Tobacco Images Choice and Its Association with Craving and Dependence in People who Smoke Cigarettes.

INTRODUCTION: Increased salience of drug-related cues over non-drug reinforcers can drive drug use and contribute to tobacco use disorder (TUD). An important scientific and clinical goal is to effectively measure this elevated drug-seeking behavior in TUD. However, most TUD assessments rely on self-reported cravings and cigarette consumption, not providing an objective measure of the impact of drug-cues on biasing behavior towards drugs. The probabilistic image choice (PIC) task investigates the choice of viewing drug-related pictures as compared to other salient pictures (e.g., pleasant and unpleasant). This study aimed to develop and validate the PIC task for TUD and evaluate the associations between behavioral choice and tobacco craving, daily cigarette consumption, quit attempts and motivation to quit, and nicotine dependence (the Fagerström score). METHODS: We recruited 468 smokers and 121 nonsmokers using the Prolific online platform. Participants performed the PIC task twice (at a one-month interval) and completed other measures relevant to TUD. RESULTS: compared to nonsmokers, tobacco smokers selected to view significantly more tobacco images and less pleasant (non-drug reinforcer) images, a profile that remained stable at retest. Individual differences in choice of tobacco as compared to pleasant images on the PIC task were associated with craving but not with the other tobacco dependence measures, suggesting that the task may serve as a behavioral proxy measure of drug "wanting" rather than of cumulative nicotine exposure or physical dependence. CONCLUSIONS: these results suggest that the PIC task can be a valuable tool for objectively assessing craving-associated tobacco seeking in TUD. IMPLICATIONS SECTION: which should provide a brief description about what the study addsMost of the current measures of tobacco use disorder (TUD) rely on self-reports of consumption, dependence and craving and do not take into consideration the role of drug-related cues in driving tobacco seeking. This study shows that the probabilistic image choice (PIC) task provides an objective, reliable proxy measure of tobacco image seeking behavior in people who smoke cigarettes that is linked to craving (desire) for smoking but not to other measures of TUD. Therefore, the PIC task may be a useful complementary tool for the classification, diagnosis, and prognosis of TUD.

Treating refractory obsessive compulsive disorder with cathodal transcranial direct current stimulation over the supplementary motor area: a large multisite randomized sham-controlled double-blind study.

Background: The present study evaluated the therapeutic efficacy and tolerability of 10 transcranial direct current stimulation (tDCS) sessions in treatment-resistance obsessive-compulsive disorder (OCD) patients using a multisite double-blind sham-controlled design. Methods: Eighty treatment-resistance outpatients suffering from obsessive-compulsive disorder were randomized to receive either active or sham transcranial direct current stimulation. The cathode was positioned over the supplementary motor area and the anode over the right supraorbital area. Patients were evaluated at baseline, end of treatment (day 14), one-month follow-up (day 45), and three-month follow-up (day 105) on the Yale-Brown Obsessive Compulsive Scale. Results: Although a significant interaction between time and treatment was observed, the primary endpoint-measuring the change in Yale-Brown obsessive compulsive scale scores after two weeks-was not achieved. Conversely, the secondary endpoint, which concerned the change in Yale-Brown obsessive compulsive scale scores after three months, was successfully met. It is important to note, however, that there were no significant differences in the percentage of responders and remitters at any of the post-treatment assessments. This suggests that the treatment may not have had a clinically relevant impact. Patients well received the transcranial direct current stimulation treatment, indicating its good tolerability. Conclusion: This is the largest controlled trial using transcranial direct current stimulation in treatment-resistance obsessive-compulsive disorder patients. Our results indicate the importance of studying the placebo effect in transcranial direct current stimulation and the necessity to consider a long follow-up time to best evaluate the effects of the intervention. Clinical trial registration: ClinicalTrials.gov, identifier NCT03304600.

Tobacco Images Choice and Its Association with Craving and Dependence in Cigarette Smokers.

