Understanding addiction: the contributions of basic science

1. Understanding addiction: the contributions of basic science Matt Field Department of Psychological Sciences

2. Overview • Theoretical background • Automatic cognitive processes in addiction • Cognitive training in other domains • Interventions for addiction: • Attentional bias modification • Cue avoidance training • Inhibitory control training • Where do we go from here?

3. Theoretical background Healthy brain Dysregulated (addicted) brain Volkow et al. (2008)

4. Automatic cognitive processes in addiction

5. Attentional bias: the visual probe task ===============

6. Attentional bias in smokers vs. non-smokers (Mogg et al., 2003)

7. In real life….? Courtesy of Ingmar Franken

8. Clinically significant? Marhe et al. 2013

9. Automatic approach tendencies: the stimulus-response compatibility task (1a)

10. The stimulus-response compatibility task (1b)

11. The stimulus-response compatibility task (2a)

12. The stimulus-response compatibility task (2b)

13. Heavy vs. light social drinkers – automatic approach bias Christiansen et al., 2012; Field et al., 2008, 2011

14. Clinical significance? • Automatic approach predicts problem drinking in adolescents (Peeters et al., 2012, 2013) • But strong automatic avoidance seems to predicts relapse to drinking in alcoholics tested in treatment (Spruyt et al., 2013).

15. Measuring disinhibition: the stop-signal task

16. Disinhibition and alcohol use disorders • Alcohol-dependent patients have relatively poor performance on the stop-signal and related tasks (e.g. Goudriaan et al., 2006). • Disinhibition is positively correlated with alcohol consumption and problems in ‘social’ drinkers (Christiansen et al., 2012).

17. Role in future drinking? Fernie et al., 2013

18. Cognitive training – could it work?

19. ‘Brain training’?

20. Attentional training: ‘attend alcohol’ group (1) 500 ms

21. Attentional training: ‘attend alcohol’ group (2) ↑ Probe consistently replaces alcohol pictures. Over repeated (896) trials, participants should attend to the alcohol pictures.

22. Attentional training: ‘avoid alcohol’ group (1) 500 ms

23. Attentional training: ‘avoid alcohol’ group (2) ↑ Probe consistently replaces control pictures. Over repeated (896) trials, participants should avoid the alcohol pictures.

24. Experimental manipulation of attentional bias (Field & Eastwood, 2005)

25. Summary: effects of a single session of attentional bias reduction

26. Attentional bias modification (ABM) treatment • Fadardi & Cox (2010): reduction in drinking behaviour (but no control group) • Schoenmakers et al. (2010): no group differences in relapse rate, although ABM did delay the time until relapse • Other studies….

27. AAT training studies

28. Promising effects in patients

29. Can we train people to improve their self-control? Jones et al. (2013) (Inhibit)

30. Jones et al. (2013): Method contd Alcohol restraint group: Mostly go Mostly stop Alcohol restraint group: Mostly stop Mostly go Disinhibition group: Always go Always go

31. Jones et al. (2013) results

32. Related findings • Houben et al (2011) – cued Go/No-Go training leads to reduced alcohol consumption at one-week follow-up, but not immediately • Houben et al (2012) – replicated, and also showed that effects were mediated by change in implicit alcohol associations • Bowley et al (2013) – same intervention, produced immediate reduction in drinking behaviour but no change at one-week follow-up • > All studies with student volunteers, who were not motivated to cut down

33. What next?

35. ADDITIONAL COMPONENT ?

36. ?

38. Discussion • Could all types of training work through similar mechanism (changing automatic alcohol associations)? • Is there robust evidence that these cognitive processes play a causal role in addiction? • Are cognitive interventions likely to improve on existing treatments?

39. Acknowledgments