1. Matt Field Department of Psychological Sciences

2.  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. Healthy brain Dysregulated (addicted) brain Volkow et al. (2008)

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

7. Courtesy of Ingmar Franken

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. Christiansen et al., 2012; Field et al., 2008, 2011

14.  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).

16.  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).

20. 500 ms

21. ↑ 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.

25. StudyEffects on bias? Generalisation?Effects on craving? Effects on drug- seeking? Field & Eastwood (05) - alcohol YESNot assessedYES Field et al (07) - alcohol YESNO (?)Aware onlyNO Schoenmakers et al (07) - alcohol YESNO Attwood et al (09) - tobacco YESNot assessedMales onlyNO Field et al (09) - tobacco YESNO McHugh et al (10) – tobacco NO Not assessed

26.  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….

29. (Inhibit)

30. Alcohol restraint group: Mostly goMostly stop Alcohol restraint group: Always go Mostly stop Disinhibition group: Always go Mostly go

32.  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

35. ADDITIONAL COMPONENT ?

36. ?

38.  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?