Introduction: Increased salience of drug-related cues over non-drug reinforcers can drive drug use and contribute to tobacco use disorder (TUD). An important scientific and clinical goal is to effectively measure this elevated drug-seeking behavior in TUD. However, most TUD assessments rely on self-reported cravings and cigarette consumption, not providing an objective measure of the impact of drug-cues on biasing behavior towards drugs. The probabilistic image choice (PIC) task investigates the choice of viewing drug-related pictures as compared to other salient pictures (e.g., pleasant and unpleasant). This study aimed to develop and validate the PIC task for TUD and evaluate the associations between behavioral choice and tobacco craving, daily cigarette consumption, quit attempts and motivation to quit, and nicotine dependence (the Fagerström score). Methods: We recruited 468 smokers and 121 nonsmokers using the Prolific online platform. Participants performed the PIC task twice (at a one-month interval) and completed other measures relevant to TUD. Results: compared to nonsmokers, tobacco smokers selected to view significantly more tobacco images and less pleasant (non-drug reinforcer) images, a profile that remained stable at retest. Individual differences in choice of tobacco as compared to pleasant images on the PIC task were associated with craving but not with the other tobacco dependence measures, suggesting that the task may serve as a behavioral proxy measure of drug "wanting" rather than of cumulative nicotine exposure or physical dependence. Conclusions: these results suggest that the PIC task can be a valuable tool for objectively assessing craving-associated tobacco seeking in TUD.

Suicidal ideations and self-dehumanization in recently detoxified patients with severe alcohol use disorder: an experimental exploration through joint explicit-implicit measures.

BACKGROUND: Metadehumanization (the feeling of being considered as less than human by others) is a pervasive phenomenon in psychiatric states, notably promoting self-dehumanization and suicide antecedents. However, its role in suicidal ideations among patients with addictive disorders remains unexplored. We thus investigated the involvement of metadehumanization/self-dehumanization in suicidal ideations and suicidal thoughts interference in severe alcohol use disorder. METHODS: We measured metadehumanization, suicidal ideations, and desire for social contact through questionnaires among 35 recently detoxified patients with severe alcohol use disorder (26 males). We measured animalistic/mechanistic self-dehumanization using an Implicit Association Task, and suicidal thoughts interference using a Stroop Task with suicide-related words. We performed regression analyses while controlling for depression/anxiety. RESULTS: Animalistic self-dehumanization was positively associated with suicidal thoughts interference and with decreased desire for social interactions, such link being absent for metadehumanization or mechanistic self-dehumanization. CONCLUSIONS: This link between self-dehumanization and suicide-related factors suggests that a reduced sense of belonging to humanity is associated with self-harm antecedents. Results also emphasize the importance of using indirect measures to investigate sensitive variables, such as self-dehumanization and suicidal thoughts.

Effect of environmental enrichment on relapse rates in patients with severe alcohol use disorder: protocol for a randomised controlled trial.

INTRODUCTION: Alcohol use disorder (AUD) ranks among the most prevalent psychiatric disorders worldwide. Despite current treatments, more than half of patients relapse within weeks after treatment. In animal models, exposure to environmental enrichment (EE) has been shown to be a promising approach to reduce relapse. However, controlled, multimodal EE is difficult to transpose to humans. To address this gap, this study aims at assessing the effectiveness of exposure to a newly designed EE protocol during AUD treatment in reducing relapse to alcohol use. Our EE will allow an enhancement of the standard intervention, and will combine several promising enrichment factors identified in the literature-physical activity, cognitive stimulation, mindfulness and virtual reality (VR). METHODS AND ANALYSIS: A randomised controlled trial involving 135 participants receiving treatment for severe AUD will be conducted. Patients will be randomised to an intervention enhancement group or a control group. The enhanced intervention will consist of six 40-min sessions of EE spread over 9 days. During the first 20 min of these sessions, patients will practise mindfulness in multisensory VR, in virtual environments designed to practise mindfulness and use it to regulate craving induced by virtual cues or stress. Then, participants will practise indoor cycling combined with cognitive training exercises. The control group will undergo standard management for AUD. The primary outcome is relapse assessed at 2 weeks after treatment, using a questionnaire and biological indicators. Relapse will be defined as drinking at least five drinks per occasion or drinking at least five times a week. It is predicted that the group receiving the EE intervention will have a lower relapse rate than the control group. The secondary outcomes are relapse at 1 month and 3 months after treatment, craving and drug-seeking behaviour, mindfulness skills acquisition and the effect of the intervention enhancement on the perceived richness of the daily environment, assessed by questionnaires and neuropsychological tasks. ETHICS AND DISSEMINATION: All participants have to give written informed consent to the investigator. This study is approved by the Ethics Committee Nord Ouest IV of Lille (reference number 2022-A01156-37). Results will be disseminated through presentations, peer-reviewed journals and seminar conferences. All information on ethical considerations and open science practices can be accessed at https://osf.io/b57uj/ TRIAL REGISTRATION NUMBER: NCT05577741.

