Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Australia.
Drug Alcohol Depend. 2022 Oct 1;239:109621. doi: 10.1016/j.drugalcdep.2022.109621. Epub 2022 Sep 5.
Approach bias modification (ApBM) for alcohol use disorder helps prevent relapse, yet the psychological mechanisms underlying its efficacy remain unclear. Alcohol craving predicts relapse and appears to be related to the biased processing of alcohol stimuli which is reduced by ApBM. However, there is little research examining whether ApBM reduces alcohol craving.
In a randomised controlled trial testing the effect of 4 ApBM sessions (vs. sham training) on post-treatment alcohol use in 300 alcohol withdrawal inpatients, we administered the Alcohol Craving Questionnaire - Short Form - Revised (ACQ-SF-R) pre and post-training and at 2-week, 3, 6 and 12-month follow ups; and a cue-induced craving measure pre and post training.
Groups did not significantly differ in terms of declines in ACQ-SF-R total scores (p = .712) or cue-induced craving (p = .841) between the first and last training session, nor in terms of ACQ-SF-R scores at follow-ups (p = .509). However, the ACQ-SF-R Expectancy subscale, which assesses craving based on anticipated positive reinforcement from alcohol, was significantly lower in the ApBM group than in controls following training (p = .030), although the group x time interaction for this subscale was non-significant (p = .062). Post-intervention Expectancy scores mediated only a small portion of ApBM's effect on post-discharge alcohol use (14% in intention-to-treat analysis, p = .046; 15% in per-protocol analysis, p = .020).
ApBM does not appear to have robust, sustained effects on alcohol craving. Reduced craving is unlikely to account for ApBM's relapse prevention effects. However, further research on whether ApBM's effects are related to devaluation of alcohol reward expectancy is warranted.
Australian New Zealand Clinical Trials Registry Identifier: ACTRN12617001241325.
针对酒精使用障碍的趋近偏差修正（ApBM）有助于预防复发，但其疗效背后的心理机制仍不清楚。酒精渴求预测复发，似乎与对酒精刺激的偏向处理有关，而 ApBM 则可以减少这种偏向处理。然而，很少有研究探讨 ApBM 是否可以减少酒精渴求。
在一项针对 300 名酒精戒断住院患者的随机对照试验中，我们测试了 4 次 ApBM 疗程（与假训练相比）对治疗后酒精使用的影响，在训练前后以及 2 周、3 个月、6 个月和 12 个月的随访中，我们使用了酒精渴求问卷 - 短式 - 修订版（ACQ-SF-R）；并在训练前后进行了线索诱导渴求测量。
两组在 ACQ-SF-R 总分（p=0.712）或线索诱导渴求（p=0.841）在第一次和最后一次训练期间的下降方面没有显著差异，在随访时的 ACQ-SF-R 评分方面也没有显著差异（p=0.509）。然而，在训练后，ApBM 组的 ACQ-SF-R 期望分量表（该量表评估基于对酒精的预期正强化的渴求）显著低于对照组（p=0.030），尽管该分量表的组间时间交互作用不显著（p=0.062）。干预后，期望分数仅部分介导了 ApBM 对出院后酒精使用的影响（意向治疗分析中为 14%，p=0.046；方案分析中为 15%，p=0.020）。
ApBM 似乎对酒精渴求没有明显、持续的影响。渴求的减少不太可能解释 ApBM 的预防复发作用。然而，进一步研究 ApBM 的效果是否与酒精奖励期望的贬值有关是有必要的。
澳大利亚新西兰临床试验注册中心标识符：ACTRN12617001241325。
