiety (MA) seriously affects an individual's math achievement. However, few studies have focused on the cognitive mechanisms of MA in elementary school children. Based on attention control theory (ACT), this research aimed to explore the cognitive mechanism of MA in elementary school children using two studies. In Study 1, the dual-task paradigm of number memory and computation span was used to investigate the difference in processing efficiency between the high-mathematical anxiety (HMA) group and the low-mathematical anxiety (LMA) group. In total, 59 students with HMA and 54 students with LMA participated in Study 1. The results showed that students with HMA had lower processing efficiency in dealing with high-load math tasks. To further investigate the underlying mechanism of low processing efficiency for students with HMA, Study 2 explored the attention bias toward math-related stimuli of students with HMA using the Posner paradigm. In total, 48 students with HMA and 49 students with LMA participated in Study 2. The results showed that math trials put children with HMA in a state of heightened vigilance in general, which might be related to the low processing efficiency in dealing with high-load math tasks. These findings support the ACT and further reveal the mechanism of MA in elementary school children from a cognitive perspective.

Do evaluation and self-identification relate to self-reported and actual social media use?

Background and aims

Social media use can sometimes become excessive and damaging. To deal with this issue, scholars and practitioners have called for the development of measures that predict social media use. The current studies test the utility of evaluation and self-identification measures for predicting social media use.

Method

Study 1 examined the relation between evaluation (n = 58) and self-identification (n = 56) measures on the one hand and several self-report measures of social media use on the other hand. Study 2 examined whether the main results of Study 1 could be replicated and whether evaluation (n = 68) and self-identification (n = 48) also relate to actual social media use. We probed evaluation and self-identification using implicit and explicit measures.

Results

Explicit evaluation and self-identification measures significantly correlated with several of the self-report measures of social media. Explicit evaluation also significantly correlated with several indices of actual social media use. Implicit measures did not relate to social media use.

Discussion and conclusions

The current results suggest that researchers and practitioners could benefit from using explicit evaluation and self-identification measures when predicting social media use, especially an evaluation measure since this measure also seems to relate to actual social media use. Study 2 was one of the first to test the ecological validity of social media use measures. Although implicit measures could provide benefits for predicting social media use, the current studies did not show evidence for their predictive utility.

Individual factors associated with the consumption of illicit substances: a review of reviews

INTRODUCTION

According to national studies, the use of illicit drugs is growing in Colombia. With this, the prevalence of substance use disorders and the set of health effects related to this practice also increases. Knowledge of the factors associated with the use of illicit drugs is necessary to guide the comprehensive care of the phenomenon.

METHODS

This is a systematic review of reviews on factors associated with the consumption of illicit drugs with seven databases and evaluation of the quality of the manuscripts according to AMSTAR.

RESULTS

Information was extracted from 38 reviews on individual factors associated with the use of illicit drugs. Demographic factors are associated with consumption through other factors. There is evidence of the association between mental and behavioural disorders and personality disorders.

CONCLUSIONS

The likelihood of consumption of illicit substances and disorders due to their use is affected by a set of personal factors including sociodemographic characteristics, mental health conditions, sexual behaviour, legal drug use, age of onset and risk perception.

Assessing the attentional bias of smokers in a virtual reality anti-saccade task using eye tracking

INTRODUCTION

Cognitive biases (among them attentional bias, AB) are considered an important factor in the development, maintenance, and recurrence of addiction. However, traditional paradigms to measure AB have been criticized regarding external validity and methodical issues. Therefore, and because the neurophysiological correlates of anti-saccade tasks are known, we implemented a novel smoking anti-saccade task in virtual reality (VR) to measure AB and inhibitory control in different contexts and with higher ecological validity.

METHODS

Smokers (n = 20) and non-smokers (n = 20) were tested on a classic pro- and anti-saccade task, a VR anti-saccade task and a VR attention fixation task (all containing smoking-related and neutral stimuli) while eye-tracking data was collected. Two VR contexts (park and office room) were applied.