No mercy for victims: Exploring the link between dark personality traits, aggressive video game behavior, and severe traffic violations.

This study investigates the relationship between dark personality traits, aggressive behavior in violent video games, and severe traffic violations among 200 driving offenders from Tehran, Iran, participating in a rehabilitation program. Participants engaged in a computerized shooting decision task, where their tendency to shoot unarmed targets (innocent victims), compared to armed targets (criminals), was used as an indicator of aggressive behavior toward innocent victims. Additionally, they completed self-report measures of narcissism, Machiavellianism, psychopathy, and sadism to evaluate the impact of Dark Tetrad personality traits on their behavior. Bivariate analyses revealed associations between Dark Tetrad personality traits and aggressive behavior in the video game with serious traffic offenses. Multivariate analyses identified Machiavellianism, sadism, and aggressive behavior in video games as significant predictors of severe traffic offenses. The results suggest that dark personality traits and aggressive behavior in video games may aid in better identifying road traffic offenders with the most severe violations. Potential implications for preventing repeated traffic offenses by tailoring rehabilitation programs are discussed.

Under the veil of tolerance: A justification-suppression approach to anti-Islamic implicit bias in reaction to terrorist attacks.

Twenty years after 9/11, the impact of terrorism on social and political attitudes remains unclear. Several large-scale surveys suggest that terrorism has no discernible effects on direct, self-report measures of prejudice toward Arab-Muslims. However, direct measures may lack the sensitivity to detect subtle underlying attitudes that are considered socially unacceptable to openly express. To tap these subtle reactions, we assessed more sensitive and implicit measures of the cognitive-affective aspects of prejudice. Building on the justification-suppression model of prejudice, we hypothesized that terrorist attacks increase implicit bias toward Arab-Muslims, especially among individuals who are unable to regulate automatic hostile reactions due to personality or situational variables. Study 1, using data from Project Implicit (N = 276,311), showed that terrorist attacks increased implicit bias but not expressed prejudice toward Arab-Muslims. Study 2, using data from Google Trends, showed that terrorist attacks increased anti-Islamic searches on the internet. Four studies that collected original data (total N = 851) showed that the effects of reminders of terrorism on anti-Islamic implicit bias are moderated by individual differences in prejudice and automaticity (Studies 3-4), by the strength of implicit Muslim-terrorist associations (Study 5), and by momentary self-control depletion (Study 6). Overall, the present research indicates that despite little evidence for elevated overt expression of prejudice against Arab-Muslims following terrorist attacks, terrorist attacks increase anti-Islamic implicit bias whenever individuals are unlikely to control automatic hostile reactions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The distinct associations of ingroup attachment and glorification with responses to the coronavirus pandemic: Evidence from a multilevel investigation in 21 countries.

While public health crises such as the coronavirus pandemic transcend national borders, practical efforts to combat them are often instantiated at the national level. Thus, national group identities may play key roles in shaping compliance with and support for preventative measures (e.g., hygiene and lockdowns). Using data from 25,159 participants across representative samples from 21 nations, we investigated how different modalities of ingroup identification (attachment and glorification) are linked with reactions to the coronavirus pandemic (compliance and support for lockdown restrictions). We also examined the extent to which the associations of attachment and glorification with responses to the coronavirus pandemic are mediated through trust in information about the coronavirus pandemic from scientific and government sources. Multilevel models suggested that attachment, but not glorification, was associated with increased trust in science and compliance with federal COVID-19 guidelines. However, while both attachment and glorification were associated with trust in government and support for lockdown restrictions, glorification was more strongly associated with trust in government information than attachment. These results suggest that both attachment and glorification can be useful for promoting public health, although glorification's role, while potentially stronger, is restricted to pathways through trust in government information.

