1. Breaking Out of the Joint:
Hans van der Baan, ADAPT lab, Department of Psychology, University of Amsterdam
Breaking Out of the Joint:
Intorduce myself
We look at alcohol as a very commonly used substance, but our primary focus is cannabis as it is the most used drug in juvenile detention centres
Cognitive Bias Modification Targeting the Cannabis and Alcohol Consumption of Youth in Juvenile Detention Centers

2. Cannabis Use in Dutch Youth
15 years, general population:
21.3 % has used cannabis
11% potentially at risk
17-18 years, general population:
44.6% has used cannabis
18% potentially at risk
(Peilstations Study, Trimbos, 2011)
Youth in juvenile detention centers:
65% used cannabis during the month prior to incarceration
39% indications for drug abuse, largely cannabis
(van der Nagel & Kea, 2013)
Next slide, delinquents and use
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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)
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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)
This makes CBM extra useful
Next slide: Dual Process models
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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)
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6. Duale Proces Model - Cognitive bias + Rational decision Pros and Cons
Situation
/ cues
Behaviour
Perception
Motivational orientation
Motor
Schemas
Associative/Impulsive processes
Reflective Processes
Executive Function, Working Memory, “ability” -
Cognitive bias +
Motivation, “wanting” other life-goals
Next slide: Attention Bias

7. Attention Bias
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8. Approach Bias Next slide: Dual Process in addiction and offenders
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9. Strong (positive) associations with substance use
In Addiction:
Frequent, repeated use behaviour strenghtens the biasses, sustaining use behaviour
In Young Offenders:
Strong (positive) associations with substance use
Repeated usage damages the developing cognitive control
Teenagers tend to be more impulsive in general and have limited long-term planning capabilities.
Next slide: CBM previous research
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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)
Next slide; research question
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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?
Next slide: SCREEN
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12. 7 Dutch juvenile detention centres, nation wide from 2014-2017
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 juvenile detention centres, nation wide from
600 youth screened
Independent study financed with a grant from the Dutch Ministery of Security and Justice
¹University of Amsterdam
²VU University, Amsterdam
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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
Next slide: Design
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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)
AAT
VPT
Active
Placebo
Next: Tasks
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15. Approach Bias: The Approach / Avoid Task (AAT)
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16. Approach Bias: The Approach / Avoid Task (AAT)
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17. Approach Bias: The Approach / Avoid Task (AAT)
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18. Attentional Bias: The Visual Probe Task (VPT)+
Next: sample
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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
Next: Cognitive bias
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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) and alcohol (M=10.51, SD=33.44, t(48)=2.20, p=.03) but none for AAT
Next: Substance use
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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
Next: Conclusions
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22. Conclusions
There is an attention bias for cannabis and alcohol in detained youth
No approach/avoid bias
Cannabis use decreases over time, but the effect is small
There is no effect of attentional
retraining
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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
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24. Thank you for your attention!
Hans van der Baan, ADAPT lab, Department of Psychology, University of Amsterdam
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