Feasibility and acceptability of approach bias modification during methamphetamine withdrawal and related methamphetamine use outcomes.

Approach bias modification (ApBM), a computerised cognitive training task which aims to reduce automatic, impulsive responding to drug-related cues, has been found to reduce alcohol consumption among individuals seeking treatment for their drinking. However, this approach has not been trialled in patients with methamphetamine use disorder (MUD), where altered impulsivity and reward processing are well-established. As such, this study aimed to examine the feasibility and acceptability of four consecutive days of ApBM training during a residential admission for methamphetamine withdrawal. Abstinence rates were examined 2-weeks and 3-months post-discharge. In terms of uptake, 52 of the 99 eligible patients approached agreed to participate and 47 of these 52 commenced training. Uptake and training completion rates (62%) were lower than those achieved in similar trials of ApBM for residential alcohol withdrawal, suggesting there are challenges to its delivery in this setting. This is likely due to the severity of acute methamphetamine withdrawal syndrome and associated behavioural characteristics. However, participants' ratings of the task and reports of post-session craving suggest acceptability was high. Abstinence rates were 61% at 2 weeks and 54% at 3-months, which compare favourably with the abstinence rates observed in a previous large treatment outcome study. The evidence of acceptability and apparent effectiveness suggest future trials of ApBM with MUD patients are warranted. However, ApBM may be more feasible in certain settings or among particular sub-groups where patients are more clinically stable and therefore more likely to complete the training (e.g., residential rehabilitation, after acute withdrawal has subsided).

Combining approach bias modification with working memory training during inpatient alcohol withdrawal: an open-label pilot trial of feasibility and acceptability.

BACKGROUND: According to contemporary neurocognitive models, addiction is maintained by the biasing of information-processing and decision-making systems towards relatively automatic, impulsive, reward-seeking responses to drug-related stimuli, and away from more controlled, deliberative, "reflective" states of processing that could result in decisions to delay or avoid drug use. Cognitive training programs aimed at either countering "impulsive" processing or enhancing "reflective" processing alone have shown promise. However, there has been no attempt to simultaneously target both aspects of processing with a combined training program. We aimed to test the feasibility and acceptability of a novel 'dual-training' program targeting both processes during residential alcohol withdrawal, and to measure abstinence rates following discharge. METHODS: Thirty-seven patients undergoing alcohol withdrawal at a residential unit participated in this open-label pilot feasibility study. We tested a 4-session program of dual cognitive training targeting both impulsive (approach bias) and reflective (working memory) aspects of processing. Descriptive statistics were used to examine feasibility (training uptake and completion rates) and acceptability (withdrawal from the study; participants' ratings of the tasks). Alcohol abstinence rates were examined 2-weeks post-discharge. RESULTS: Seven participants withdrew after commencing training. Twenty-six (70%) completed the 4-session training protocol, and four completed 3 sessions before discharging. Among participants who provided ratings, nearly all (93%) rated the training as interesting. Most (87%) indicated that they felt it had improved their attention. However, most did not feel it had decreased their craving for alcohol. At 2-weeks post-discharge, 16 (53%) participants reported abstaining from alcohol. For comparison, an earlier pilot trial in the same setting found a 68% abstinence rate with approach bias training alone, and 47% abstinence in a non-training control group. CONCLUSIONS: Dual training during residential alcohol detoxification appears to be both acceptable and feasible, suggesting that future research is warranted to test its effectiveness at reducing likelihood of relapse.