RESULTS

Saccade latencies were significantly higher for the smoking group in the VR anti-saccade task. However, this effect did not differ between smoking-related and neutral stimuli, thus overall no AB was observed. Instead, AB was only present in the park context. Additionally, saccade latencies and error rates were significantly higher in the park context.

CONCLUSIONS

Results indicate impaired inhibitory control in smokers relative to non-smokers. The lack of evidence for a general AB might be due to the lower severity of smoking dependence in the smoking sample. Instead, results suggest context specificity of AB. Implications for smoking cessation interventions in the field of inhibitory control training and attention bias modification are discussed.

Changes in Drug-Related Implicit Associations during Substance Use Disorder Treatment: The Role of the Therapeutic Context

BACKGROUND

Implicit cognition has been linked to relapse in substance use disorder (SUD). Studies on attentional bias have found different outcomes related to the therapeutic context, finding an association with relapse in inpatients but not in outpatients. There are no similar studies that use associations in semantic memory as a measure of implicit cognition.

OBJECTIVES

(i) to analyze the relationship between a measure of associations in semantic memory and relapse in inpatients and outpatients; (ii) to compare the evolution of these associations between inpatients and outpatients after 3 months of treatment.

METHODS

Eighty nine outpatients and 94 inpatients with SUD for cocaine and alcohol participated in this study. We employed a longitudinal design with a baseline evaluation and follow-up after three months, using the Word Association Task for Drug Use Disorder (WAT-DUD).

RESULTS

The choice of drug-related words predicted relapse in cocaine (odds ratio = 1.97, z = 2.01, p = .045) and alcohol-cocaine (odds ratio = 2.39, z = 2.55, p = .011) use. Follow-up at 3 months revealed a reduction in the choice of drug-related words in inpatients (Z = 2.031, p = .042).

CONCLUSIONS

A greater choice of drug-associated words in the presence of ambiguous images was related to relapse in inpatients but not in outpatients. The inpatients group showed a reduction in the semantic association with drugs during the first three months of treatment.

A meta-analysis of the relationship between eating restraint, impaired cognitive control and cognitive bias to food in non-clinical samples

AIM

Food restriction is argued to be a precursor for unhealthy preoccupation with food, possibly leading to the development of an eating disorder. We updated previous meta-analyses that examined the relationship between eating restraint and deficits in either general or food-related attentional and inhibitory control. We hypothesized that inconsistencies in the literature around eating restraint, impaired cognitive control, impulsivity and cognitive biases for food could be attributed to the scale used to measure eating restraint.

METHOD

A (preregistered) subgroup meta-analysis examined whether patterns of impaired cognitive control and cognitive bias for food in predominantly healthy (non-clinical) samples differed as a function of the scale used to measure eating restraint. A series of exploratory meta-analyses were carried out for specific attentional bias tasks. In total 57 datasets were included.

RESULTS

The subgroup analysis did not provide evidence that the relationship between eating restraint and impaired or biased cognitions differed significantly as a function of restraint scale. Heterogeneity across studies was high. When examining specific attentional bias tasks there was no evidence that increased eating restraint was associated with increased attentional bias or distraction by food cues, regardless of which scale was used to measure eating restraint.

CONCLUSIONS

There is little experimental evidence for the common narrative that increased eating restraint is related to impaired cognitive control generally or increased cognitive bias for food, in non-clinical samples.

Implicit and Explicit Self-Identification as a Drug User in People Who Used Heroin and Methamphetamine

