Toward a Triadic Approach to Craving in Addictive Disorders: The Metacognitive Hub Model

Virtual reality cue-exposure therapy in reducing cocaine craving: the Promoting Innovative COgnitive behavioral therapy for Cocaine use disorder (PICOC) study protocol for a randomized controlled trial

BACKGROUND

Cocaine craving is a central symptom of cocaine use disorders (CUD). Virtual reality cue-exposure therapy for craving (VRCET) allows more immersive, realistic, and controllable exposure than traditional non-VR cue-exposure therapy (CET), whose efficacy is limited in treating substance use disorders. The purpose of this study is to evaluate the efficacy and acceptability of VRCET, as a stand-alone and add-on intervention (i.e., combined with cognitive therapy), compared to a picture-based CET (PCET), in reducing self-reported cocaine craving in inpatients hospitalized for CUD.

METHODS

Fifty-four inpatients hospitalized for CUD will be randomized in one of two intensive 3-week treatment arms: 10 meetings/2-week treatment of VRCET plus 5 meetings/1-week treatment of memory-focused cognitive therapy (MFCT; experimental arm), or 15 meetings/3-week treatment of PCET (active control arm). The Craving Experience Questionnaire (CEQ - F & S) will be used to assess the primary outcome, i.e., the post-treatment decrease of self-reported cocaine craving frequency (within the past 2 weeks) and intensity scores (in VR exposure to cocaine cues). Secondary endpoints include urinary, physiological, and self-reported cocaine use-related measures. Assessments are scheduled at pretreatment, after 2 weeks of treatment (i.e., VRCET vs. PCET), post-treatment (3 weeks, i.e., VRCET + MFCT vs. PCET), and at 1-month follow-up. Acceptability will be evaluated via (i) the Spatial Presence for Immersive Environments - Cybersickness along VRCET and (ii) the Client Satisfaction Questionnaires after 2 weeks of treatment and post-treatment.

DISCUSSION

This study will be the first to evaluate the acceptability and efficacy of VRCET for CUD, as a psychotherapeutic add-on, to reduce both cocaine craving frequency and intensity. Additionally, this study will provide evidence about the specific interest of VRCET, compared to a non-VR-based CET, as a cue reactivity and exposure paradigm for treating substance use disorders.

TRIAL REGISTRATION

NCT05833529 [clinicaltrials.gov]. Prospectively registered on April 17, 2023.

Identifying the role of (dis)inhibition in the vicious cycle of substance use through ecological momentary assessment and resting-state fMRI

Functional inhibition is known to improve treatment outcomes in substance use disorder (SUD), potentially through craving management enabled by underlying cerebral integrity. Whereas treatment is challenged by a multitude of substances that patients often use, no study has yet unraveled if inhibition and related cerebral integrity could prevent relapse from multiples substances, that is, one's primary drug of choice and secondary ones. Individuals with primary alcohol, cannabis, or tobacco use disorders completed intensive Ecological Momentary Assessment (EMA) coupled with resting-state functional MRI (rs-fMRI) to characterize the extent to which inhibition and cerebral substrates interact with craving and use of primary and any substances. Participants were 64 patients with SUD and 35 healthy controls who completed one week EMA using Smartphones to report 5 times daily their craving intensity and substance use and to complete Stroop inhibition testing twice daily. Subsamples of 40 patients with SUD and 34 control individuals underwent rs-fMRI. Mixed Model Analysis revealed that reported use of any substance by SUD individuals predicted later use of any and primary substance, whereas use of the primary substance only predicted higher use of that same substances. Craving and inhibition level independently predicted later use but did not significantly interact. Preserved inhibition performance additionally influenced use indirectly by mediating the link between subsequent uses and by being linked to rs-fMRI connectivity strength in fronto-frontal and cerebello-occipital connections. As hypothesized, preserved inhibition performance, reinforced by the integrity of inhibitory neurofunctional substrates, may partake in breaking an unhealthy substance use pattern for a primary substance but may not generalize to non-target substances or to craving management.

