Schenkel Edwin J, Schöneck Robert, Wiers Reinout W, Veling Harm, Becker Eni S, Lindenmeyer Johannes, Rinck Mike
Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany.
Salus Clinic Lindow, Lindow, Germany.
Alcohol Clin Exp Res (Hoboken). 2023 May;47(5):963-974. doi: 10.1111/acer.15055. Epub 2023 Mar 23.
Alcohol-dependent individuals tend to selectively approach alcohol cues in the environment, demonstrating an alcohol approach bias. Because approach bias modification (ApBM) training can reduce the approach bias and decrease relapse rates in alcohol-dependent patients when added to abstinence-focused treatment, it has become a part of regular treatment. Moreover, in selective inhibition (SI) training, responses to one category of stimuli (i.e., alcohol stimuli) are selectively inhibited in an adapted Go/No-Go task. SI-Training has been found to effectively devalue the inhibited category and to reduce consumption of alcohol among social drinkers. This study investigated whether SI-Training can further improve the effects of treatment as usual that includes ApBM, and if so, whether the effect is mediated by a devaluation of the inhibited alcohol stimuli.
Abstinent alcohol-dependent inpatients (N=434) were randomly assigned to receive 6 sessions of either active (n = 214, 32% female) or sham (n = 220, 38% female) SI-Training, in addition to standard treatment that includes active ApBM. Ratings were used to assess changes in the evaluation of alcohol stimuli after the training. Relapse rates were assessed 3 and 12 months after treatment discharge.
Alcohol stimuli were rated negatively before and after the training, and the training did not influence these ratings. Evaluation of nonalcoholic drinks became more positive after active SI-Training. Both ApBM and SI-Training showed the expected training effects on reaction times. Contrary to expectations, SI-Training conditions did not yield different abstinence rates 3 or 12 months after treatment.
We found no evidence supporting the hypothesis that SI-Training amplifies the relapse-preventing effect of ApBM. Moreover, alcohol stimuli were rated negatively before and after treatment and were not influenced by SI-Training.
酒精依赖个体倾向于在环境中选择性地接近酒精线索，表现出对酒精的趋近偏向。由于趋近偏向矫正（ApBM）训练在以戒酒为重点的治疗基础上，可减少酒精依赖患者的趋近偏向并降低复发率，因此已成为常规治疗的一部分。此外，在选择性抑制（SI）训练中，在适应性的“是/否”任务中，对一类刺激（即酒精刺激）的反应被选择性抑制。研究发现，SI训练能有效降低被抑制类别的价值，并减少社交饮酒者的酒精摄入量。本研究调查了SI训练是否能进一步改善包含ApBM的常规治疗的效果，如果可以，这种效果是否由对被抑制的酒精刺激的贬值所介导。
434名戒酒的酒精依赖住院患者被随机分配接受6次主动（n = 214，32%为女性）或假（n = 220，38%为女性）SI训练，此外还接受包括主动ApBM的标准治疗。训练后，使用评分来评估对酒精刺激评估的变化。出院后3个月和12个月评估复发率。
训练前后对酒精刺激的评分均为负面，且训练并未影响这些评分。主动SI训练后，对非酒精饮料的评价变得更加积极。ApBM和SI训练均对反应时间显示出预期的训练效果。与预期相反，治疗后3个月或12个月，SI训练组的戒酒率并无差异。
我们没有发现证据支持SI训练能增强ApBM预防复发效果的假设。此外，治疗前后对酒精刺激的评分均为负面，且不受SI训练的影响。
