What is abnormal about addiction-related attentional biases?

Decoding and modifying dynamic attentional bias in gaming disorder

With the spread of smartphones and computer games, concerns have escalated regarding the rising prevalence of gaming disorder. Patients often display attentional biases, unconsciously turning their attention towards gaming-related stimuli. However, attempts to discover and ameliorate these attentional deficits have yielded inconsistent outcomes, potentially due to the dynamic nature of attentional bias. This study investigated neural mechanisms underlying attentional bias state by combining neuroimaging (functional magnetic resonance imaging -fMRI) with an approach-avoidance task tailored to an individual's gaming preference. We conducted a multivariate pattern analysis of endogenous brain activity in 21 participants with probable gaming disorder. Our analyses revealed that activity patterns in the insula tracked temporal attentional bias states specific to gaming stimuli. A broad network of frontal and parietal regions instead appeared to predict a general temporal attentional bias state. Finally, we conducted a proof-of-concept study for 'just-in-time' attentional bias training through fMRI-decoded neurofeedback of insula activity patterns, named decoded attentional bias training (DecABT). Our preliminary results suggest that DecABT may help to decrease the attractiveness of gaming stimuli via a insula- and precuneus-based neural mechanism. This work provides new evidence for the insula as an endogenous regulator of attentional bias states in gaming disorder and a starting point to develop novel, individualized therapeutic approaches to treat addiction.This article is part of the theme issue 'Neurofeedback: new territories and neurocognitive mechanisms of endogenous neuromodulation'.

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.

Attentional bias to social media stimuli is moderated by fear of missing out among problematic social media users

Background and aims

Previous evidence has indicated that problematic social media use (PSMU) is characterized by an attentional bias to social media icons (such as Facebook icons), but not to social webpages (such as Facebook webpages). They suggest that there may be other factors influencing attentional bias like fear of missing out (FoMO). But it remains unclear how FoMO moderates attentional bias in PSMU. This study aims to investigate whether PSMU show attentional bias for stimuli associated with social media, and how FoMO moderates on attentional bias among PSMU through experimental methods.

Methods

Based on the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, this study explored mechanisms of attentional bias to social media icons (such as WeChat) related to PSMU and further examined the role of FoMO in this relationship. Specifically, attentional bias patterns to social media icons of 62 participants (31 PSMU and 31 control group) were explored during a dot-probe paradigm combined with eye-tracking in Experiment 1, and attentional bias patterns to social media icons of another 61 individuals with PSMU with different FoMO levels was explored during a dot-probe paradigm combined with eye-tracking in Experiment 2.

Results

Results revealed that individuals with PSMU had an attentional bias toward social media icons, demonstrated by attentional maintenance, and such bias such bias was moderated by FoMO negatively, demonstrated by attentional vigilance and maintenance in PSMU/high FoMO.

Conclusion

These results suggest that attentional bias is a common mechanism associated with PSMU, and FoMO is a key factor on the development of PSMU.

Exploring the Utility of a Functional Magnetic Resonance Imaging (fMRI) Cannabis Cue-Reactivity Paradigm in Treatment Seeking Adults with Cannabis Use Disorder

BACKGROUND

Functional magnetic resonance imaging (fMRI) studies examining cue-reactivity in cannabis use disorder (CUD) have either had small sample sizes or involved non-treatment-seeking participants. As a secondary analysis, we administered an fMRI cue-reactivity task to CUD participants entering two separate clinical trials (varenicline or repetitive Transcranial Magnetic Stimulation-rTMS) to determine the task activation patterns for treatment-seeking participants with CUD. We aimed to determine the activation patterns for the total sample and determined behavioral correlates. We additionally compared studies to determine if patterns were consistent.

METHODS

Treatment-seeking participants with moderate or severe CUD had behavioral craving measured at baseline via the short form of the Marijuana Craving Questionnaire (MCQ-SF) and completed a visual cannabis cue-reactivity task during fMRI (measuring the Blood-Oxygen-Level-Dependent-BOLD response) following 24-hours of cannabis-abstinence.

RESULTS

Sixty-five participants were included (37-varenicline, 28-rTMS; 32% female; mean-age 30.4±9.9SD). When contrasting cannabis-images vs. matched-neutral-images, participants showed greater BOLD response in bilateral ventromedial-prefrontal, dorsolateral-prefrontal, anterior cingulate, and visual cortices, as well as the striatum. There was stronger task-based functional-connectivity (tbFC) between the medial prefrontal cortex and both the amygdala and the visual cortex. Craving negatively correlated with BOLD response in the left ventral striatum (R2=-0.32; p=0.01) in the full sample. There were no significant differences in either activation or tbFC between studies.

DISCUSSION

Among two separate treatment-seeking groups with CUD, there was increased cannabis cue-reactivity and tbFC in regions related to executive function and reward processing. Cannabis-craving was negatively associated with cue-reactivity in the left ventral striatum.

Dissociation of drug and negative emotional cue induced attentional bias in individuals with methamphetamine-use disorder

BACKGROUND AND OBJECTIVES

Although both drugs and negative emotions can trigger drug craving or relapse in individuals with methamphetamine-use disorder (MUD), it remains unclear whether individuals with MUD have attentional biases toward both drug and negative emotional cues and whether this bias involves attention orientation or difficulty in attention disengagement. This study aimed to measure different components of attentional bias toward drug-related and negative emotional cues in individuals with MUD.

METHODS

Two dot-probe tasks were used to investigate attentional bias toward drug (drug task) and negative emotional cues (emotion task) in individuals with MUD. Forty-three males with MUD (average age of 43.44 ± 11.91 years, average drug-use duration of 11.35 ± 8.39 years) participated in the study voluntarily.

RESULTS

There was a significant interaction between the task type and location (p = .01). Specifically, for drug cues, participants showed significant difficulty in attention disengagement toward drug cues (p = .01); however, no attention orientation (p = .46). For negative emotional cues, neither significant attention orientation (p = .07) nor significant difficulty in attention disengagement (p = .50) was found.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Attentional bias in individuals with MUD was highly selective for drug cues; thus, difficulty in attention disengagement from drug cues can be considered a potential mediating mechanism for attentional bias modification interventions for individuals with MUD. This study served to generate hypotheses or suggest future experiments on interventions for individuals with MUD.

Trichotomy revisited: A monolithic theory of attentional control

The control of attention was long held to reflect the influence of two competing mechanisms of assigning priority, one goal-directed and the other stimulus-driven. Learning-dependent influences on the control of attention that could not be attributed to either of those two established mechanisms of control gave rise to the concept of selection history and a corresponding third mechanism of attentional control. The trichotomy framework that ensued has come to dominate theories of attentional control over the past decade, replacing the historical dichotomy. In this theoretical review, I readily affirm that distinctions between the influence of goals, salience, and selection history are substantive and meaningful, and that abandoning the dichotomy between goal-directed and stimulus-driven mechanisms of control was appropriate. I do, however, question whether a theoretical trichotomy is the right answer to the problem posed by selection history. If we reframe the influence of goals and selection history as different flavors of memory-dependent modulations of attentional priority and if we characterize the influence of salience as a consequence of insufficient competition from such memory-dependent sources of priority, it is possible to account for a wide range of attention-related phenomena with only one mechanism of control. The monolithic framework for the control of attention that I propose offers several concrete advantages over a trichotomy framework, which I explore here.