Towards virtual reality exposure therapy for cocaine use disorder: A feasibility study of inducing cocaine craving through virtual reality

Background

Craving is a core symptom of cocaine use disorders (CUD). Inducing craving in exposure to substance cues is of relevant interest for numerous clinical applications. Virtual reality exposure (VRE) might be a promising candidate for improving cue-exposure paradigms but remains almost not studied for cocaine. This feasibility study's main aim is to assess whether VRE to cocaine cues is capable to induce cocaine craving compared with VRE to neutral cues.

Methods

We conducted a within-subjects controlled trial in which cocaine users performed 3 consecutive 10 mins-tasks: VRE to neutral and cocaine cues, and a relaxation-based resting procedure. The primary outcome was the change in Cocaine Craving Questionnaire-Brief (CCQ-Brief) scores between VRE to neutral and cocaine cues. Secondary outcomes included between-tasks changes in scores of cocaine craving, pleasant/unpleasant emotions as well as self-efficacy to cope with craving.

Results

We recruited 11 chronic cocaine users including mostly crack smokers (45 %), cocaine snorters (36 %) and injectors (18 %), with 73 % of participants meeting DSM-IV criteria for cocaine dependence and/or abuse. Non-parametrical sign tests indicated significant large increases of CCQ-Brief scores from neutral to cocaine cue-VRE (S(11) = 11, p < 0.01, Cliff's Δ = 0.65, 95 % CI: 0.17-0.88). Exploratory comparative analyses indicated significant changes after our post-cues VRE relaxation procedure, with cocaine craving and emotions restored to baseline.

Conclusions

VRE to cocaine cues was feasible and capable to induce cocaine craving in cocaine users. This second VRE-based cue-reactivity study in cocaine paves the way for unexplored research on VRE clinical applications for CUD.

Multi-level prediction of substance use: Interaction of white matter integrity, resting-state connectivity and inhibitory control measured repeatedly in every-day life

Substance use disorders are characterized by inhibition deficits related to disrupted connectivity in white matter pathways, leading via interaction to difficulties in resisting substance use. By combining neuroimaging with smartphone-based ecological momentary assessment (EMA), we questioned how biomarkers moderate inhibition deficits to predict use. Thus, we aimed to assess white matter integrity interaction with everyday inhibition deficits and related resting-state network connectivity to identify multi-dimensional predictors of substance use. Thirty-eight patients treated for alcohol, cannabis or tobacco use disorder completed 1 week of EMA to report substance use five times and complete Stroop inhibition testing twice daily. Before EMA tracking, participants underwent resting state functional MRI and diffusion tensor imaging (DTI) scanning. Regression analyses were conducted between mean Stroop performances and whole-brain fractional anisotropy (FA) in white matter. Moderation testing was conducted between mean FA within significant clusters as moderator and the link between momentary Stroop performance and use as outcome. Predictions between FA and resting-state connectivity strength in known inhibition-related networks were assessed using mixed modelling. Higher FA values in the anterior corpus callosum and bilateral anterior corona radiata predicted higher mean Stroop performance during the EMA week and stronger functional connectivity in occipital-frontal-cerebellar regions. Integrity in these regions moderated the link between inhibitory control and substance use, whereby stronger inhibition was predictive of the lowest probability of use for the highest FA values. In conclusion, compromised white matter structural integrity in anterior brain systems appears to underlie impairment in inhibitory control functional networks and compromised ability to refrain from substance use.

Craving dynamics and related cerebral substrates predict timing of use in alcohol, tobacco, and cannabis use disorders

Background

Patients treated for Substance Use Disorders exhibit highly fluctuating patterns of craving that could reveal novel prognostic markers of use. Accordingly, we 1) measured fluctuations within intensively repeated measures of craving and 2) linked fluctuations of craving to connectivity indices within resting-state (rs) brain regions to assess their relation to use among patients undergoing treatment for Alcohol, Tobacco and Cannabis Use Disorders.

Method

Participants -64 individuals with SUD for tobacco, alcohol, or cannabis and 35 healthy controls-completed a week of Ecological Momentary Assessment (EMA) during which they reported craving intensity and substance use five times daily. Before EMA, a subsample of 50 patients, and 34 healthy controls also completed resting-state (rs)-MRI acquisitions. Craving temporal dynamics within each day were characterized using Standard Deviation (SD), Auto-Correlation Factor (ACF), and Mean Successive Square Difference (MSSD). Absolute Difference (AD) in craving between assessments was a prospective prediction measure.