(Eye-)tracking the escape from the self: guilt proneness moderates the effect of failure on self-avoidance.

Failure increases the motivation to escape self-awareness. To date, however, the role of self-conscious emotions (shame and guilt) in triggering escape responses after failure has not been sufficiently addressed. In this pre-registered study (N = 156 undergraduates), we adapted a classic paradigm (avoidance of one's image in a mirror) to a modern eye-tracking technology to test the hypothesis that shame proneness moderates the effect of failure on self-awareness avoidance. Individual differences in guilt and shame proneness were assessed before priming thoughts of failure or success. Then, an eye-tracking paradigm was used to monitor gaze avoidance of one's screen-reflected face during a neutral, unrelated task. Unexpectedly, results showed that guilt but not shame proneness exacerbated self-avoidance after failure. The present findings challenge the dominant view that shame fosters avoidance more so than guilt.

Preliminary Evidence That the Short Allele of 5-HTTLPR Moderates the Association of Psychiatric Symptom Severity on Suicide Attempt: The Example in Obsessive-Compulsive Disorder.

Background: The severity of symptoms represents an important source of distress in patients with a psychiatric disease. However, the extent to which this endogenous stress factor interacts with genetic vulnerability factors for predicting suicide risks remains unclear. Methods: We evaluated whether the severity of symptoms interacts with a genetic vulnerability factor (the serotonin transporter gene-linked promoter region variation) in predicting the frequency of lifetime suicide attempts in patients with a psychiatric disease. Symptom severity and 5-HTTLPR polymorphism were collected from a sample of 95 patients with obsessive-compulsive disorder (OCD). Lifetime suicide attempt was the primary outcome, and antecedent of multiple suicide attempts was the secondary outcome. Results: The gene-by-symptoms interaction was associated with an excess risk of suicide attempts (OR = 4.39, 95CI[1.44, 13.38], p < 0.009) and of multiple suicide attempts (OR = 4.18, 95CI[1.04, 16.77], p = 0.043). Symptom severity (moderate, severe, or extreme) was associated with an approximately five-fold increase in the odds of a lifetime suicide attempt in patients carrying one or two copies of the short allele of 5-HTTLPR. No such relationship was found for patients carrying the long allele. Conclusion: This study provides preliminary evidence for the gene-by-stress interaction on suicide attempt when stress is operationalized as symptom severity. Progress in suicide research may come from efforts to investigate the gene-by-symptoms interaction hypothesis in a variety of diseases.

Trust in scientific information mediates associations between conservatism and coronavirus responses in the U.S., but few other nations.

U.S.-based research suggests conservatism is linked with less concern about contracting coronavirus and less preventative behaviors to avoid infection. Here, we investigate whether these tendencies are partly attributable to distrust in scientific information, and evaluate whether they generalize outside the U.S., using public data and recruited representative samples across three studies (Ntotal = 34,710). In Studies 1 and 2, we examine these relationships in the U.S., yielding converging evidence for a sequential indirect effect of conservatism on compliance through scientific (dis)trust and infection concern. In Study 3, we compare these relationships across 19 distinct countries. Although the relationships between trust in scientific information about the coronavirus, concern about coronavirus infection, and compliance are consistent cross-nationally, the relationships between conservatism and trust in scientific information are not. These relationships are strongest in North America. Consequently, the indirect effects observed in Studies 1-2 only replicate in North America (the U.S. and Canada) and in Indonesia. Study 3 also found parallel direct and indirect effects on support for lockdown restrictions. These associations suggest not only that relationships between conservatism and compliance are not universal, but localized to particular countries where conservatism is more strongly related to trust in scientific information about the coronavirus pandemic.

Reduced calibration between subjective and objective measures of episodic future thinking in alcohol use disorder.

