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Breaking Out of the Joint:

Hans van der Baan, ADAPT lab, Department of Psychology, University of Amsterdam. Breaking Out of the Joint:. Cognitive Bias Modification Targeting the Cannabis and Alcohol Consumption of Youth in Juvenile Detention Centers. Cannabis Use in Dutch Youth. 15 years , general population :

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Breaking Out of the Joint:

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  1. Hans van der Baan, ADAPT lab, Department of Psychology, University of Amsterdam Breaking Out of the Joint: Cognitive Bias Modification Targeting the Cannabis and Alcohol Consumption of Youth in Juvenile Detention Centers

  2. Cannabis Use in Dutch Youth • 15 years, generalpopulation: • 21.3 % has used cannabis • 11% potentially at risk • 17-18 years, generalpopulation: • 44.6% has used cannabis • 18% potentially at risk (Peilstations Study, Trimbos, 2011) • Youth in juveniledetention centers: • 65% used cannabis duringthemonth prior toincarceration • 39% indicationsfor drug abuse, largely cannabis (van der Nagel & Kea, 2013) Breaking Out of the Joint

  3. Young offenders and Substance (ab)Use • Cannabis and alcohol dependence is related to more aggressive and offending behaviour (Lennings et al., 2003; Arsenault et al., 2012) and increases the risk of psychopathology (e.g. Degenhardt et al., 2015) • Usage continues during incarceration, particularly cannabis (Cope, 2003; Rao et al, 2016) • Most treatment programmes in juvenile detention centres adopt a cognitive behavioural approach, are rarely systematically evaluated and often not evidence based (Koehler, 2013; Trimbos, 2014) Breaking Out of the Joint

  4. Young offenders show a higher incidence of characteristics that predict substance use, such as poor working memory (Ellingson et al., 2014), sensation seeking (Hopley & Brunelle, 2016) and psychopathology (Vermeiren, 2003). • Lower cognitive control increases vulnerability to cognitive biases (van Hemel-Ruiter et al., 2015) Breaking Out of the Joint

  5. Dual Process Models • Behaviour is a reaction to an in- or external cue • Behaviour is chosen via two distinct but interactive and reiterative cognitive processes • Explicit (or Reflective) processes (e.g. long-term planning) • Implicit (or Impulsive) processes (e.g. immediate gratification) Breaking Out of the Joint

  6. Duale Proces Model Motivation, “wanting” other life-goals - Executive Function, Working Memory, “ability” Reflective Processes Rational decision Pros and Cons Motivational orientation Situation / cues Motor Schemas Behaviour Perception Cognitive bias Cognitive bias + Associative/Impulsive processes

  7. Attention Bias Breaking Out of the Joint

  8. Approach Bias Breaking Out of the Joint

  9. In Addiction: • Frequent, repeatedusebehaviourstrenghtensthebiasses, sustainingusebehaviour In Young Offenders: • Strong (positive) associationswithsubstanceuse • Repeatedusagedamagesthedevelopingcognitive control • Teenagers tendtobe more impulsive in generaland have limited long-term planning capabilities. Breaking Out of the Joint

  10. Cognitive Bias Modification (CBM) • Cognitive Biasses can be retrained (e.g. Wiers et al., 2010, Addiction) • Previous research showed clinical effects when combined with TAU (e.g. Wiers et al., 2011, Psychological Science) • Applied not just with substance use, but also anxiety, depression and eating disorders (www. impliciet.eu) Breaking Out of the Joint

  11. Main research question • Does CBM combined with TAU lead to greater reductions in cannabis and alcohol use in detained young offenders, compared to TAU only? Breaking Out of the Joint

  12. Study Consortium for Reatributional E-training Effectiveness and Neuroprediction (SCREEN)Primary researchers: Hans v.d. Baan¹, Esther de Ruigh² Supervisors: prof. dr. Reinout Wiers¹, dr. Bruno Vercheuere¹, dr. Annemat Collot D’Escury-Koenigs¹, prof. dr. Arne Popma², dr. Lucres Nauta² • 7 Dutch juveniledetentioncentres, nationwidefrom 2014-2017 • 600 youthscreened • Independent studyfinancedwith a grantfromthe Dutch Ministery of Security andJustice ¹University of Amsterdam ²VU University, Amsterdam Breaking Out of the Joint

  13. Procedure • At T0 we screened anyone and everyone who wanted to participate (excluding VIC and FOBA) • Cannabis use (Cannabis Use Disorder Identification Test – Revised) and alcohol use (Alcohol Use Disorder Identification Test) • Users were invited for training based on highest scored substance • 6 training sessions of 2 CBM computer tasks • Follow up at 12 months Breaking Out of the Joint

  14. The Training Tasks • Participants did both an AAT and a VPT • Either task could be an active training version or a placebo version • 2x2 design • Stratified randomization (per institute) Breaking Out of the Joint

  15. Approach Bias: The Approach / Avoid Task (AAT) Breaking Out of the Joint

  16. Approach Bias: The Approach / Avoid Task (AAT) Breaking Out of the Joint

  17. Approach Bias: The Approach / Avoid Task (AAT) Breaking Out of the Joint

  18. Attentional Bias: The Visual Probe Task (VPT) + Breaking Out of the Joint

  19. Sample • 186 youth trained • 114 retained (not retRained) at 12-month follow up • 91% male, mAge = 18.47 • 82 cannabis trained, 32 alcohol trained • No significant differences between retained participants and drop-outs on age, gender, CUDIT or AUDIT scores Breaking Out of the Joint

  20. Cognitive Biases • At least 70% of trials should be correct (-11 AAT, -1 VPT) • One Sample T-tests • Significant results for VPT cannabis (M=14.98, SD=32.74, t(122)=5.07, p<.01) andalcohol (M=10.51, SD=33.44, t(48)=2.20, p=.03) but none for AAT Breaking Out of the Joint

  21. Substance Use After 1 Year • Active VPT training vs Placebo training • 56% received active alcohol training & 53% received active cannabis training • Repeated Measures Factorial Anova • Cannabis use decreased significantly (F(1,79) = 15.66, p<.01) between T0 (M=14.05, SD=6.17) and T9 (M=10.30, SD=7.53). No effect of time for alcohol. • No main effect of training (active vs placebo) nor an interaction effect for either substance Breaking Out of the Joint

  22. Conclusions • There is an attention bias for cannabis and alcohol in detainedyouth • No approach/avoid bias • Cannabis usedecreases over time, but the effect is small • There is no effect of attentional retraining Breaking Out of the Joint

  23. Discussion points • Motivation to change substance use and/or do the training tasks is low • AAT may have been too complex compared to VPT • Substance use patterns are different during incarceration • Motivation as a moderator has (not yet) been assessed • Combination with Motivational Interviewing Breaking Out of the Joint

  24. Thank you for your attention! • Hans van der Baan, ADAPT lab, Department of Psychology, University of Amsterdam • h.s.vanderbaan@uva.nl • Or check out our website at: • www.impliciet.eu Breaking Out of the Joint

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