Lateral hypothalamic GABAergic neurons encode alcohol memories

In alcohol use disorder, the alcohol memories persist during abstinence, and exposure to stimuli associated with alcohol use can lead to relapse. This highlights the importance of investigating the neural substrates underlying not only relapse but also encoding and expression of alcohol memories. GABAergic neurons in the lateral hypothalamus (LH-GABA) have been shown to be critical for food-cue memories and motivation; however, the extent to which this role extends to alcohol-cue memories and motivations remains unexplored. In this study, we aimed to describe how alcohol-related memories are encoded and expressed in LH GABAergic neurons. Our first step was to monitor LH-GABA calcium transients during acquisition, extinction, and reinstatement of an alcohol-cue memory using fiber photometry. We trained the rats on a Pavlovian conditioning task, where one conditioned stimulus (CS+) predicted alcohol (20% EtOH) and another conditioned stimulus (CS-) had no outcome. We then extinguished this association through non-reinforced presentations of the CS+ and CS- and finally, in two different groups, we measured relapse under non-primed and alcohol-primed induced reinstatement. Our results show that initially both cues caused increased LH-GABA activity, and after learning only the alcohol cue increased LH-GABA activity. After extinction, this activity decreases, and we found no differences in LH-GABA activity during reinstatement in either group. Next, we inhibited LH-GABA neurons with optogenetics to show that activity of these neurons is necessary for the formation of an alcohol-cue association. These findings suggest that LH-GABA might be involved in attentional processes modulated by learning.

Intrinsic Functional Connectivity between the Anterior Insular and Retrosplenial Cortex as a Moderator and Consequence of Cocaine Self-Administration in Rats

While functional brain imaging studies in humans suggest that chronic cocaine use alters functional connectivity (FC) within and between key large-scale brain networks, including the default mode network (DMN), the salience network (SN), and the central executive network (CEN), cross-sectional studies in humans are challenging to obtain brain FC prior to cocaine use. Such information is critical to reveal the relationship between individual's brain FC and the subsequent development of cocaine dependence and brain changes during abstinence. Here, we performed a longitudinal study examining functional magnetic resonance imaging (fMRI) data in male rats (n = 7), acquired before cocaine self-administration (baseline), on 1 d of abstinence following 10 d of cocaine self-administration, and again after 30 d of experimenter-imposed abstinence. Using repeated-measures analysis of variance (ANOVA) with network-based statistics (NBS), significant connectivity changes were found between anterior insular cortex (AI) of the SN, retrosplenial cortex (RSC) of the DMN, somatosensory cortex, and caudate-putamen (CPu), with AI-RSC FC showing the most robust changes between baseline and 1 d of abstinence. Additionally, the level of escalated cocaine intake is associated with AI-RSC and AI-CPu FC changes between 1 d and 30 d of abstinence; further, the subjects' AI-RSC FC prior to cocaine intake is a significant moderator for the AI-RSC changes during abstinence. These results provide novel insights into the roles of AI-RSC FC before and after cocaine intake and suggest this circuit to be a potential target to modulate large-scale network and associated behavioral changes in cocaine use disorders.

Value-modulated attentional capture is augmented by win-related sensory cues

Attentional prioritisation of stimuli in the environment plays an important role in overt choice. Previous research shows that prioritisation is influenced by the magnitude of paired rewards, in that stimuli signalling high-value rewards are more likely to capture attention than stimuli signalling low-value rewards; and this attentional bias has been proposed to play a role in addictive and compulsive behaviours. A separate line of research has shown that win-related sensory cues can bias overt choices. However, the role that these cues play in attentional selection is yet to be investigated. Participants in this study completed a visual search task in which they responded to a target shape in order to earn reward. The colour of a distractor signalled the magnitude of reward and type of feedback on each trial. Participants were slower to respond to the target when the distractor signalled high reward compared to when the distractor signalled low reward, suggesting that the high-reward distractors had increased attentional priority. Critically, the magnitude of this reward-related attentional bias was further increased for a high-reward distractor with post-trial feedback accompanied by win-related sensory cues. Participants also demonstrated an overt choice preference for the distractor that was associated with win-related sensory cues. These findings demonstrate that stimuli paired with win-related sensory cues are prioritised by the attention system over stimuli with equivalent physical salience and learned value. This attentional prioritisation may have downstream implications for overt choices, especially in gambling contexts where win-related sensory cues are common.

Exploring the Utility of a Functional Magnetic Resonance Imaging (fMRI) Cannabis Cue-Reactivity Paradigm in Treatment Seeking Adults with Cannabis Use Disorder

Introduction

Functional magnetic resonance imaging (fMRI) studies examining cue-reactivity in cannabis use disorder (CUD) to date have either involved non-treatment seeking participants or been small. We addressed this gap by administering an fMRI cue-reactivity task to CUD participants entering two separate clinical trials.

Methods

Treatment-seeking participants with moderate or severe CUD had behavioral craving measured at baseline via the Marijuana Craving Questionnaire (MCQ-SF). They additionally completed a visual cannabis cue-reactivity paradigm during fMRI following 24-hours of abstinence from cannabis. During fMRI, the Blood Oxygen Level Dependent (BOLD) signal was acquired while participants viewed cannabis-images or matched-neutral-images. BOLD responses were correlated with the MCQ-SF using a General Linear Model.

Results

N=65 participants (32% female; mean age 30.4±9.9SD) averaged 46.3±15.5SD on the MCQ-SF. When contrasting cannabis-images vs. matched-neutral-images, participants showed greater BOLD response in bilateral ventromedial prefrontal, dorsolateral prefrontal, anterior cingulate, and visual cortices, as well as the striatum. Similarly, there was stronger task-based functional-connectivity (tbFC) between the medial prefrontal cortex and both the amygdala and the visual cortex. There were no significant differences in either activation or tbFC between studies or between sexes. Craving negatively correlated with BOLD response in the left ventral striatum (R 2 =-0.25; p =0.01).

Conclusions

We found that, among two separate treatment-seeking CUD groups, cannabis cue-reactivity was evidenced by greater activation and tbFC in regions related to executive function and reward processing, and craving was negatively associated with cue-reactivity in the ventral striatum. Future directions include examining if pharmacological, neuromodulatory, or psychosocial interventions can alter corticostriatal cue-reactivity.

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.