Results

Within-day, higher MSSD predicted greater substance use while controlling for mean craving. Prospectively higher AD predicted later increased substance use independently of previous use or craving level. Moreover, MSSD was linked to strength in five functional neural connections, most involving frontotemporal systems. Cerebello-thalamic and thalamo-frontal connectivity were also linked to substance use and distinguished the SUD from the controls.

Conclusion

To the best of our knowledge, this is the first study to indicate that instability in craving may be a trigger for use in several SUD types, beyond the known effect of craving intensity.

Connectome-based prediction of craving in gambling disorder and cocaine use disorder

INTRODUCTION

Craving, involving intense and urgent desires to engage in specific behaviours, is a feature of addictions. Multiple studies implicate regions of salience/limbic networks and basal ganglia, fronto-parietal, medial frontal regions in craving in addictions. However, prior studies have not identified common neural networks that reliably predict craving across substance and behavioural addictions.

METHODS

Functional magnetic resonance imaging during an audiovisual cue-reactivity task and connectome-based predictive modelling (CPM), a data-driven method for generating brain-behavioural models, were used to study individuals with cocaine-use disorder and gambling disorder. Functions of nodes and networks relevant to craving were identified and interpreted based on meta-analytic data.

RESULTS

Craving was predicted by neural connectivity across disorders. The highest degree nodes were mostly located in the prefrontal cortex. Overall, the prediction model included complex networks including motor/sensory, fronto-parietal, and default-mode networks. The decoding revealed high functional associations with components of memory, valence ratings, physiological responses, and finger movement/motor imagery.

CONCLUSIONS

Craving could be predicted across substance and behavioural addictions. The model may reflect general neural mechanisms of craving despite specificities of individual disorders. Prefrontal regions associated with working memory and autobiographical memory seem important in predicting craving. For further validation, the model should be tested in diverse samples and contexts.

From game engagement to craving responses - The role of gratification and compensation experiences during video-gaming in casual and at-risk gamers

Introduction

Although playing videogames is a common leisure activity some individuals develop problematic gaming behaviors or even symptoms of a gaming disorder. Game engagement may be involved in reinforcement learning that may result in experiences of craving, an important feature of gaming disorder. In the following study we aimed to approach the question which aspects contribute to increased craving for gaming.

Methods

Overall, 439 individuals participated in an online survey, answering questionnaires on game engagement, experience of gratification and compensation, craving, and symptoms of gaming disorder. A mediation model testing if the association between game engagement and facets of craving are mediated by the experience of gratification and compensation during gaming.

Results

Three facets of craving (reward/relief, physiological, obsessive craving) were statistically explained by game engagement and the experience of gratification and compensation. Models differed between casual gamers and at-risk gamers. The effects on reward/relief and physiological craving were fully mediated in the casual group and partially mediated in the at-risk group by gratification and compensation experiences.

Conclusion

Game engagement may contribute to the development of craving by increasing the experience of gratification and compensation and thus might be important in reinforcement learning. Games evoking a high engagement may therefore have a higher addictive potential. Further processes potentially related to game engagement, such as intrusive thoughts and desire thinking, which are related to craving experiences, should be considered in future studies.

Music therapy, neural processing, and craving reduction: an RCT protocol for a mixed methods feasibility study in a Community Substance Misuse Treatment Service

BACKGROUND

Music therapy has been shown to be effective for multiple clinical endpoints associated with substance use disorder such as craving reduction, emotion regulation, depression, and anxiety, but there are a lack of studies investigating those effects in UK Community Substance Misuse Treatment Services (CSMTSs). Furthermore, there is a demand for identifying music therapy mechanisms of change and related brain processes for substance use disorder treatment. The present study aims to evaluate the feasibility and acceptability of music therapy and a pre-test, post-test, and in-session measurement battery in a CSMTS.

METHODS

Fifteen participants, from a community service based in London, will take part in a mixed-methods non-blind randomized-controlled trial. Ten participants will receive six-weekly sessions of music therapy in addition to the standard treatment offered by the CSMTS-five of them will receive individual music therapy and five of them will receive group music therapy-while a further five participants will act as a control group receiving standard treatment only. Satisfaction and acceptability will be evaluated in focus groups with service users and staff members following the final treatment session. Moreover, attendance and completion rates will be monitored throughout the intervention. Subjective and behavioral indexes will be assessed before and after the interventions to explore the effects of music therapy on craving, substance use, symptoms of depression and anxiety, inhibitory control, and will be correlated with associated neurophysiological signatures. In-session analysis of two individual music therapy sessions will serve to explore how music and emotion are processed in the brain within the therapy. The data collected at each step will be included in an intention-to-treat analysis basis.