Implicit and explicit self-identification as a drug user specific to the substance used (e.g., viewing oneself as a drinker) have been examined, as they relate to that drug use. However, studies have rarely explored whether identifying as a "drug user" differs implicitly and explicitly for people who use different drugs and how this identification relates to drug-use behaviors or abstinence. This study examined implicit and explicit self-identification as a "drug user" and their associations with drug-use behaviors and abstinence in people who used heroin (PWUH) and people who used methamphetamine (PWUM). Forty PWUH and 35 PWUM in a rehabilitation facility completed the single category implicit association test (SC-IAT), which evaluated implicit associations of a "drug user" with "self," and a measure of explicit self-identification as a "drug user." Prior drug-use behaviors and current abstinence duration of the participants were assessed. PWUH demonstrated stronger implicit "self + drug user" associations and higher levels of explicit self-identification as a "drug user" than PWUM. A higher frequency of drug use was associated with higher levels of explicit drug-user self-identity, and longer abstinence duration was positively related to stronger implicit "self + drug user" associations in PWUH. The drug type of heroin (vs. methamphetamine) participants used was associated with a higher frequency of use, which, in turn, predicted higher levels of explicit drug-user self-identity. Given that the PWUH group differs from the PWUM group in terms of implicit and explicit self-identification as "drug users," it would be more appropriate to address drug-user self-identity of individuals according to the substance they use rather than as a collective group.

Acceptance of Drug Use Mediates Future Hard Drug Use Among At-Risk Adolescent Marijuana, Tobacco, and Alcohol Users

Alternative high school (AHS) students typically report higher levels of alcohol and other drug use compared to students attending traditional high schools. Greater use of such drugs as heroin, methamphetamines, and cocaine in this at-risk population may be driven, in part, by a greater latitude of acceptance toward substance use in general, which may accelerate the transition from gateway drugs to hard drugs. Seven hundred seventy-seven adolescents (mean age 16.6; 56% female) were recruited from alternative high schools throughout Southern California. To understand the factors that may lead AHS students to use hard drugs, a model was tested in order to determine if AHS students' latitude of acceptance toward substance use was a mediator between the relationship of past use of gateway drugs and future use of hard drugs. Latitude of acceptance was found to be a statistically significant mediator of future hard drug use (b = 0.03, 95% confidence intervals = 0.01 to 0.05) among gateway drug users. An individual's latitude of acceptance to various drug use behaviors may be consistent with societal norms. However, after exposure to, or use of, gateway drugs, attitudes that are more permissive toward hard drug use may be encountered, the acceptance of hard drugs may expand, and the use of hard drugs may escalate. Interventions designed to reduce the use of hard drugs among at-risk youth may be more persuasive by crafting messages that are within the latitude of acceptance of the target population and prevent the acceptance of hard drug use.

Craving for Ketamine and Its Relationship With Clinical Outcome Indicators in Males With Ketamine Use Disorder

Background: Craving is considered a hallmark of substance use disorder and is one of the criteria of substance use disorder. The Desires for Drug Questionnaire (DDQ) is a widely used questionnaire to assess craving for heroin. This study aimed to examine the psychometric properties of the ketamine version of the DDQ (DDQ-K) and the associations between craving for ketamine as measured using the DDQ-K and clinical outcome indicators in individuals with ketamine use disorder. Methods: In total, 651 individuals with ketamine use disorder completed the DDQ-K and the Visual Analog Craving Scale (VACS). Demographic data, severity of ketamine use, money spent on ketamine, positive/negative aspects of ketamine use, and readiness to change ketamine use were also recorded. We examined the reliability (internal consistency), construct validity (factor structure), and concurrent validity of the DDQ-K. Multiple regression analysis was used to examine the relationships of craving measured using the DDQ-K with clinical outcome indicators, including money spent on ketamine, severity of ketamine use, positive/negative aspects of ketamine use, and readiness to change ketamine use. Results: The original three-factor model of the DDQ-K was acceptable for use in individuals with ketamine use disorder according to confirmatory factor analysis. The subscales of Desire and Intention and Negative Reinforcement of the DDQ-K, but not the subscale of Control, were of acceptable concurrent validity. The score on the Desire and Intention subscale was positively associated with the level of ketamine dependence, money spent on ketamine use, and positive/negative aspects of ketamine use and negatively associated with readiness to change ketamine use. Conclusion: This study supported the use of the Desire and Intention and Negative Reinforcement subscales of the DDQ-K to assess craving in patients with ketamine use.

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.