The role of attention in decision-making under risk in gambling disorder: An eye-tracking study

Gambling disorder (GD) is a behavioural addiction characterized by impairments in decision-making, favouring risk- and reward-prone choices. One explanatory factor for this behaviour is a deviation in attentional processes, as increasing evidence indicates that GD patients show an attentional bias toward gambling stimuli. However, previous attentional studies have not directly investigated attention during risky decision-making. 26 patients with GD and 29 healthy matched controls (HC) completed a mixed gambles task combined with eye-tracking to investigate attentional biases for potential gains versus losses during decision-making under risk. Results indicate that compared to HC, GD patients gambled more and were less loss averse. GD patients did not show a direct attentional bias towards gains (or relative to losses). Using a recent (neuro)economics model that considers average attention and trial-wise deviations in average attention, we conducted fine-grained exploratory analyses of the attentional data. Results indicate that the average attention for gains in GD patients moderated the effect of gain value on gambling choices, whereas this was not the case for HC. GD patients with high average attention for gains started gambling at less high gain values. A similar trend-level effect was found for losses, where GD patients with high average attention for losses stopped gambling at lower loss values. This study gives more insight into how attentional processes in GD play a role in gambling behaviour, which could have implications for the development of future treatments focusing on attentional training or for the development of interventions that increase the salience of losses.

Cross-modal generalization of value-based attentional priority

This study aimed to determine whether value-based attentional biases learned in the auditory domain can correspondingly shape visual attention. A learning phase established associations between auditory words and monetary rewards via a modified version of the dichotic listening task. In a subsequent test phase, participants performed a Stroop task including written representations of auditory words previously paired with reward and semantic associates of formerly rewarded words. Results support a semantic generalization of value-driven attention from the auditory to the visual domain. The findings provide valuable insight into a critical aspect of adaptation and the understanding of maladaptive behaviors (e.g., addiction).

Effects of Transcranial Direct Current Stimulation on Attentional Bias to Methamphetamine Cues and Its Association With EEG-Derived Functional Brain Network Topology

BACKGROUND

Although transcranial direct current stimulation (tDCS) has shown to potentially mitigate drug craving and attentional bias to drug-related stimuli, individual differences in such modulatory effects of tDCS are less understood. In this study, we aimed to investigate a source of the inter-subject variability in the tDCS effects that can be useful for tDCS-based treatments of individuals with methamphetamine (MA) use disorder (IMUD).

METHODS

Forty-two IMUD (all male) were randomly assigned to receive a single-session of either sham or real bilateral tDCS (anodal right/cathodal left) over the dorsolateral prefrontal cortex. The tDCS effect on MA craving and biased attention to drug stimuli were investigated by quantifying EEG-derived P3 (a measure of initial attentional bias) and late positive potential (LPP; a measure of sustained motivated attention) elicited by these stimuli. To assess the association of changes in P3 and LPP with brain connectivity network (BCN) topology, the correlation between topology metrics, specifically those related to the efficiency of information processing, and the tDCS effect was investigated.

RESULTS

The P3 amplitude significantly decreased following the tDCS session, whereas the amplitudes increased in the sham group. The changes in P3 amplitudes were significantly correlated with communication efficiency measured by BCN topology metrics (r = -0.47, P = .03; r = -0.49, P = .02). There was no significant change in LPP amplitude due to the tDCS application.

CONCLUSIONS

These findings validate that tDCS mitigates initial attentional bias, but not the sustained motivated attention, to MA stimuli. Importantly, however, results also show that the individual differences in the effects of tDCS may be underpinned by communication efficiency of the BCN topology, and therefore, these BCN topology metrics may have the potential to robustly predict the effectiveness of tDCS-based interventions on MA craving and attentional bias to MA stimuli among IMUD.

Transdiagnostic phenotypes of compulsive behavior and associations with psychological, cognitive, and neurobiological affective processing

Compulsivity is a poorly understood transdiagnostic construct thought to underlie multiple disorders, including obsessive-compulsive disorder, addictions, and binge eating. Our current understanding of the causes of compulsive behavior remains primarily based on investigations into specific diagnostic categories or findings relying on one or two laboratory measures to explain complex phenotypic variance. This proof-of-concept study drew on a heterogeneous sample of community-based individuals (N = 45; 18-45 years; 25 female) exhibiting compulsive behavioral patterns in alcohol use, eating, cleaning, checking, or symmetry. Data-driven statistical modeling of multidimensional markers was utilized to identify homogeneous subtypes that were independent of traditional clinical phenomenology. Markers were based on well-defined measures of affective processing and included psychological assessment of compulsivity, behavioral avoidance, and stress, neurocognitive assessment of reward vs. punishment learning, and biological assessment of the cortisol awakening response. The neurobiological validity of the subtypes was assessed using functional magnetic resonance imaging. Statistical modeling identified three stable, distinct subtypes of compulsivity and affective processing, which we labeled "Compulsive Non-Avoidant", "Compulsive Reactive" and "Compulsive Stressed". They differed meaningfully on validation measures of mood, intolerance of uncertainty, and urgency. Most importantly, subtypes captured neurobiological variance on amygdala-based resting-state functional connectivity, suggesting they were valid representations of underlying neurobiology and highlighting the relevance of emotion-related brain networks in compulsive behavior. Although independent larger samples are needed to confirm the stability of subtypes, these data offer an integrated understanding of how different systems may interact in compulsive behavior and provide new considerations for guiding tailored intervention decisions.

Value-based cognition and drug dependency

Value-based decision-making is thought to play an important role in drug dependency. Achieving elevated levels of euphoria or ameliorating dysphoria/pain may motivate goal-directed drug consumption in both drug-naïve and long-time users. In other words, drugs become viewed as the preferred means of attaining a desired internal state. The bias towards choosing drugs may affect one's cognition. Observed biases in learning, attention and memory systems within the brain gradually focus one's cognitive functions towards drugs and related cues to the exclusion of other stimuli. In this narrative review, the effects of drug use on learning, attention and memory are discussed with a particular focus on changes across brain-wide functional networks and the subsequent impact on behaviour. These cognitive changes are then incorporated into the cycle of addiction, an established model outlining the transition from casual drug use to chronic dependency. If drug use results in the elevated salience of drugs and their cues, the studies highlighted in this review strongly suggest that this salience biases cognitive systems towards the motivated pursuit of addictive drugs. This bias is observed throughout the cycle of addiction, possibly contributing to the persistent hold that addictive drugs have over the dependent. Taken together, the excessive valuation of drugs as the preferred means of achieving a desired internal state affects more than just decision-making, but also learning, attentional and mnemonic systems. This eventually narrows the focus of one's thoughts towards the pursuit and consumption of addictive drugs.