BACKGROUND: A reduced capacity to mentally simulate future scenarios could be of clinical importance in alcohol use disorder (AUD). However, little is known about the mechanisms underlying episodic future thinking (EFT) impairment in AUD. METHODS: We tested patients with severe AUD using two measures of EFT: the individual's own subjective experience of their imaginings (phenomenology) and the objective number of details included in imagined events, as assessed by an independent observer (examination). The comparison between the two measures allowed us to investigate the extent to which the subjective and objective characteristics of EFT are calibrated in healthy and AUD participants matched for age, education, and gender. The possible impact of cognitive functioning and disturbed mood on EFT measures was also investigated. RESULTS: In terms of objective details of EFT, patients with AUD (n = 40) generated fewer episodic components and more non-episodic components than control participants (n = 40), even when controlling for cognitive functioning. However, self-ratings of phenomenological characteristics indicated that participants with AUD perceived imagined future events at a similar level of detail as control participants. Additionally, there was a significant correlation between objective and subjective measures in healthy individuals but not in the AUD group. A higher depression score in the AUD group was not associated with the EFT measures. CONCLUSIONS: These results suggest a distorted self-assessment of the richness of imagined future events in individuals with AUD. We discuss these apparent limitations in metacognitive abilities and verbal descriptions of imagined events among individuals with AUD and their clinical implications.

Impact of brain-derived neurotrophic factor Val66Met polymorphism and response to escitalopram or paroxetine in obsessive-compulsive disorder.

OBJECTIVE: Obsessive-compulsive disorder (OCD) is a severe psychiatric disorder characterized by its heterogeneous nature and by different dimensions of obsessive-compulsive (OC) symptoms. Serotonin reuptake inhibitors (SRIs) are used to treat OCD, but up to 40% to 60% of patients do not show a significant improvement with these medications. In this study, we aimed to test the impact of brain-derived neurotrophic factor (BDNF) Val66Met polymorphism on the efficacy of antidepressants in OCD overall, and in relation to the different OC dimensions. METHODS: In a 6-month prospective treatment study, 69 Caucasian OCD patients were treated with escitalopram for 24 weeks or with escitalopram for 12 weeks followed by paroxetine for an additional 12-week period. Patients were genotyped and assessed for treatment response. The main clinical outcomes were improvement of the Yale-Brown Obsessive-Compulsive Scale score and in different OC symptom dimension scores. RESULTS: The Val/Val group comprised 43 (62%) patients, the Val/Met and Met/Met group comprised 26 (38%) patients. Forty-two patients were classified as responders at 12 weeks and 38 at 24 weeks; no significant association was found between BDNF Val66Met and SRIs response at 12 and 24 weeks. In analyses of the different OC symptom dimensions, the Met allele was associated with a slightly reduced score in the aggressive/checking dimension at 6 months (P = .048). CONCLUSIONS: Our findings do not support the usefulness of BDNF Val66Met genotyping to predict overall response to treatment with SRIs in OCD; they did however suggest a better outcome at 6 months for the aggressive/checking symptom dimension for patients carrying the Met allele.

Transcranial direct current stimulation combined with alcohol cue inhibitory control training reduces the risk of early alcohol relapse: A randomized placebo-controlled clinical trial.

BACKGROUND: Approximately half of all people with alcohol use disorder (AUD) relapse into alcohol reuse in the next few weeks after a withdrawal treatment. Brain stimulation and cognitive training represent recent forms of complementary interventions in the context of AUD. OBJECTIVE: To evaluate the clinical efficacy of five sessions of 2 mA bilateral transcranial direct current stimulation (tDCS) for 20 min over the dorsolateral prefrontal cortex (DLPFC) (left cathodal/right anodal) combined with alcohol cue inhibitory control training (ICT) as part of rehabilitation. The secondary outcomes were executive functioning (e.g. response inhibition) and craving intensity, two mechanisms strongly related to abstinence. METHODS: A randomized clinical trial with patients (n = 125) with severe AUD at a withdrawal treatment unit. Each patient was randomly assigned to one of four conditions, in a 2 [verum vs. sham tDCS] x 2 [alcohol cue vs. neutral ICT] factorial design. The main outcome of treatment was the abstinence rate after two weeks or more (up to one year). RESULTS: Verum tDCS improved the abstinence rate at the 2-week follow-up compared to the sham condition, independently of the training condition (79.7% [95% CI = 69.8-89.6] vs. 60.7% [95% CI = 48.3-73.1]; p = .02). A priori contrasts analyses revealed higher abstinence rates for the verum tDCS associated with alcohol cue ICT (86.1% [31/36; 95% CI = 74.6-97.6]) than for the other three conditions (64% [57/89; 95% CI = 54-74]). These positive clinical effects on abstinence did not persist beyond two weeks after the intervention. Neither the reduction of craving nor the improvement in executive control resulted specifically from prefrontal-tDCS and ICT. CONCLUSIONS: AUD patients who received tDCS applied to DLPFC showed a significantly higher abstinence rate during the weeks following rehabilitation. When combined with alcohol specific ICT, brain stimulation may provide better clinical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov number NCT03447054 https://clinicaltrials.gov/ct2/show/NCT03447054.