DISCUSSION

This study will provide a first report on the feasibility of music therapy as an intervention for participants with substance use disorder engaged within a community service. It will also provide valuable information regarding the implementation of a multifaceted methodology that includes neurophysiological, questionnaire-based, and behavioral assessments in this cohort. Notwithstanding the limitation of a small sample size, the present study will provide novel preliminary data regarding neurophysiological outcomes in participants with substance use disorder that received music therapy.

TRIAL REGISTRATION

ClinicalTrails.gov, NCT0518061, Registered 6 January 2022, https://clinicaltrials.gov/ct2/show/NCT05180617.

Confusion of Alcohol Craving With Food Hunger in Alcohol-Dependent Individuals Entering In-Patient Drug Treatment

AIM

To identify the distinguishing characteristics of alcohol dependent patients who confuse alcohol cravings with pre-meal hunger.

METHODS

Data were collected at interview on sociodemographic status, clinical status and anthropometry in 179 patients (163 men and 16 women) undergoing in-patient treatment for alcohol dependence.

RESULTS

A comparison of the patient subgroups studied showed that patients who did not confuse, and those who did confuse, alcohol craving with pre-meal hunger differed significantly in terms of alcohol craving scale scores (9 vs. 4 points). Patients confusing alcohol cravings with pre-meal hunger were more likely to recognize that experiencing severe pre-meal hunger can cause relapse (67.9 vs. 22.8%) and that not being able to distinguish between the sensations under study also increases the risk of breaking abstinence (75.0% vs. 50.4%). This was independent of severity of dependence and intensity of recent alcohol consumption.

CONCLUSIONS

Alcohol-dependent persons who confuse alcohol craving with pre-meal hunger differ from those who do not confuse these hunger pangs in terms of feeling stronger alcohol craving and more frequent occurrence of symptoms accompanying the feeling of alcohol craving during pre-meal hunger. At the start of treatment for alcohol withdrawal, alcohol-dependent individuals who report confusing alcohol cravings with pre-meal hunger are less confident of maintaining abstinence. This is relevant to treatment. The role of possible confounders (depressive symptoms, cognitive and educational deficiency) could not be elucidated definitively.

Neuroplastic Changes in Addiction Memory-How Music Therapy and Music-Based Intervention May Reduce Craving: A Narrative Review

Recent findings indicate that Music Therapy (MT) and Music-Based Interventions (MBIs) may reduce craving symptoms in people with Substance Use Disorders (SUD). However, MT/MBIs can lead SUD clients to recall memories associated with their drug history and the corresponding strong emotions (addiction memories). Craving is a central component of SUD, possibly linked to relapse and triggered by several factors such as the recall of memories associated with the drug experience. Therefore, to address the topic of what elements can account for an improvement in craving symptoms after MT/MBIs, we conducted a narrative review that (1) describes the brain correlates of emotionally salient autobiographical memories evoked by music, (2) outlines neuroimaging and neurophysiological studies suggesting how the experience of craving may encompass the recall of emotionally filled moments, and (3) points out the role of perineuronal nets (PNNs) in addiction memory neuroplasticity. We highlight how autobiographical memory retrieval, music-evoked autobiographical memories, and craving share similar neural activations with PNNs which represent a causal element in the processing of addiction memory. We finally conclude by considering how the neuroplastic characteristics of addiction memory might represent the ground to update and/or recalibrate, within the therapy, the emotional content related to the recall.

How drug cravings affect metacognitive monitoring in methamphetamine abusers

BACKGROUND AND OBJECTIVE

Metacognitive monitoring refers to the process in which an individual analyzes their own mental state, then monitors and adjusts cognitive activities to achieve a predetermined goal. Recent research has suggested a strong link between metacognition and drug cravings. Conversely, few studies on the impact of metacognitive monitoring on methamphetamine (MA) cravings exist. Thus, this study investigated whether drug cravings would impair MA abusers' metacognitive monitoring and explored the prediction effects of drug cravings.