The past, present, and future of selection history

The last ten years of attention research have witnessed a revolution, replacing a theoretical dichotomy (top-down vs. bottom-up control) with a trichotomy (biased by current goals, physical salience, and selection history). This third new mechanism of attentional control, selection history, is multifaceted. Some aspects of selection history must be learned over time whereas others reflect much more transient influences. A variety of different learning experiences can shape the attention system, including reward, aversive outcomes, past experience searching for a target, target‒non-target relations, and more. In this review, we provide an overview of the historical forces that led to the proposal of selection history as a distinct mechanism of attentional control. We then propose a formal definition of selection history, with concrete criteria, and identify different components of experience-driven attention that fit within this definition. The bulk of the review is devoted to exploring how these different components relate to one another. We conclude by proposing an integrative account of selection history centered on underlying themes that emerge from our review.

Dynamic Interplay between Reward and Voluntary Attention Determines Stimulus Processing in Visual Cortex

Reward enhances stimulus processing in the visual cortex, but the mechanisms through which this effect occurs remain unclear. Reward prospect can both increase the deployment of voluntary attention and increase the salience of previously neutral stimuli. In this study, we orthogonally manipulated reward and voluntary attention while human participants performed a global motion detection task. We recorded steady-state visual evoked potentials to simultaneously measure the processing of attended and unattended stimuli linked to different reward probabilities, as they compete for attentional resources. The processing of the high rewarded feature was enhanced independently of voluntary attention, but this gain diminished once rewards were no longer available. Neither the voluntary attention nor the salience account alone can fully explain these results. Instead, we propose how these two accounts can be integrated to allow for the flexible balance between reward-driven increase in salience and voluntary attention.

Acute depletion of dopamine precursors in the human brain: effects on functional connectivity and alcohol attentional bias

Individuals who abuse alcohol often show exaggerated attentional bias (AB) towards alcohol-related cues, which is thought to reflect reward conditioning processes. Rodent studies indicate that dopaminergic pathways play a key role in conditioned responses to reward- and alcohol-associated cues. However, investigation of the dopaminergic circuitry mediating this process in humans remains limited. We hypothesized that depletion of central dopamine levels in adult alcohol drinkers would attenuate AB and that these effects would be mediated by altered function in frontolimbic circuitry. Thirty-four male participants (22-38 years, including both social and heavy drinkers) underwent a two-session, placebo-controlled, double-blind dopamine precursor depletion procedure. At each visit, participants consumed either a balanced amino acid (control) beverage or an amino acid beverage lacking dopamine precursors (order counterbalanced), underwent resting-state fMRI, and completed behavioral testing on three AB tasks: an alcohol dot-probe task, an alcohol attentional blink task, and a task measuring AB to a reward-conditioned cue. Dopamine depletion significantly diminished AB in each behavioral task, with larger effects among subjects reporting higher levels of binge drinking. The depletion procedure significantly decreased resting-state functional connectivity among ventral tegmental area, striatum, amygdala, and prefrontal regions. Beverage-related AB decreases were mediated by decreases in functional connectivity between the fronto-insular cortex and striatum and, for alcohol AB only, between anterior cingulate cortex and amygdala. The results support a substantial role for dopamine in AB, and suggest specific dopamine-modulated functional connections between frontal, limbic, striatal, and brainstem regions mediate general reward AB versus alcohol AB.

Curing the broken brain model of addiction: Neurorehabilitation from a systems perspective

The dominant biomedical perspective on addictions has been that they are chronic brain diseases. While we acknowledge that the brains of people with addictions differ from those without, we argue that the "broken brain" model of addiction has important limitations. We propose that a systems-level perspective more effectively captures the integrated architecture of the embodied and situated human mind and brain in relation to the development of addictions. This more dynamic conceptualization places addiction in the broader context of the addicted brain that drives behavior, where the addicted brain is the substrate of the addicted mind, that in turn is situated in a physical and socio-cultural environment. From this perspective, neurorehabilitation should shift from a "broken-brain" to a systems theoretical framework, which includes high-level concepts related to the physical and social environment, motivation, self-image, and the meaning of alternative activities, which in turn will dynamically influence subsequent brain adaptations. We call this integrated approach system-oriented neurorehabilitation. We illustrate our proposal by showing the link between addiction and the architecture of the embodied brain, including a systems-level perspective on classical conditioning, which has been successfully translated into neurorehabilitation. Central to this example is the notion that the human brain makes predictions on future states as well as expected (or counterfactual) errors, in the context of its goals. We advocate system-oriented neurorehabilitation of addiction where the patients' goals are central in targeted, personalized assessment and intervention.

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.

Risks versus consequences of adolescent and young adult substance use: A focus on executive control

PURPOSE OF REVIEW

This review examines the role of executive control processes in the liability for substance misuse and whether substance use, once initiated, leads to subsequent decrements as proposed by neurotoxicity models of substance use disorder (SUD).

RECENT FINDINGS

As indicated by a number of recent meta-analyses, executive control processes, which include working memory, cognitive flexibility and numerous aspects of attentional, behavioral and emotional control, are impaired in the context of active SUD. Longitudinal studies of behaviorally disinhibited children, individuals with familial risks for SUD, and twins within whom genetic versus environmental influences on behavior can be modeled robustly indicate that relatively poor control is a vulnerability factor for early substance use initiation, binge patterns of use, and subsequent SUD. Evidence of further declines in executive control, once substance use is initiated, is mixed, although a growing number of neuroimaging studies indicate that frontostriatal, frontolimbic, and frontocerebellar systems are altered as a consequence of use.

SUMMARY

Together these patterns suggest strategies for identifying children and adolescents at high risk for SUD, avenues through which substance-related neurotoxicities can be more reliably detected, and the need to structure prevention efforts in a manner that is developmentally appropriate and perhaps personalized to individual vulnerabilities.

Reward history impacts attentional orienting and inhibitory control on untrained tasks

It has been robustly shown that stimuli with reward history receive attentional priority. However, the majority of this research tests reward history effects on attentional bias using similar tasks for both the reward learning phase and the unrewarded testing phase, which limits our understanding of how the effects of reward history generalize beyond the trained tasks and mental sets. Across two new experiments, the current study addresses these issues by first associating reward with a stimulus in a visual search paradigm, and then testing value-driven effects of that stimulus in untrained and unrewarded tasks, including a cueing paradigm, a go/no-go task, and a delay discounting task. Results of Experiment 1 demonstrate that history of reward association in a visual search task generalizes to value-driven attentional bias in a different attention paradigm (i.e., cueing), indicating these effects are indeed attributable to imbued value that can transfer to other tasks beyond that in which the reward was trained. The results of Experiment 2 demonstrate that in addition to eliciting attentional orienting on untrained tasks, reward history can lead to better inhibitory control in the go/no-go task. We find no evidence for reward history effects in the delay discounting task. Together, these experiments demonstrate that when the reward association task is in the attention domain, reward history modulates attentional priority, and this effect generalizes to untrained and unrewarded tasks that utilize both spatial and nonspatial attention.