I am what I am: A meta-analysis of the association between substance user identities and substance use-related outcomes

OBJECTIVE

Research indicates that a substance user identity (i.e., drinking, smoking, and marijuana identity) is positively correlated with substance use-related outcomes (e.g., frequency, quantity, consequences, and disorder symptoms). The current study aimed to meta-analytically derive single, weighted effect size estimates of the identity-outcome association as well as to examine moderators (e.g., substance use type, explicit/implicit assessment, demographic characteristics, and research design) of this association.

METHOD

Random effects meta-analysis was conducted on 70 unique samples that assessed substance user identity and at least one substance use-related outcome (frequency, quantity, consequences, and/or disorder symptoms), and provided the necessary information for effect size calculations.

RESULTS

Substance user identity was found to be a statistically significant moderate-to-large correlate of all substance use-related outcomes examined in the current study (r _w = .365, p < .001, r_w² = .133). The strongest associations were observed between identity and disorder symptoms (alcohol) and frequency of substance use (tobacco or marijuana). In terms of moderators of the identity-outcome association, the link between explicit drinking identity and alcohol use-related outcomes appeared to be stronger in magnitude than the relationship between implicit drinking identity and alcohol use-related outcomes; however, this difference appears to be largely due to the finding that implicit measures have lower reliability. The strongest identity-outcome association was observed among younger individuals.

CONCLUSIONS

Substance user identity is clearly an important correlate of substance use-related outcomes and this association is stronger among younger individuals. Additional theoretical, empirical, and intervention research is needed to utilize knowledge gleaned from the current study on the identity-outcome association. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Approach bias retraining through virtual reality in smokers willing to quit smoking: A randomized-controlled study

Automatic approach biases toward smoking-related cues have been implicated in the development and maintenance of addictive behaviors. Studies aiming at modifying such biases have shown promise in changing maladaptive approach tendencies for smoking cues and reducing smoking behavior. However, training effects tend to be small and partly inconsistent. The present randomized-controlled trial incorporated virtual reality (VR) technology into Approach Bias Modification (ABM) to improve efficacy. One-hundred-eight smokers attended behavioral counseling for smoking cessation and were thereafter randomized to receive VR-ABM or VR-control training. During VR-ABM, participants trained to implicitly avoid smoking-related objects and to approach alternative objects, while no such contingency existed in the VR-control condition. Trainings were administered in six sessions within a two-week period. Assessments were conducted at baseline, post-intervention (three weeks after baseline), and at follow-up (seven weeks after baseline). VR-ABM did not change approach biases, nor other cognitive biases, but it was superior in reducing daily smoking. However, this effect was limited to the two-week training period. Both groups improved in other smoking- and health-related variables across time. Future work should continue to investigate working mechanisms of ABM, in particular crucial training ingredients. VR could prove valuable for public health as the potential of VR-based treatments is large and not fully explored.

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.

Craving and implicit attitude toward heroin use and their relationships with the levels of heroin dependence and methadone adherence in heroin users

Craving is a core feature of heroin use disorder. Craving for heroin is a conscious cognitive process. Recently, implicit (i.e., an implicit attitude toward heroin use) cognitive processes have been thought to be precursors of cravings. This study aimed to explore the associations of craving and implicit attitude toward heroin use with the level of heroin use disorder and adherence to methadone maintenance treatment (MMT). This study recruited 213 intravenous heroin users (196 males and 17 females) from MMT clinics of two hospitals. The mean age of participants was 42.3 years. They provided details of their severity of heroin use disorder and craving for heroin via questionnaires and also completed a computerized test to assess implicit attitude toward heroin use. The relationships between implicit attitude, craving, age, heroin use disorder, and MMT adherence were examined using path analysis. Craving was positively related to heroin use disorder (beta = 0.4). Implicit attitude directly and indirectly positively contributed to heroin use disorder (betas: 0.1 and 0.3). Craving was positively related to MMT adherence (beta: 0.2), whereas implicit attitude had an indirect effect on MMT adherence (beta: 0.03). Age was negatively associated with craving but was not associated with implicit attitude toward heroin. Methadone dosage was negatively associated with craving. Craving is significantly associated with the levels of heroin use disorder and MMT adherence. Meanwhile, craving mediates the relationship between implicit attitude and heroin use disorder, as well as MMT adherence. Implicit attitude also contributes to the level of heroin use disorder directly. For reducing craving, adequate dosage may be necessary.