Distinct Whole-Body Movements in Response to Alcohol and Sexual Content in Alcohol Use Disorder.

BACKGROUND: Spontaneous motor responses of approach and avoidance toward stimuli are important in characterizing psychopathological conditions, including alcohol use disorder (AUD). However, divergent results have been reported, possibly due to confounded parameters (e.g., using a symbolic vs. a sensorimotor task, implementation of approach-avoidance as a measure vs. a manipulation). METHODS: We studied whole-body/posturometric changes by using a sensorimotor measure relying on embodied cognition principles to assess forward (approach) and backward (avoidance) spontaneous leaning movements. Over a 12-second period, 51 male patients with AUD and 29 male control participants were instructed to stand still in response to both alcohol and sexual visual content. Patients with AUD were then divided into "abstainers" and "relapsers," depending on their continuous abstinence at 2 weeks postdischarge (obtained via a telephone follow-up interview). The effects of the group, the stimulus type, the experimental period, and their interactions on the posturometric changes were tested using mixed Analyses of variance (ANOVAs), with a significance threshold set at 0.05. RESULTS: Contrary to our expectations, patients and controls did not show significant difference in their forward/backward micromovements while passively viewing alcohol or sexual content (p > 0.1). However, in line with our hypothesis, patients who relapsed several weeks following discharge from the rehabilitation program were significantly more reactive and more likely to lean back during the first seconds of viewing alcohol cues (p = 0.002). Further, "relapsers" were more likely to lean forward during exposure to sexual content than participants who remained abstinent (p < 0.001). CONCLUSIONS: Among individuals with AUD, there are distinct pattern of spontaneous movements that differentiate "abstainers" and "relapsers," findings that can be understood in light of existing data and theories on action tendencies.

Evaluative Threat Increases Effort Expenditure in a Cycling Exercise: An Exploratory Study.

Research shows that negative or threatening emotional stimuli can foster movement velocity and force. However, less is known about how evaluative threat may influence movement parameters in endurance exercise. Based on social self-preservation theory, the authors predicted that evaluative threat would facilitate effort expenditure in physical exercise. In an exploratory study, 27 young men completed a bogus intelligence test and received either low-intelligence-quotient feedback (evaluative threat) or no feedback (control). Next, they were asked to pedal on a stationary bicycle for 30 min at a constant cadence. After 10 min (calibration period), the cadence display was hidden. Findings show that participants under evaluative threat increased cadence more than control participants during the subsequent 20-min critical period. These findings underline the potential importance of unrelated evaluative threat on physical performance.

Treating refractory obsessive-compulsive disorder with transcranial direct current stimulation: An open label study.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a complex disorder with 40%-60% of patients' refractory to treatment. Transcranial direct current stimulation (tDCS) has been shown to induce potent and long-lasting effects on cortical excitability. The aim of the present clinical trial was to evaluate the therapeutic efficacy and tolerability of cathodal tDCS over the supplementary motor area (SMA) in treatment-resistant OCD patients. METHODS: Twenty-one treatment-resistant OCD outpatients received 10 sessions of tDCS. Each treatment session consisted of 2 mA stimuli for 30 min. The cathode was positioned over the bilateral SMA and the anode over the right supraorbital area. Patients were evaluated at baseline, end of treatment, one-month follow-up, and three-month follow-up. Response to treatment was defined as at least a decrease of 35% on the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and a score of 2 or less on the Clinical Global Impressions-Improvement (CGI-I) between baseline and 1-month follow-up. RESULTS: There was a significant decrease of YBOCS scores between baseline and one-month assessment. At one month, five patients (24%) were considered as responders and 3 (15%) at 3 months. We also observed concomitant changes in depressive symptoms, and insight. The treatment was well tolerated. Short-lasting side effects were reported as localized tingling sensation and skin redness. CONCLUSION: Our results suggest that the use of cathodal tDCS over the SMA and anodal tDCS over the right supraorbital area in OCD treatment-refractory patients is safe and promising to improve obsessive and compulsive symptoms. Large randomized controlled trials are needed to confirm this positive result.

