Effects of attentional bias modification therapy on the cue reactivity and cognitive control networks in participants with cocaine use disorders

Attentional biases in abstinent patients with cocaine use disorder: rapid orienting or delayed disengagement?

Addiction-related attentional biases may play a central role in the development and maintenance of drug-seeking and drug-taking behaviors. However, evidence in cocaine dependence is limited and mixed. This study examined the time course and component processes of attentional biases for cocaine-related cues in a sample of 47 outpatients (38 men) with cocaine use disorder (CUD) with varying durations of current abstinence. Reaction times in a visual dot-probe task with two picture exposure durations -500 ms, to assess initial stages of attention, and 2,000 ms, to assess maintained attention- were recorded. We found faster responses to probes replacing cocaine-related vs. matched control pictures in the 500 ms but not in the 2,000 ms condition, indicative of early but not late attentional biases for cocaine cues in abstinent patients with CUD. Further comparisons with a neutral baseline revealed that it was not due to rapid orienting but to delayed disengagement from cocaine-related pictures, being this effect greater the longer the period of current abstinence. Consistent with the incentive-sensitization theory, these data suggest that cocaine-related stimuli maintain the capacity to hold spatial attention in abstinent patients with CUD, even after months of abstinence, highlighting the relevance of carrying out stimulus control to avoid relapses.

Be more mindful: Targeting addictive responses by integrating mindfulness with cognitive bias modification or cue exposure interventions

This review provides an overview of the most prominent neurocognitive effects of cognitive bias modification (CBM), cue-exposure therapy and mindfulness interventions for targeting addictive responses. It highlights the key insights that have stemmed from cognitive neuroscience and brain imaging research and combines these with insights from behavioural science in building a conceptual model integrating mindfulness with response-focused CBM or cue-exposure interventions. This furthers our understanding of whether and how mindfulness strategies may i) facilitate or add to the induced response-focused effects decreasing cue-induced craving, and ii) further weaken the link between craving and addictive responses. Specifically, awareness/monitoring may facilitate, and decentering may add to, response-focused effects. Combined awareness acceptance strategies may also diminish the craving-addiction link. The conceptual model presented in this review provides a specific theoretical framework to deepen our understanding of how mindfulness strategies and CBM or cue-exposure interventions can be combined to greatest effect. This is important in both suggesting a roadmap for future research, and for the further development of clinical interventions.

Cognitive Alterations in Addictive Disorders: A Translational Approach

The cognitive decline in people with substance use disorders is well known and can be found during both the dependence and drug abstinence phases. At the clinical level, cognitive decline impairs the response to addiction treatment and increases dropout rates. It can be irreversible, even after the end of drug abuse consumption. Improving our understanding of the molecular and cellular alterations associated with cognitive decline could be essential to developing specific therapeutic strategies for its treatment. Developing animal models to simulate drug abuse-induced learning and memory alterations is critical to continue exploring this clinical situation. The main aim of this review is to summarize the most recent evidence on cognitive impairment and the associated biological markers in patients addicted to some of the most consumed drugs of abuse and in animal models simulating this clinical situation. The available information suggests the need to develop more studies to further explore the molecular alterations associated with cognitive impairment, with the ultimate goal of developing new potential therapeutic strategies.

Can we enhance the clinical efficacy of cognitive and psychological approaches to treat substance use disorders through understanding their neurobiological mechanisms?

Despite decades of research in the field of addiction, relapse rates for substance use disorders remain high. Consequently, there has been growing focus on providing evidence-based treatments for substance use disorders, resulting in the increased development and use of cognitive and psychological interventions. Such treatment approaches, including contingency management, community-reinforcement approach, and cognitive bias modification, have shown promising clinical efficacy in reducing substance use and promoting abstinence during treatment. However, these interventions are still somewhat limited in achieving sustained periods of abstinence post-treatment. The neurobiological mechanisms underpinning these treatment approaches remain largely unknown and under-studied, in part, due to a lack of translational animal models. The adoption of a reverse translational approach may assist in development of more representative models that can facilitate elucidation of the mechanisms behind these clinically relevant interventions. This review examines our current understanding of addiction neurobiology from clinical, preclinical research and existing animal models, and considers how the efficacy of such behavioral-oriented interventions alone, or in combination with pharmacotherapy, may be enhanced to improve treatment outcomes.

Cognitive Bias Modification for Addictive Disorders: Emerging Knowledge and Persistent Gaps

The advances in experimental psychology have led to the discovery of unconscious, automatic biases (attentional and approach biases) that account for the lapse and relapses amongst individuals with addictive disorders. To date, there has been extensive investigation into the assessment and modification of attention biases amongst individuals with the highly prevalent substance use disorders. Alternative modalities, such as technology, has also been evaluated for the delivery of these interventions. Given this, the specific objectives of this perspective article are in highlighting the emerging knowledge that has accrued over the last three years, and in addressing several of the research gaps in the previous article. Firstly, this perspective article will examine the evidence for biases and bias modification amongst the highly prevalent substance use disorders. This article will also examine how such bias modification has been utilized clinically. Secondly, this perspective article will also examine how technology has been applied to these bias modification interventions. Thirdly, this article will also examine the literature to highlight the biological underpinnings following bias modification. Fourthly, this article also examines the limitations of existing bias modification paradigms and methods taken to better these conventional interventions. The article concludes with highlighting the outstanding gaps in the current knowledge. To date, there remains mixed evidence for the modification of attention biases; and there are a paucity of studies examining the effectiveness of mobile delivery of bias intervention. Only one study has considered patients’ perspective in the development of an intervention. There remained several gaps in the knowledge, which future research could address.