METHOD

Seventy MA abusers from the Zhejiang Compulsory Isolation Drug Rehabilitation Center and 65 non-users from the Wenzhou Medical University were recruited for this experimental study. The judgment of learning (JOL) paradigm was used to examine metacognitive monitoring, and cue-induced pictures were used to induce MA abusers' drug cravings. Analysis of covariance (ANCOVA), partial correlation, and regression analysis were performed.

RESULTS

Compared with non-users, MA abusers had significantly poorer metacognitive monitoring and tended to overestimate their performance. Furthermore, there was a significant correlation between the accuracy of JOLs and drug cravings, which indicated that metacognitive monitoring was weakened by drug cravings with higher cravings imposing more severe impacts. In addition, the regression analysis suggested that drug cravings can predict metacognitive monitoring.

Clinical insight level predicts successful quit or control attempts during the first three months of outpatient addiction treatment

INTRODUCTION

Low clinical insight in psychiatry is defined as poor recognition of one's mental illness, including disability to self-evaluate symptom severity. It has been reported as common in addiction and is associated with lower treatment compliance. Longitudinal studies suggest that low clinical insight could be linked to more relapse. However, association with successful quit attempts remains unknown.

OBJECTIVE

Our objective was to examine the prospective link between baseline clinical insight level and self-reports of successful attempts to quit / control use during the first 3 months of outpatient addiction treatment.

METHODS

Participants were recruited from the ADDICTAQUI cohort at outpatient treatment intake for substance or behavioral addictions. They completed a baseline evaluation using the Addiction Severity Index (ASI), the Mini International Neuropsychiatric Interview (MINI), and the modified Hanil Alcohol Insight Scale (m-HAIS) with a follow-up ASI 3 months later. Data were analyzed using multiple logistic regression and non-parametric tests.

RESULTS

Lower clinical insight level at baseline was associated with less successful quit / control attempts during the first 3 months of outpatient treatment compared to a higher clinical insight level, controlling for sociodemographic factors, baseline addiction severity, and comorbidities (n = 54; exp(B) = 0.76; p (FDRcor) = 0.033).

CONCLUSION

Poor clinical insight may be a barrier to treatment success, and future studies should examine underlying mechanisms.

"It's a beer!": Brain functional hyperconnectivity during processing of alcohol-related images in young binge drinkers

Alcohol attentional bias has been pointed as a major marker of alcohol misuse. Recent evidence has revealed that brain functional connectivity (FC) may be a valuable index of the brain networks' integrity in young binge drinkers (BDs). However, there is no study to date examining the FC networks linked to the processing of alcohol-related images in this population. The present study aimed to explore the FC signatures underlying alcohol attention bias in young BDs. Thus, electroencephalographic (EEG) activity was recorded in 54 college students (55.5% females; 27 non/low-drinkers and 27 BDs) while performing a visual alcohol cue-reactivity task. We evaluated whole-brain FC profiles during the processing of alcoholic and non-alcoholic cues, as well as their potential relationship with craving and severity of alcohol use. Results showed that, at the behavioural level, BDs rated alcohol-related images as more pleasant/attractive than non/low-drinkers. Furthermore, at the electrophysiological level, BDs exhibited increased beta-band FC-particularly in the fronto-parieto-occipital network-when processing alcoholic cues. Conversely, they displayed reduced theta-band FC relatively to non/low-drinkers for non-alcoholic images. These hyper-/hypo-connectivity patterns were associated with higher alcohol craving levels. Findings are congruent with previous neurofunctional studies reporting an attentional bias towards alcohol-related information in BDs. These results may have important clinical implications as this neural reactivity to alcoholic cues may contribute to the maintenance and/or escalation of the drinking pattern. Finally, the present study constitutes the first evidence showing that FC networks may be a sensitive indicator to alcohol attentional bias in BDs.