ABC Training: A New Theory-Based Form of Cognitive-Bias Modification to Foster Automatization of Alternative Choices in the Treatment of Addiction and Related Disorders

Recent years have seen a surge in the popularity of interventions that target common distortions in thinking (cognitive-bias modification, or CBM). Although there is evidence of their effectiveness as add-ons to regular treatment in alcohol addiction, the effects are typically small, and recent findings from lab studies have called into question the dominant theoretical underpinnings of CBM. We provide a novel theoretical approach in terms of automatic inferences that integrates previous findings and suggests ways to improve CBM into ABC training. In ABC training, patients are trained in the context of personally relevant antecedents (A) to make behavioral choices (B) that accord with patients’ health goals in light of their consequences (C). We discuss preliminary evidence suggesting that ABC training might be a useful tool in the treatment of addictions and related disorders.

The Development Study of Smoking Stroop Test on a Turkish Sample

INTRODUCTION

The purpose of this study is to engender a language and culture specific Smoking Stroop Test (SST) in Turkish.

METHODS

The study is performed in three stages (N=334) with smokers and non-smokers of three age groups. On the third stage, all participants have filled STT and were administered Beck Depression Inventory. Besides, the smokers were applied Fagerström Test for Nicotine Dependence, and the elder participants were also assessed with Standardized Mini Mental State Examination Test.

RESULTS

In the first stage, a list comprising a total of 92 words related and not related with smoking have been formed and in the second stage the participants were asked to evaluate the relatedness of these words with cigarette and smoking. As a result of this evaluation 9 related and 9 unrelated words were selected for SST. In the third stage SST was administered to a sample of 70 participants. A 3×2×2 repeated measures for last factor ANOVA was used to determine whether the variance in response times depends on age, cigarette use and word type. The results revealed that there was no significant difference among the non-smoker participants' response times towards related or unrelated words in all age groups. On the other hand, the smokers in young and adult age groups displayed longer response times towards cigarette related words. Internal consistency and test-retest reliability analysis revealed that the test is reliable.

DISCUSSION

SST is a valid, reliable and original tool that can be used in studies in Turkey.

Relating value-driven attention to psychopathology

Reward-associated objects receive preferential attention, reflecting a bias in information processing that develops automatically following associative learning. Mounting evidence suggests that such value-driven attention operates abnormally in certain psychopathologies, with attentional biases for reward-associated objects being either exaggerated or blunted compared to healthy controls. Here, I review the evidence linking value-driven attention to psychopathology, including drug addiction, depression, attention-deficit hyperactivity disorder (ADHD), compulsivity, and impulsive and risky decision-making. I conclude by offering an integrative framework for conceptualizing the link between value-driven attention and psychopathology, along with suggestions for future research into this burgeoning area of investigation, including research on object attachment.

The influence of the noradrenergic/stress system on perceptual biases for reward

Previous research has established a role for the norepinephrine (NE)/stress system in individual differences in biases to attend to reward or punishment. Outstanding questions concern its role in the flexibility with which such biases can be changed. The goal of this preregistered study was to examine the role of the NE/stress system in the degree to which biases can be trained along the axis of valence in the direction of reward. Participants genotyped for a common deletion variant of ADRA2b (linked to altered NE availability) experienced either an acute stress induction or a control procedure. Following stress induction, a "bias probe" task was presented before and after training. In the bias probe task, participants made forced choice judgments (happy or angry) on emotional faces with varying degrees of ambiguity. For bias training, participants viewed unambiguously angry faces in a task exploiting visual adaptation effects. The results revealed an overall shift from a slightly positive bias in categorizing faces pretraining to a more positive bias after training. Carriers of the deletion variant overall showed a more positive bias than did the noncarriers. Follow-up analyses showed that pretraining bias was a significant predictor of bias change, with those who showed a more negative bias preadaptation changing more in a positive direction. Critically, this effect was observed under control but not under stress conditions. These results suggest that the NE/stress system plays an important role in influencing trait-like biases as well as short-term changes in the tendency to perceive ambiguous stimuli as being more rewarding than threatening.

Motivated suppression of value- and threat-modulated attentional capture

Attention prioritizes stimuli previously associated with reward or punishment. The present study examined whether this attentional bias, widely considered to be involuntary and automatic, could be suppressed with sufficient motivation. Participants performed visual search for a shape-defined target. One color-singleton distractor predicted the possibility of receiving a reward and another an electric shock, with each outcome occurring infrequently. Participants were informed that the likelihood to earn a reward or avert punishment depended on fast and accurate performance, thus providing strong motivation to resist distraction by reward- and shock-related stimuli. Results revealed a reduction in the magnitude of attentional capture by reward- and threat-associated distractors, relative to neutral distractors, that persisted into extinction. In a second experiment, we replicated the suppression of value-modulated attentional capture in the absence of the shock condition, thus confirming that the suppression did not result from the presence of threat. Finally, in a third experiment, we replicated the typical pattern of attentional capture by reward cues using a more conventional procedure in which the motivation to suppress valent stimuli was low (the likelihood to be rewarded was high and not contingent on fast performance). This study demonstrates that signals for reward and threat can be actively suppressed with sufficient motivation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Using a smartphone while walking: The cost of smartphone-addiction proneness

Distracted walking is an ever-increasing problem. Studies have already shown that using a smartphone while walking impairs attention and increases the risk of accidents. This study seeks to determine if smartphone-addiction proneness magnifies the risks of using a smartphone while walking. In an experimental design, participants, while walking on a treadmill and engaged in a smartphone task, were required to switch tasks by responding to an external stimulus, i.e., determining the direction of movement of a point-light walker. Participants were chosen to cover a range of smartphone-addiction proneness. Four smartphone-use conditions were simulated: a control condition with no smartphone-use, an individual conversation condition, a gaming condition, and a group conversation condition. Our results show that using a smartphone while walking decreases accuracy and increases the number of missed stimuli. Moreover, participants with higher smartphone-addiction proneness scores were also prone to missing more stimuli, and this effect was found regardless of experimental condition. The effect of the smartphone task on accuracy and the number of missed stimuli was mediated by the emotional arousal caused by the smartphone task. Smartphone-addiction proneness was positively correlated with a declared frequency of smartphone use while walking. Furthermore, of all the smartphone tasks, the gaming condition was found to be the most distracting.

Emotional Objectivity: Neural Representations of Emotions and Their Interaction with Cognition

Recent advances in our understanding of information states in the human brain have opened a new window into the brain's representation of emotion. While emotion was once thought to constitute a separate domain from cognition, current evidence suggests that all events are filtered through the lens of whether they are good or bad for us. Focusing on new methods of decoding information states from brain activation, we review growing evidence that emotion is represented at multiple levels of our sensory systems and infuses perception, attention, learning, and memory. We provide evidence that the primary function of emotional representations is to produce unified emotion, perception, and thought (e.g., “That is a good thing”) rather than discrete and isolated psychological events (e.g., “That is a thing. I feel good”). The emergent view suggests ways in which emotion operates as a fundamental feature of cognition, by design ensuring that emotional outcomes are the central object of perception, thought, and action.