Profiles of patients with cocaine and alcohol use disorder based on cognitive domains and their relationship with relapse

BACKGROUND

Relapse in drug use constitutes a research topic on addiction that is relevant for understanding both the addictive process and its clinical implications. The objective of this study was to explore if it is possible to identify patient profiles according to their performance on cognitive tasks whilst examining the relationship between such profiles and relapse.

METHODS

The sample consisted of 222 patients with dependence on cocaine and / or alcohol, of which 86 % were men. Cognitive domains related to salience, decision- making, and emotional processing were measured.

RESULTS

Latent class analysis revealed three patient profiles that differ in terms of performance on cognitive tasks. Two of these profiles are clearly differentiated in terms of their execution of the impulsive decision-making task. The third patient profile, unlike the latter two, is composed of patients with severe alterations in the three domains evaluated. Analysis revealed that patients in Profile 3 are those with the highest rates of relapse in cocaine (Profile 1 = 40.3 %; Profile 2 = 35.6 %; Profile 3 = 69.2 %; Chi2 = 9.169; p < .05) and cocaine and alcohol use (Profile 1 = 55.1 %; Profile 2 = 54.1 %; Profile 3 = 80 %; Chi2 = 6.698; p < .05).

CONCLUSIONS

The results support the postulates of the I-RISA model. From a clinical perspective, these findings highlight the need for a comprehensive evaluation of the cognitive domains involved in addiction.

Free Associations as A Measure of Stable Implicit Attitudes

Two studies explored the psychometric properties of free association methods for the assessment of attitudes. Even though the stability of the actual associations was rather low, psychometric properties of the valence estimates of the free associations were highly satisfactory. Valence estimates of associations were provided by independent judges who rated the valence of the associations that were generated by participants. Valence estimates of the associations showed satisfactory internal consistencies and retest reliabilities over three weeks. Additionally, valence estimates of the associations were significantly and independently related to both explicit self–reported attitudes and implicit attitudes that were assessed with an Ossi–Wessi Implicit Association Test. Free association methods represent a useful complement to the family of implicit measures and are especially suitable for the assessment of non–relative attitudes towards single attitude objects. Copyright © 2012 John Wiley & Sons, Ltd.

Inertia in value-driven attention

Previously reward-associated stimuli persistently capture attention. We attempted to extinguish this attentional bias through a reversal learning procedure where the high-value color changed unexpectedly. Attentional priority shifted during training in favor of the currently high-value color, although a residual bias toward the original high-value color was still evident. Importantly, during a subsequent test phase, attention was initially more strongly biased toward the original high-value color, counter to the attentional priorities evident at the end of training. Our results show that value-based attentional biases do not quickly update with new learning and lag behind the reshaping of strategic attentional priorities by reward.

Buying despite negative consequences: Interaction of craving, implicit cognitive processes, and inhibitory control in the context of buying-shopping disorder

BACKGROUND

Buying-shopping disorder (BSD) is a severe mental disorder in which individuals lose control over their buying/shopping behavior. It is debated whether BSD shares characteristics with other behavioral addictions. The current study aimed at investigating addiction-related concepts, i.e. cue-reactivity/craving, implicit cognitions, and inhibitory control mechanisms, in the context of BSD.

METHODS

An analog sample of 277 participants completed a cue-reactivity paradigm with shopping-related pictures. To assess implicit cognitions (attentional bias and implicit associations) and inhibitory control, a visual dot probe paradigm, an implicit association test, and an affective shifting task, all with shopping-related and control pictures, were administered. The sequence of the three tasks was randomized across participants. Craving was measured prior and after the cue-reactivity paradigm and after completion of the experimental procedure. BSD severity was assessed using the Pathological Buying Screener (PBS).