Repetitive Transcranial Magnetic Stimulation (rTMS) as a Promising Treatment for Craving in Stimulant Drugs and Behavioral Addiction: A Meta-Analysis

Addiction is a mental disorder with limited available treatment options. The therapeutic potential of repetitive transcranial magnetic stimulation (rTMS) on it, by targeting craving in particular, has been explored with heterogenous results. This meta-analysis uses updated evidence to assess overall rTMS efficacy on craving, differential effects between addiction types clustered into three groups (depressant (alcohol, cannabis, opiate), stimulant (nicotine, cocaine, methamphetamine), and behavioral addiction (gambling, eating disorder)), and stimulation settings. Studies on substance use, gambling, and eating disorders are included, with unrestricted stimulation settings, by searching the PubMed, Embase, PsycINFO, and Cochrane databases up to 30 April 2020. A total of 34 eligible studies (42 units of analysis) were identified. Because of highly significant heterogeneity in primary results, a sensitivity analysis was performed on a remaining sample of 26 studies (30 units of analysis). Analyses performed using random effects model revealed a small effect size favoring active rTMS over shamTMS stimulation in the reduction in craving. We found a significant difference between addiction types, with a persistent small effect only for stimulant and behavioral groups. In these groups we found no difference between the different combinations of target and frequency of stimulation, but a significant correlation between number of sessions and craving reduction. In conclusion, efficacy of rTMS on craving in stimulant and behavioral addiction was highlighted, but recommendations on optimal stimulation settings and its clinical application await further research.

Precision Preventive Medicine of Relapse in Smoking Cessation: Can MRI Inform the Search of Intermediate Phenotypes?

Simple Summary

Addiction to tobacco is a serious health and economical problem because it is one of the most addictive and the most consumed substance in the world. Although well documented, and despite the desire of numerous smokers to quit, maintenance of abstinence is a daily challenge for most of them. The heterogeneity in achieving this maintenance raises the question of potential differences in brain reactivity. An emerging field of research has been interested in brain markers helping to identify individuals who are the most likely to relapse. Using brain imaging techniques such as Magnetic Resonance Imaging (MRI), one can hope it will be possible to offer tailored care for each patient.

Abstract

Chronic tobacco smoking remains a major health problem worldwide. Numerous smokers wish to quit but most fail, even if they are helped. The possibility of identifying neuro-biomarkers in smokers at high risk of relapse could be of incredible progress toward personalized prevention therapy. Our aim is to provide a scoping review of this research topic in the field of Magnetic Resonance Imaging (MRI) and to review the studies that investigated if MRI defined markers predicted smoking cessation treatment outcome (abstainers versus relapsers). Based on the available literature, a meta-analysis could not be conducted. We thus provide an overview of the results obtained and take stock of methodological issues that will need to be addressed to pave the way toward precision medicine. Based on the most consistent findings, we discuss the pivotal role of the insula in light of the most recent neurocognitive models of addiction.

Cognitive function in binge eating disorder and food addiction: A systematic review and three-level meta-analysis

BACKGROUND

An extensive body of recent research has focused on the contribution of cognitive functioning to eating behaviors. In binge eating disorder (BED) and food addiction (FA), the extent of cognitive impairment is still unclear. This study aimed to characterize, among those with BED and FA, neurocognitive functions using performances based on neuropsychological tasks in the context of neutral stimuli in adults.

METHOD

MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL and gray literature (ProQuest and OpenGrey) were used to identify studies that reported neurocognitive assessments in BED or FA up to December 2019. A three-level meta-analysis was conducted.

RESULTS

A significant overall effect was found for global cognitive impairments, suggesting that individuals with BED or FA have poorer performances when completing cognitive tasks. Analyses for specific cognitive domains revealed that individuals with BED showed poorer performances at tasks assessing cognitive flexibility, inhibitory control, attention and planning. Analyses regarding FA were inconclusive due to a lack of studies. Thus, the results were described qualitatively.

CONCLUSION

Our meta-analysis highlighted the cognitive weaknesses that seem to come with BED and the necessity to integrate them in the assessment and treatment of this condition. It also stressed the lack of quality studies surrounding the cognitive features of FA.

Integrating Desire Thinking into the I-PACE Model: a Special Focus on Internet-Use Disorders

Purpose of Review

This manuscript aims to propose an integration of desire thinking into the Interaction of Person-Affect-Cognition-Execution (I-PACE) model based on theoretical considerations within the Elaborated Intrusion Theory of Desire and Self-Regulatory Execution Function model and empirical evidence from the field of internet-use disorders.