Neural correlates of reward magnitude and delay during a probabilistic delay discounting task in alcohol use disorder

RATIONALE

Alcohol-use disorder (AUD) is associated with the propensity to choose smaller sooner options on the delay discounting task. It is unclear, however, how inherent risk underlies delay discounting behavior. As impulsive choice is a hallmark feature in AUD, it is important to understand the neural response to reward and delay while accounting for risk in impulsive decision-making.

OBJECTIVE

This study examined activation associated with delay and reward magnitude, while controlling for risk in a probabilistic delay discounting task in AUD and examined if differences in activation were associated with treatment outcomes.

METHODS

Thirty-nine recently abstinent alcohol-dependent volunteers and 46 controls completed a probabilistic delay discounting task paired with functional magnetic resonance imaging. Alcohol use was collected using a self-report journal for 3 months following baseline scan.

RESULTS

During delay stimulus presentations, Controls exhibited greater activation compared to the Alcohol group notably in the anterior insula, middle/dorsal anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (PFC), and inferior parietal lobule. For magnitude, the Alcohol group exhibited greater activation than Controls primarily in medial PFC, rostral ACC, left posterior parietal cortex, and right precuneus. Within the Alcohol group, alcohol craving severity negatively correlated with right lateral PFC activation during reward magnitude in individuals who completed the 3-month study without relapse, while non-completers showed the opposite relationship.

CONCLUSIONS

The results of this study extend previous findings that alcohol use disorder is associated with differences in activation during an immediate or delayed choice by delineating activation associated with the parameters of impulsive choice.

Dysfunctional attentional bias and inhibitory control during anti-saccade task in patients with internet gaming disorder: An eye tracking study

BACKGROUND

Although internet gaming disorder (IGD) is considered an addictive disorder, evidence of the neurobiological underpinnings of IGD as an addictive disorder is currently lacking. We investigated whether attentional bias toward game-related stimuli was altered in IGD patients using an eye-tracking method during an anti-saccade task.

METHODS

Twenty-three IGD patients and 27 healthy control (HC) subjects participated in the anti-saccade task with game-related, neutral, and scrambled images during eye tracking. Participants rated subjective scores of valence, arousal, and craving for each image stimulus after finishing eye tracking. Mixed design analysis of variance was performed to compare the differences between eye movement latency and error rate in the pro-saccade and anti-saccade conditions according to image type across the IGD and HC groups.

RESULTS

In the anti-saccade task, the IGD group exhibited higher error rates in the case of game-related images than in neutral or scrambled images. However, ratings on valence, arousal, and craving did not vary among image types. The error rates of the HCs did not vary across image types, but higher arousal/craving and lower valence were reported with respect to the game-related images.

CONCLUSIONS

Increased error rate during anti-saccade tasks with game-related stimuli in IGD may be due to disabilities in goal-directed behavior or inhibitory control, as observed in other addictive disorders. These findings suggest that attentional bias toward game-related stimuli can be a sensitive biological marker of IGD as an addictive disorder.

Semantic generalization of value-based attentional priority

This study aimed to determine whether attentional prioritization of stimuli associated with reward transfers across conceptual knowledge independently of physical features. Participants successively performed two color-word Stroop tasks. In the learning phase, neutral words were associated with high, low, or no monetary reward. In the generalization phase (in which no reward was delivered), synonyms of words previously paired with reward served as Stroop stimuli. Results are consistent with semantic generalization of stimulus-reward associations, with synonyms of high-value words impairing color-naming performance, although this effect was particular to participants who were unaware of the reward contingencies.

Mild Effect of Nalmefene on Alcoholic Cue-Induced Response Invigoration in Alcohol Use Disorder Without Accompanying Changes in Electrophysiological Signatures of Early Visual Processing and Executive Control

Nalmefene is approved for as-needed pharmacological treatment in alcohol use disorder (AUD) by the European Medicines Agency. While the cellular effects of nalmefene have been thoroughly investigated, data are very limited on how this agent influences neural signals associated with inhibitory control and the visual analysis of environmental cues. This double-blind crossover study assessed the behavioral and neural effects of acute nalmefene administration in patients diagnosed with AUD. In experiment 1, we validated our experimental paradigm (electroencephalography combined with a modified Go/NoGo task using images of alcoholic and nonalcoholic drinks as prime stimuli) in 20 healthy adults to ensure that our protocol is suitable for assessing the behavioral and neural aspects of executive control. In experiment 2, we recruited 19 patients with AUD, and in a double-blind crossover design, we investigated the effects of nalmefene versus placebo on task performance (response accuracy, the sensitivity index, and reaction times), visual responses to appetitive cues (occipital P1, N1, and P2 components), and electrophysiological markers of conflict detection and response inhibition (frontal N2 and P3 waveforms). Under placebo, patients produced faster reaction times to alcohol-primed Go stimuli, an effect that was weak despite being statistically significant. However, the effect of alcoholic cues on the speed of response initiation disappeared after receiving nalmefene. We found no placebo versus nalmefene difference regarding our patients’ ability to accurately inhibit responses to NoGo stimuli or for occipital and frontal event-related potentials. Our results suggest that nalmefene might be potent in reducing the vigor to act upon alcoholic cues in AUD patients, but this effect is most probably mediated via subcortical (rather than cortical) neural circuits.

Measuring attention to reward as an individual trait: the value-driven attention questionnaire (VDAQ)

Reward history is a powerful determinant of what we pay attention to. This influence of reward on attention varies substantially across individuals, being related to a variety of personality variables and clinical conditions. Currently, the ability to measure and quantify attention-to-reward is restricted to the use of psychophysical laboratory tasks, which limits research into the construct in a variety of ways. In the present study, we introduce a questionnaire designed to provide a brief and accessible means of assessing attention-to-reward. Scores on the questionnaire correlate with other measures known to be related to attention-to-reward and predict performance on multiple laboratory tasks measuring the construct. In demonstrating this relationship, we also provide evidence that attention-to-reward as measured in the lab, an automatic and implicit bias in information processing, is related to overt behaviors and motivations in everyday life as assessed via the questionnaire. Variation in scores on the questionnaire is additionally associated with a distinct biomarker in brain connectivity, and the questionnaire exhibits acceptable test-retest reliability. Overall, the Value-Driven Attention Questionnaire (VDAQ) provides a useful proxy-measure of attention-to-reward that is much more accessible than typical laboratory assessments.