RESULTS

Increases in craving during the cue-reactivity paradigm, but decreases after the experimental procedure were observed. Craving, attentional bias and implicit cognitions were related to BSD severity-but not to inhibitory control. However, we found moderating effects of attentional bias and inhibitory control as well as implicit associations and inhibitory control on the relationship between craving and BSD severity.

DISCUSSION/CONCLUSION

Results emphasize the role of cue-reactivity/craving, implicit cognitions and inhibitory control in the context of BSD. In line with models for behavioral addictions (I-PACE; Brand et al., 2019), the interaction of affective and cognitive biases towards shopping cues and dysfunctional inhibitory control mechanisms seems to explain the pathological engagement in buying/shopping despite negative consequences.

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.

Implicit memory associations and video gaming

BACKGROUND AND OBJECTIVES

The aim of this study was to develop measures to assess implicit memory associations for video gaming and to examine the relationship between implicit memory associations, video gaming involvement, and problem video gaming.

METHODS

A survey of online panelists from across Canada was conducted that included 166 problem video gamers who were recruited for participation in a larger study examining the relationship between gambling, video gaming, and collectible card play. Memory associations were assessed using a 10-item measures of word associations and behaviour associations. Video gaming involvement was assessed via self-report of time and frequency of play, and problem video gaming was assessed using the Behavioral Addiction Measure for Video Gaming (BAM-VG).

RESULTS

Significant Kendall tau-b correlations ranging from 0.297 to 0.405 were found between measures of memory associations and both level of video gaming involvement and problem video gaming.

CONCLUSIONS

There is a robust relationship between memory associations for video gaming with level of video gaming involvement and problem video gaming. The results suggest that implicit associations may have utility in the assessment of problem video gaming.

Change in implicit alcohol associations over time: Moderation by drinking history and gender

Implicit measures of alcohol-related associations or implicit alcohol associations are associated with drinking outcomes over time and can be understood as vulnerability markers for problem drinking. Longitudinal research remains rare, leaving open questions about how implicit alcohol associations themselves change over time and what factors moderate that change. We examined these questions with data from a larger study of first and second year U.S. college students. We investigated how these implicit alcohol associations change over time and potential moderators of those changes (gender, lifetime drinking history, family history of problem drinking, and class standing). A sample of 506 students (57% women) completed baseline demographic measures and implicit measures (variants of the Implicit Association Test [IAT]) assessing associations with drinking and the self [drinking identity], alcohol and excite [alcohol-excite], and alcohol and approach [alcohol-approach]). IATs were completed at 3-month intervals for a total of 8 assessments. Results indicated small, but significant, change in alcohol-excite and alcohol-approach IAT scores over time, and mixed findings for hypothesized moderators. Drinking history moderated change in drinking identity IAT scores, with increases over time among individuals with no history of drinking or no history of intoxication and decreases among individuals with a history of intoxication. Gender moderated change in alcohol-excite IAT scores with greater change among women (vs. men). No significant moderators of change in alcohol approach IAT scores were found. Results point to the importance of evaluating implicit associations' trajectories and identifying additional factors that predict those trajectories and concomitant vulnerability to problem drinking.

Predicting relapse in patients with severe alcohol use disorder: The role of alcohol insight and implicit alcohol associations

Low insight is reported as a risk factor for relapse among patients treated for alcohol use disorders. However, to date, little is known on why patients with low insight are at higher risk for relapse. In this study, we tested the hypothesis that an implicit preference for alcohol over abstinence predicts relapse in patients with low, but not high, alcohol insight. Participants consisted of 77 patients who had received treatment for severe alcohol use disorder in a hospital in France. During hospitalization, they completed a self-report measure of insight and an implicit association test to assess implicit preference for alcohol over abstinence. The primary outcome was relapse assessed one month after discharge. Control variables were gender, age, cognitive deficit, anxiety, depression, craving, and impulsivity. Data were analysed using logistic regression analysis. After adjusting for demographic and clinical variables, relapse was predicted by the interaction between insight and implicit preference for alcohol but not by their main effects alone. Implicit preference for alcohol predicted relapse among patients with relatively low insight, but not among those with relatively high insight. These findings suggest that patients with low insight and strong implicit preference for alcohol are at a higher risk of relapse. Clinicians may therefore focus on and tailor specific interventions to prevent relapse in this vulnerable and at-risk population.