Predicting relapse in patients with severe alcohol use disorder: The role of alcohol insight and implicit alcohol associations.

Low insight is reported as a risk factor for relapse among patients treated for alcohol use disorders. However, to date, little is known on why patients with low insight are at higher risk for relapse. In this study, we tested the hypothesis that an implicit preference for alcohol over abstinence predicts relapse in patients with low, but not high, alcohol insight. Participants consisted of 77 patients who had received treatment for severe alcohol use disorder in a hospital in France. During hospitalization, they completed a self-report measure of insight and an implicit association test to assess implicit preference for alcohol over abstinence. The primary outcome was relapse assessed one month after discharge. Control variables were gender, age, cognitive deficit, anxiety, depression, craving, and impulsivity. Data were analysed using logistic regression analysis. After adjusting for demographic and clinical variables, relapse was predicted by the interaction between insight and implicit preference for alcohol but not by their main effects alone. Implicit preference for alcohol predicted relapse among patients with relatively low insight, but not among those with relatively high insight. These findings suggest that patients with low insight and strong implicit preference for alcohol are at a higher risk of relapse. Clinicians may therefore focus on and tailor specific interventions to prevent relapse in this vulnerable and at-risk population.

Effects of Evaluative Conditioning on Implicit Evaluation of Alcohol and Drinking Behaviors: A Direct Replication.

AIMS: Recent research suggests that evaluative conditioning (EC) can change implicit evaluations of alcohol and reduce drinking behaviors among college students (Houben et al., 2010a). This research has been conceptually replicated in two previous studies. To date, however, no direct and independent replication of the original study has been performed. In this paper, we report a high-powered direct replication of Houben et al.'s (2010a) study. METHOD: About 168 French college students took part in this preregistered study. Drinking behavior was assessed before and 2 weeks after the intervention. The intervention consisted of 120 trials of words related to alcoholic beverages or soft drinks paired with neutral, positive or negative pictures. The two conditions were factually equivalent and differed only in the repeated pairing between alcohol-related words and negative pictures; in the EC condition, but not in the control condition, alcohol-related words were systematically paired with negative pictures. RESULTS: EC did not change participants' implicit evaluations of alcohol and drinking behaviors. However, EC reduced drinking behaviors among hazardous drinkers. Yet, further non-preregistered Bayesian analysis did not provide much support for this hypothesis. CONCLUSION: This high-powered preregistered direct replication of Houben et al.'s (2010a) study suggests that the original effects are more fragile than initially thought. The effect of EC on drinking behaviors may be restricted to heavy drinkers, and we found no evidence that this effect is mediated by a change in implicit attitudes. It is necessary to perform further studies to test the original effects in clinical populations.

Habitual Routines and Automatic Tendencies Differential Roles in Alcohol Misuse Among Undergraduates.

There is a debate over whether actions that resist devaluation (i.e., compulsive alcohol consumption) are primarily habit- or goal-directed. The incentive habit account of compulsive actions has received support from behavioral paradigms and brain imaging. In addition, the self-reported Creature of Habit Scale (COHS) has been proposed to capture inter-individual differences in habitual tendencies. It is subdivided into two dimensions: routine and automaticity. We first considered a French version of this questionnaire for validation, based on a sample of 386 undergraduates. The relationship between two dimensions of habit and the risk of substance use disorder and impulsive personality traits was also investigated. COHS has good psychometric properties with both features of habits positively associated with an Obsessive-Compulsive Inventory score. Besides, the propensity to rely more on routines was associated with lower levels of alcohol abuse and nicotine use, suggesting that some degree of routine might act as a protective factor against substance use. In contrast, a high automaticity score was associated with an increased risk of harmful alcohol use. These results demonstrate that the COHS is a valid measure of habitual tendencies and represents a useful tool for capturing inter-individual variations in drug use problems in undergraduates.