Neural evidence for automatic value-modulated approach behaviour

Reward learning has the ability to bias both attention and behaviour. The current study presents behavioural and neural evidence that irrelevant responses evoked by previously reward-associated stimuli are more robustly represented in the motor system using a combined go/no-go and flankers task. Following a colour-reward association training, participants were instructed to respond to a central target only in a response-relevant context, while ignoring flankers that appeared either in a high-value or low-value colour. The motor cortex and cerebellum exhibited reduced activation to low-value flankers in a response-irrelevant context, consistent with goal-directed response suppression. However, these same regions exhibited similar activation to high-value flankers regardless of their response relevance, indicating less effective suppression, and the resulting interaction in motor cortex activation was strongly predicted by the influence of the flankers on behaviour. These findings suggest that associative reward learning produces a general approach bias, which is particularly evident when it conflicts with task goals, extending the principle of value-driven attention to stimulus-evoked responses in the motor system.

Revealing Dissociable Attention Biases in Chronic Smokers Through an Individual-Differences Approach

Addiction is accompanied by attentional biases (AB), wherein drug-related cues grab attention independently of their perceptual salience. AB have emerged in different flavours depending on the experimental approach, and their clinical relevance is still debated. In chronic smokers we sought evidence for dissociable attention abnormalities that may play distinct roles in the clinical manifestations of the disorder. Fifty smokers performed a modified visual probe-task measuring two forms of AB and their temporal dynamics, and data on their personality traits and smoking history/status were collected. Two fully dissociable AB effects were found: A Global effect, reflecting the overall impact of smoke cues on attention, and a Location-specific effect, indexing the impact of smoke cues on visuospatial orienting. Importantly, the two effects could be neatly separated from one another as they: (i) unfolded with dissimilar temporal dynamics, (ii) were accounted for by different sets of predictors associated with personality traits and smoking history and (iii) were not correlated with one another. Importantly, the relevance of each of these two components in the single individual depends on a complex blend of personality traits and smoking habits, a result that future efforts addressing the clinical relevance of addiction-related AB should take into careful consideration.

Threat reduces value-driven but not salience-driven attentional capture

What we direct our attention to is strongly influenced by both bottom-up and top-down processes. Moreover, the control of attention is biased by prior learning, such that attention is automatically captured by stimuli previously associated with either reward or threat. It is unknown whether value-oriented and threat-oriented mechanisms of selective information processing function independently of one another, or whether they interact with each other in the selection process. Here, we introduced the threat of electric shock into the value-driven attentional capture paradigm to examine whether the experience of threat influences the attention capturing quality of previously reward-associated stimuli. The results showed that value-driven attentional capture was blunted by the experience of threat. This contrasts with previous reports of threat potentiating attentional capture by physically salient stimuli, which we replicate here. Our findings demonstrate that threat selectively interferes with value-based but not salience-based attentional priority, consistent with a competitive relationship between value-based and threat-based information processing. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Neural correlates of attentional capture by stimuli previously associated with social reward

Our attention is strongly influenced by reward learning. Stimuli previously associated with monetary reward have been shown to automatically capture attention in both behavioral and neurophysiological studies. Stimuli previously associated with positive social feedback similarly capture attention; however, it is unknown whether such social facilitation of attention relies on similar or dissociable neural systems. Here, we used the value-driven attentional capture paradigm in an fMRI study to identify the neural correlates of attention to stimuli previously associated with social reward. The results reveal learning-dependent priority signals in the contralateral visual cortex, posterior parietal cortex, and caudate tail, similar to studies using monetary reward. An additional priority signal was consistently evident in the right middle frontal gyrus (MFG). Our findings support the notion of a common neural mechanism for directing attention on the basis of selection history that generalizes across different types of reward.

Dissociable Components of Experience-Driven Attention

What we pay attention to is influenced by current task goals (goal-directed attention) [1, 2], the physical salience of stimuli (stimulus-driven attention) [3-5], and selection history [6-12]. This third construct, which encompasses reward learning, aversive conditioning, and repetitive orienting behavior [12-18], is often characterized as a unitary mechanism of control that can be contrasted with the other two [12-14]. Here, we present evidence that two different learning processes underlie the influence of selection history on attention, with dissociable consequences for orienting behavior. Human observers performed an antisaccade task in which they were paid for shifting their gaze in the direction opposite one of two color-defined targets. Strikingly, such training resulted in a bias to do the opposite of what observers were motivated and paid to do, with associative learning facilitating orienting toward reward cues. On the other hand, repetitive orienting away from a target produced a bias to repeat this behavior even when it conflicted with current goals, reflecting instrumental conditioning of the orienting response. Our findings challenge the idea that selection history reflects a common mechanism of learning-dependent priority and instead suggest multiple distinct routes by which learning history shapes orienting behavior. We also provide direct evidence for the idea that value-based attention is approach oriented, which limits the effectiveness of attentional bias modification techniques that utilize incentive structures.

Knowledge about the predictive value of reward conditioned stimuli modulates their interference with cognitive processes

Stimuli conditioned with a substance can generate drug-approach behaviors due to their acquired motivational properties. According to implicit theories of addiction, these stimuli can decrease cognitive control automatically. The present study (n = 49) examined whether reward-associated stimuli can interfere with cognitive processes in the absence of knowledge about stimulus–outcome contingencies. Conditioned stimuli (CS) were paired with high-reward (HR) or low-reward (LR) probabilities of monetary reward using a Pavlovian learning task. Participants were categorized as Aware or Unaware of contingencies using a Bayesian analysis. CS were then used as task-irrelevant distractors in modified flanker and N-back tasks. Results show HR CS can generate increased interference in the flanker task for participants Unaware of contingencies, contributing further evidence for the existence of implicit Pavlovian conditioning. For the N-back task, working memory performance was affected by HR CS, albeit only for Aware participants. These results suggest that CS can interfere implicitly with cognitive processes in a similar way to drug-related stimuli. Such an effect could occur in a stimulus-driven fashion, devoid of top-down goal-directedness. These findings have implications for the conceptualization and study of implicit processes in addiction and highlights the necessity to reconsider the measurement of such phenomena.

Cognitive impairment in substance use disorders

Cognitive impairments in substance use disorders have been extensively researched, especially since the advent of cognitive and computational neuroscience and neuroimaging methods in the last 20 years. Conceptually, altered cognitive function can be viewed as a hallmark feature of substance use disorders, with documented alterations in the well-known "executive" domains of attention, inhibition/regulation, working memory, and decision-making. Poor cognitive (sometimes referred to as "top-down") regulation of downstream motivational processes-whether appetitive (reward, incentive salience) or aversive (stress, negative affect)-is recognized as a fundamental impairment in addiction and a potentially important target for intervention. As addressed in this special issue, cognitive impairment is a transdiagnostic domain; thus, advances in the characterization and treatment of cognitive dysfunction in substance use disorders could have benefit across multiple psychiatric disorders. Toward this general goal, we summarize current findings in the abovementioned cognitive domains of substance use disorders, while suggesting a potentially useful expansion to include processes that both precede (precognition) and supersede (social cognition) what is usually thought of as strictly cognition. These additional two areas have received relatively less attention but phenomenologically and otherwise are important features of substance use disorders. The review concludes with suggestions for research and potential therapeutic targeting of both the familiar and this more comprehensive version of cognitive domains related to substance use disorders.