Recent Findings

Theory and research on desire thinking in the context of internet-use disorders suggest considerable relations to craving, metacognitive beliefs, and emphasizes its nature when initiated as a reaction towards unpleasant triggers. Accordingly, we postulate that desire thinking may be located at the position for affective and cognitive reactions towards triggers within the I-PACE model.

Summary

The suggested integration of desire thinking into the I-PACE model specifically implies the assumption of a relief-oriented and pleasure-oriented entry pathway into desire thinking and a feedback loop between desire thinking and the experience of gratification and compensation. The model pathways proposed here may serve as a theoretical basis for future research and need further empirical verification.

Portuguese validation of the Alcohol Craving Questionnaire-Short Form-Revised

Alcohol craving has been described as a strong subjective desire to drink, being considered highly valuable in the clinical practice, as it is recognized as a strong predictor of alcohol relapse in alcohol-dependent individuals. However, to date, there is not a multifactorial questionnaire available for assessing short-term acute craving experience in Portugal. The aim of the present study was to validate a swift and efficient tool for the assessment of acute alcohol craving in a sample of Portuguese citizens. For that purpose, the Alcohol Craving Questionnaire–Short Form–Revised (ACQ-SF-R) was translated into European Portuguese and administered to a sample of 591 college participants with ages between 18 and 30 years. Results suggested that a three-factor model (i.e., Emotionality, Purposefulness, and Compulsivity) proved to be most suitable for the Portuguese sample. Overall, the ACQ-SF-R exhibited good psychometric properties, having a good internal consistency both for the general craving index (Cronbach’s α = 0.85) and each subscale (Cronbach’s α = 0.66–0.83), as well as an appropriate convergent validity with the Penn Alcohol Craving Scale (r = 0.65, p<0.001), suggesting a good construct validity. In addition, the ACQ-SF-R also showed a good concurrent validity with the Alcohol Use Disorders Identification Test (r = 0.57, p<0.001), indicating that risky alcohol use patterns are associated with increased craving scores in the ACQ-SF-R. Collectively, these findings suggest that the Portuguese version of the ACQ-SF-R can accurately measure alcohol craving at a multifactorial level, being a valid and reliable tool to use in Portuguese samples in research settings.

Tackling heterogeneity: Individual variability of emotion decoding deficits in severe alcohol use disorder

BACKGROUND

Severe alcohol use disorder (SAUD) is associated with social cognition deficits. Patients with SAUD are impaired for the recognition of emotional facial expressions, particularly at early stages of abstinence. These deficits damage interpersonal relations and increase relapse risk. However, uncertainties still abound on their variation across emotions and on the heterogeneity of emotional impairments across patients. We addressed these questions by exploring how the deficit varies according to emotions' type/intensity and patients' heterogeneity.

METHODS

Sixty-five recently detoxified patients with SAUD and 65 matched healthy controls performed the Facial Emotion Recognition Test, assessing the ability to identify six emotions (anger, contempt, disgust, fear, happiness, sadness) displayed by morphed faces with various intensities. Accuracy scores and detection thresholds were collected for each emotion. Beyond group comparisons, multiple single-case analyses determined the percentage of patients presenting decoding deficits for each emotion.

RESULTS

When current depression and anxiety symptoms were controlled for, patients did not present a general emotion decoding deficit, but were rather characterized by specific deficits for disgust/contempt in accuracy, and for disgust in detection threshold scores. Single-case analyses showed that only a third of patients presented a clinically significant emotional deficit.

CONCLUSIONS

Patients with SAUD only present emotional decoding deficits for specific interpersonal emotions (disgust/contempt) when subclinical psychopathological states are controlled for, and show no general emotional impairment. This goes against the proposal of a generalized social cognition deficit in this population. This group effect moreover masks a massive heterogeneity across patients, which has implications at experimental and clinical levels.

Electroencephalographic signatures of the binge drinking pattern during adolescence and young adulthood: A PRISMA-driven systematic review

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Controls and binge drinkers (BDs) do not differ in their behavioral performance.

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BDs show increased neural activity during attention, working memory and inhibition.

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Augmented P3 amplitude in BDs was the most solid electrophysiological finding.

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Evidence does not support specific gender vulnerabilities to the effects of BD.

