A Neurophysiological and Behavioral Assessment of Interventions Targeting Attention Bias and Sense of Control in Binge Drinking

Does alcohol automatically capture drinkers' attention? Exploration through an eye-tracking saccadic choice task

RATIONALE

Dominant theoretical models postulate the presence of an automatic attentional bias (AB) towards alcohol-related stimuli in alcohol use disorder, such AB constituting a core feature of this disorder. An early alcohol AB has been documented in subclinical populations such as binge drinking (i.e., a drinking pattern prevalent in youth and characterized by repeated alternation between alcohol intoxications and withdrawals, generating cerebral consequences). However, the automatic nature of AB remains to be established.

OBJECTIVES

We investigated the automatic nature of AB in binge drinkers through the saccadic choice task. This eye-tracking paradigm consistently highlights the extremely fast and involuntary saccadic responses elicited by faces in humans, relative to other object categories. Through an alcohol-related adaptation of the saccadic choice task, we tested whether the early and automatic capture of attentional resources elicited by faces can also be found for alcohol-related stimuli in binge drinkers, as predicted by theoretical models.

METHODS

Forty-three binge drinkers and 44 control participants performed two versions of the saccadic choice task. In the original version, two images (a face, a vehicle) were displayed on the left and right side of the screen respectively. Participants had to perform a saccade as fast as possible towards the target stimulus (either face or vehicle). In the alcohol-related version, the task was identical, but the images were an alcoholic beverage and a non-alcoholic stimulus.

RESULTS

We replicated the automatic attraction towards faces in both groups, as faces generated higher saccadic accuracy, speed, and amplitude than vehicles, as well as higher corrective saccade proportion. Concerning the alcohol-related adaptation of the task, groups did not differ for the accuracy, speed, and amplitude of the first saccade towards alcohol. However, binge drinkers differed from controls regarding the proportion of corrective saccade towards non-alcoholic stimuli after an error saccade towards alcohol, suggesting the presence of an alcohol disengagement bias specific to binge drinkers.

CONCLUSIONS

Alcohol-related AB in binge drinkers is not characterized by an early and automatic hijacking of attention towards alcohol. This AB rather relies on later and more controlled processing stages, namely a difficulty to disengage attentional resources from alcohol-related stimuli.

Attentional bias in alcohol drinkers: A systematic review of its link with consumption variables

In severe alcohol use disorder (SAUD), attentional bias refers to the preferential allocation of attentional resources toward alcohol-related cues. Dominant models consider that this bias plays a key role in the emergence and maintenance of SAUD. We evaluate the available experimental support for this assumption through a systematic literature review, providing a critical synthesis of studies exploring the links between alcohol consumption and attentional bias. Using PRISMA guidelines, we explored three databases (PsycINFO, PubMed, Scopus) and extracted 95 papers. We assessed their methodological quality and categorized them based on the population targeted, namely patients with SAUD or subclinical populations with various drinking patterns. We also classified papers according to the measures used (i.e., behavioral or eye-tracking measures). Overall, subclinical populations present an alcohol-related bias, but many studies in SAUD did not find such bias, nor approach/avoidance patterns. Moreover, attentional bias fluctuates alongside motivational states rather than according to alcohol use severity, which questions its stability. We provide recommendations to develop further theoretical knowledge and overcome methodological shortcomings.

Alcohol-Specific Computerized Interventions to Alter Cognitive Biases: A Systematic Review of Effects on Experimental Tasks, Drinking Behavior, and Neuronal Activation

Background: In patients with alcohol use disorder, novel interventions to increase abstinence have attracted growing attention. Interventions aimed at modifying cognitive biases linked to alcohol use [i.e. cognitive bias modification (CBM)] may serve as an add-on to standard therapy. This systematic review thoroughly aggregates existing data on the effects of three alcohol-specific computerized interventions, namely attentional bias modification (AtBM), approach bias modification (ApBM), and inhibition training (IT). In doing so, each CBM's effects on experimental tasks assessing the relevant biases, drinking behavior, and neurophysiology are summarized. Also, the influence of drinking behavior severity and motivation to change drinking behavior are discussed. Methods: A literature search was conducted in four databases for original research articles published between 2000 and May 2019. Studies were eligible if investigating the effects of alcohol-specific computerized interventions (AtBM, ApBM, IT) on drinking behavior, bias change, and/or neurophysiology. Forty eligible articles were classified as being either a non-clinical experimental lab study (ELS) or clinical randomized-controlled trial (RCT) and summarized. Results: While AtBM seems to influence attentional bias, its effects on drinking behavior are inconsistent. As for ApBM, the best effects on drinking behavior are obtained in clinical samples. Effects of ApBM on approach bias are mixed. Interestingly, those clinical RCTs which investigated ApBM effects on bias change as well as on drinking outcome, reported consistent effects in both measures (i.e. either effects on bias and drinking or no effects). Studies on IT are limited to non-clinical samples and show inconsistent effects on drinking behavior. Considering ITs effects on implicit semantic associations, most studies do not support the conceptualization of IT as a form of memory bias modification, while reports on IT's effects on inhibitory control are still incomplete. Conclusions about the overall influence of drinking behavior severity are hampered by the non-uniform use of sample descriptions. Conclusions: In clinical samples, ApBM has shown more consistent beneficial effects, while evidence on AtBM is more inconsistent, and data on IT still lacks important information. Conclusions about the influence of drinking behavior severity would be facilitated by a uniform use of clearly defined sample descriptions.