Affectively Biased Competition: Sustained Attention is Tuned to Rewarding Expressions and is Not Modulated by Norepinephrine Receptor Gene Variant

It is well established that emotionally salient stimuli evoke greater visual cortex activation than neutral ones, and can distract attention from competing tasks. Yet less is known about underlying neurobiological processes. As a proxy of population level biased competition, EEG steady-state visual evoked potentials are sensitive to competition effects from salient stimuli. Here we wished to examine whether individual differences in norepinephrine activity play a role in emotionally-biased competition.

Our previous research has found robust effects of a common variation in the ADRA2B gene, coding for alpha2B norepinephrine (NE) receptors, on emotional modulation of attention and memory. In the present study, EEG was collected while 87 carriers of the ADRA2B deletion variant and 95 non-carriers (final sample) performed a change detection task in which target gratings (gabor patches) were superimposed directly over angry, happy, and neutral faces. Participants indicated the number of phase changes (0–3) in the target. Overlapping targets and distractors were flickered at a distinct driving frequencies. Relative EEG power for faces vs. targets at the driving frequency served as an index of cortical resources allocated to each of the competing stimuli. Deletion carriers and non-carriers were randomly assigned to Discovery and Replication samples and reliability of results across samples was assessed before the groups were combined for greater power.

Overall happy faces evoked higher competition than angry or neutral faces; however, we observed no hypothesized effects of ADRA2B. Increased competition from happy faces was not due to the effect of low-level visual features or individuals low in social anxiety. Our results indicate that emotionally biased competition during sustained attention, while reliably observed in young adults, is not influenced by commonly observed individual differences linked to NE receptor function. They further indicate an overall pattern of affectively-biased competition for happy faces, which we interpret in relation to previously observed boundary conditions.

Bias Toward Drug-Related Stimuli Is Affected by Loading Working Memory in Abstinent Ex-Methamphetamine Users

Background: There is a trade-off between drug-related impulsive process and cognitive reflective process among ex-drug abusers. The present study aimed to investigate the impulsive effects of methamphetamine-related stimuli on working memory (WM) performance by manipulating WM load in abstinent ex-methamphetamine users. Methods: Thirty abstinent ex-methamphetamine users and 30 nonaddict matched control participants were recruited in this study. We used a modified Sternberg task in which participants were instructed to memorize three different sets of methamphetamine-related and non-drug-related words (three, five, or seven words) while performing a secondary attention-demanding task as an interference. Results: Repeated-measures ANOVA revealed that reaction times of abstinent ex-methamphetamine users increased during low WM load (three words) compared to the control group (p = 0.01). No significant differences were observed during high WM loads (five or seven words) (both p's > 0.1). Besides, reaction times of the experimental group during trials with high interference (three, five, or seven words) were not significantly different compared to the control group (p > 0.2). Conclusion: These findings imply that increasing WM load may provide an efficient buffer against attentional capture by salient stimuli (i.e., methamphetamine-related words). This buffer might modify the effect of interference bias. Besides, presenting methamphetamine-related stimuli might facilitate the encoding phase due to bias toward task-relevant stimuli. This finding has an important implication, suggesting that performing concurrent demanding tasks may reduce the power of salient stimuli and thus improve the efficiency of emotional regulation strategies.

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.

Attentional bias in opioid users: A systematic review and meta-analysis

BACKGROUND

Opioid use in the United States is a national public health emergency. The primary treatment for opioid use disorder (OUD) is medication assisted treatment (MAT). Although effective in improving treatment outcomes in OUD, there is a need to develop behavioral treatments adjunctive to MAT. The current study investigates attentional bias in OUD as a possible target for adjunctive behavioral treatments.

METHODS

Comprehensive literature searches of psychological, medical, and educational databases were conducted through October 2017. Eligible peer-reviewed studies evaluated attentional bias in opioid users, used a task to evaluate attentional bias that included active response to study stimuli, calculated attention bias by comparing response to drug and neutral stimuli, and could isolate attentional bias specific to opioid versus neutral stimuli from bias to other salient stimuli.

CONCLUSIONS

The results of our systematic review and meta-analysis suggest that individuals with OUD exhibit robust attentional bias to opioid cues, even when engaged in MAT. Interventions that reduce attentional bias may be a useful adjunct to MAT.

Tendencies toward Internet-pornography-use disorder: Differences in men and women regarding attentional biases to pornographic stimuli

BACKGROUND AND AIMS

Several authors consider Internet-pornography-use disorder (IPD) as addictive disorder. One of the mechanisms that has been intensively studied in substance- and non-substance-use disorders is an enhanced attentional bias toward addiction-related cues. Attentional biases are described as cognitive processes of individual's perception affected by the addiction-related cues caused by the conditioned incentive salience of the cue itself. It is assumed in the I-PACE model that in individuals prone to develop IPD symptoms implicit cognitions as well as cue-reactivity and craving arise and increase within the addiction process.

METHODS

To investigate the role of attentional biases in the development of IPD, we investigated a sample of 174 male and female participants. Attentional bias was measured with the Visual Probe Task, in which participants had to react on arrows appearing after pornographic or neutral pictures. In addition, participants had to indicate their sexual arousal induced by pornographic pictures. Furthermore, tendencies toward IPD were measured using the short-Internetsex Addiction Test.

RESULTS

The results of this study showed a relationship between attentional bias and symptom severity of IPD partially mediated by indicators for cue-reactivity and craving. While men and women generally differ in reaction times due to pornographic pictures, a moderated regression analysis revealed that attentional biases occur independently of sex in the context of IPD symptoms.

DISCUSSION

The results support theoretical assumptions of the I-PACE model regarding the incentive salience of addiction-related cues and are consistent with studies addressing cue-reactivity and craving in substance-use disorders.

Test-retest reliability of value-driven attentional capture

Attention is biased toward learned predictors of reward. The degree to which attention is automatically drawn to arbitrary reward cues has been linked to a variety of psychopathologies, including drug dependence, HIV-risk behaviors, depressive symptoms, and attention deficit/hyperactivity disorder. In the context of addiction specifically, attentional biases toward drug cues have been related to drug craving and treatment outcomes. Given the potential role of value-based attention in psychopathology, the ability to quantify the magnitude of such bias before and after a treatment intervention in order to assess treatment-related changes in attention allocation would be desirable. However, the test-retest reliability of value-driven attentional capture by arbitrary reward cues has not been established. In the present study, we show that an oculomotor measure of value-driven attentional capture produces highly robust test-retest reliability for a behavioral assessment, whereas the response time (RT) measure more commonly used in the attentional bias literature does not. Our findings provide methodological support for the ability to obtain a reliable measure of susceptibility to value-driven attentional capture at multiple points in time, and they highlight a limitation of RT-based measures that should inform the use of attentional-bias tasks as an assessment tool.