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Memory, emotional processing and decision-making processes need further exploration.

Research on neurophysiological impairments associated with binge drinking (BD), an excessive but episodic alcohol use pattern, has significantly increased over the last decade. This work is the first to systematically review –following PRISMA guidelines- the empirical evidence regarding the effects of BD on neural activity –assessed by electroencephalography- of adolescents and young adults. A systematic review was conducted in 34 studies (N = 1723). Results indicated that binge drinkers (BDs) showed similar behavioral performance as non/low drinkers. The most solid electrophysiological finding was an augmented P3 amplitude during attention, working memory and inhibition tasks. This increased neural activity suggests the recruitment of additional resources to perform the task at adequate/successful levels, which supports the neurocompensation hypothesis. Similar to alcoholics, BDs also displayed increased reactivity to alcohol-related cues, augmented resting-state electrophysiological signal and reduced activity during error detection –which gives support to the continuum hypothesis. Evidence does not seem to support greater vulnerability to BD in females. Replication and longitudinal studies are required to account for mixed results and to elucidate the extent/direction of the neural impairments associated with BD.

Eye Tracking Studies Exploring Cognitive and Affective Processes among Alcohol Drinkers: a Systematic Review and Perspectives

Acute alcohol intoxication and alcohol use disorders are characterized by a wide range of psychological and cerebral impairments, which have been widely explored using neuropsychological and neuroscientific techniques. Eye tracking has recently emerged as an innovative tool to renew this exploration, as eye movements offer complementary information on the processes underlying perceptive, attentional, memory or executive abilities. Building on this, the present systematic and critical literature review provides a comprehensive overview of eye tracking studies exploring cognitive and affective processes among alcohol drinkers. Using PRISMA guidelines, 36 papers that measured eye movements among alcohol drinkers were extracted from three databases (PsycINFO, PubMed, Scopus). They were assessed for methodological quality using a standardized procedure, and categorized based on the main cognitive function measured, namely perceptive abilities, attentional bias, executive function, emotion and prevention/intervention. Eye tracking indexes showed that alcohol-related disorders are related to: (1) a stable pattern of basic eye movement impairments, particularly during alcohol intoxication; (2) a robust attentional bias, indexed by increased dwell times for alcohol-related stimuli; (3) a reduced inhibitory control on saccadic movements; (4) an increased pupillary reactivity to visual stimuli, regardless of their emotional content; (5) a limited visual attention to prevention messages. Perspectives for future research are proposed, notably encouraging the exploration of eye movements in severe alcohol use disorders and the establishment of methodological gold standards for eye tracking measures in this field.

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

BACKGROUND

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSION

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

Reducing Attentional Bias in Individuals With Alcohol Use Disorders With a Tablet Application: A Randomized Controlled Trial Pilot Study

AIMS

Cognitive bias modification (CBM) training has been considered a promising and effective intervention tool for reducing cognitive biases toward alcohol. However, the link between the cognitive process and actual behavior remains statistically insignificant because computerized tasks do not have sufficient ecological validity and suffer from high dropout rates. The recent development of 'serious games' has shown encouraging results in maintaining adherence to health-related interventions. We aim to evaluate a CBM program using a gamified attentional bias (AB) training procedure on a touchpad for individuals with alcohol use disorders.

METHODS

Forty-one patients were included in this study, 33 of whom displayed an AB and were randomly assigned into the 'CBM group' (N = 18, 16.7% women) or 'Memory group'-which involved playing a memory game-(N = 15, no woman). Eight other participants (12.5% women) with no AB comprised the 'Without AB group'. Efficacy was assessed for AB, craving, and inhibition and attentional capacities before and after the program.

RESULTS

We observed that the reduction of AB was higher for the 'CBM group' (Mbefore = 153.61, SD = 172.21; Mafter = 18.00, SD = 77.71; t (17) = 4.21, P = 0.001) than for the 'Memory group' (Mbefore = 73.20, SD = 66.65; Mafter =42.47, SD = 113.77; ts < 1). The analysis showed that for the 'Without AB group', there was no significant difference in AB (t (7) = -2.15, P = .07) after the program.

CONCLUSIONS

This study demonstrated an increased reduction of AB for patients included in the CBM program on a touchpad than for patients playing only a memory game.