Cognitive biases and excessive use of social media: The facebook implicit associations test (FIAT)

Many theoretical accounts of addictive behaviors, including models of Internet use disorders, implicate cognitive biases in the formation and maintenance of excessive behaviors. Yet, little empirical evidence regarding the role of such biases, including implicit attitude, in the development and maintenance of excessive use of social media exists. We seek to bridge this gap in this study. To this end, we present the development of the Facebook Implicit Association Test (FIAT) and employ it in a sample of 220 Facebook users. The results (1) confirm the validity of the concept of implicit attitude and its measure in the context of social media, (2) demonstrate that implicit attitude is significantly positively associated with excessive use scores, in a magnitude similar to that observed for associations with substance use, and (3) show that implicit attitude is sheltered against social desirability bias, unlike self-reported and explicit measures, such as excessive use. Overall, this study builds theoretical and methodological foundations for further inquiries into the role of implicit attitude in research on the excessive use of social media.

Individual Factors Associated with the Consumption of Illicit Substances: a Review of Reviews

INTRODUCTION

According to national studies, the use of illicit drugs is growing in Colombia. With this, the prevalence of substance use disorders and the set of health effects related to this practice also increases. Knowledge of the factors associated with the use of illicit drugs is necessary to guide the comprehensive care of the phenomenon.

METHODS

This is a systematic review of reviews on factors associated with the consumption of illicit drugs with seven databases and evaluation of the quality of the manuscripts according to AMSTAR.

RESULTS

Information was extracted from 38 reviews on individual factors associated with the use of illicit drugs. Demographic factors are associated with consumption through other factors. There is evidence of the association between mental and behavioural disorders and personality disorders.

CONCLUSIONS

The likelihood of consumption of illicit substances and disorders due to their use is affected by a set of personal factors including sociodemographic characteristics, mental health conditions, sexual behaviour, legal drug use, age of onset and risk perception.

Promoting smoking abstinence in smokers willing to quit smoking through virtual reality-approach bias retraining: a study protocol for a randomized controlled trial

Background

Automatic processes to approach smoking-related cues have been repeatedly linked to smoking status, intensity of smoking, and cigarette craving. Moreover, recent findings suggest that targeting those tendencies directly by means of approach bias modification (ABM) has merit in changing maladaptive approach tendencies for drug cues and reducing drug consumption. However, training effects tend to be small. Embedding the training into virtual reality (VR) technology could be a promising way to improve training efficacy. The present protocol describes a randomized controlled trial that aims to assess the efficacy of a newly developed VR-ABM as a means of reducing smoking-related approach biases or nicotine consumption in smokers seeking abstinence.

Methods

One hundred daily smokers who are motivated to quit smoking will be recruited into the randomized controlled trial. All participants will attend a brief smoking cessation intervention (TAU) and will be randomly assigned either to the experimental (VR-avoidance training) or the placebo-control group (VR-placebo training). During the VR-avoidance training, participants are implicitly instructed to make an avoidance movement in response to smoking-related objects (e.g., cigarettes) and an approach movement in response to alternative objects (e.g., healthy food). During the VR-placebo training, no such contingency between arm movement and item content exists. Trainings are administered in six sessions within two weeks. Training effects on automatic approach tendencies and smoking behavior are measured immediately after training and at a 7-week follow-up.

Discussion

Embedding the training into virtual reality (VR) technology could be a promising new way to improve ecological validity, realism, and immersion and thereby increase ABM training effects. The results of this study can inform future research in the optimization and advancement of treatment for addiction.

Trial registration

Registered with Current Controlled Trials: study ID ISRCTN16006023. Registered on 28 March 2019.