Attentional bias predicts heroin relapse following treatment

Institute of Psychology (IOP), Erasmus Universiteit Rotterdam, Rotterdam, South Holland, Netherlands
Addiction (Impact Factor: 4.74). 10/2006; 101(9):1306-12. DOI: 10.1111/j.1360-0443.2006.01498.x
Source: PubMed


Previous studies have shown that abstinent heroin addicts exhibit an attentional bias to heroin-related stimuli. It has been suggested that attentional bias may represent a vulnerability to relapse into drug use. In the present study, the predictive value of pre-treatment attentional bias on relapse was examined in a population of abstinent heroin addicts. Further, the effect of cue exposure therapy (CET) on attentional bias was studied.
Participants were assigned randomly to receive nine sessions of CET or placebo psychotherapy.
An in-patient drug abuse treatment setting.
Abstinent heroin-dependent patients.
Participants completed the emotional Stroop task both before and after completing treatment.
Pre-treatment attentional bias predicted relapse at 3-month follow-up, even when controlling for self-reported cravings at the test session. Further, attentional bias was reduced in both groups after therapy, independent of treatment condition.
Attentional bias may tap an important component of drug dependence as it is a predictor of opiate relapse. However, CET does not specifically reduce attentional bias.

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    • "Multi-item craving evaluation questionnaires, such as DDQ, usually include items considered equal to desire, or ask questions related to drug use intention, negative reinforcement, and lack of control (Tiffany et al., 2000; Franken et al., 2002; Tiffany et al., 2012). These 3 items are among the more emphasized ones in the field of cue-induced craving neuroimaging studies (Franken et al., 2002; Marissen et al., 2006; Shi et al., 2008; Zijlstra et al., 2009; Tabatabaei-Jafari et al., 2014). However, for evaluation of drug craving in various cue-induced craving neuroimaging studies, besides craving self-report, both multi-dimensional questionnaires and single question self-reports were used (Grant et al., 1996; Garavan et al., 2000; Schneider et al., 2001; Kilts et al., 2001, 2004; Bonson et al., 2002; McClernon et al., 2005; McBride et al., 2006; Franklin et al., 2007; Zijlstra et al., 2009; Goldstein et al., 2009; Mei et al., 2010; Li et al., 2012; Schmidt et al., 2015). "
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    ABSTRACT: Introduction: Drug craving could be described as a motivational state which drives drug dependents towards drug seeking and use. Different types of self-reports such as craving feeling, desire and intention, wanting and need, imagery of use, and negative affect have been attributed to this motivational state. By using subjective self-reports for different correlates of drug craving along with functional neuroimaging with cue exposure paradigm, we investigated the brain regions that could correspond to different dimensions of subjective reports for heroin craving. Methods: A total of 25 crystalline-heroin smokers underwent functional magnetic resonance imaging (fMRI), while viewing heroin-related and neutral cues presented in a block-design task. During trial intervals, subjects verbally reported their subjective feeling of cue induced craving (CIC). After fMRI procedure, participants reported the intensity of their “need for drug use” and “drug use imagination” on a 0-100 visual analog scale (VAS). Afterwards, they completed positive and negative affect scale (PANAS) and desire for drug questionnaire (DDQ) with 3 components of “desire and intention to drug use,” “negative reinforcement,” and “loss of control.” Results: The study showed significant correlation between “subjective feeling of craving” and activation of the left and right anterior cingulate cortex, as well as right medial frontal gyrus. Furthermore, the “desire and intention to drug use” was correlated with activation of the left precentral gyrus, left superior frontal gyrus, and left middle frontal gyrus. Subjects also exhibited significant correlation between the “need for drug use” and activation of the right inferior temporal gyrus, right middle temporal gyrus, and right parahippocampal gyrus. Correlation between subjective report of “heroin use imagination” and activation of the cerebellar vermis was also observed. Another significant correlation was between the “negative affect” and activation of the left precuneus, right putamen, and right middle temporal gyrus. Discussion: This preliminary study proposes different neural correlates for various dimensions of subjective craving self-reports. It could reflect multidimensionality of cognitive functions corresponding with drug craving. These cognitive functions could represent their motivational and affective outcomes in a single item “subjective craving feeling” or in self-reports with multiple dissociable items, such as intention, need, imagination, or negative feeling. The new psychological models of drug craving for covering various dimensions of subjective craving self-reports based on their neurocognitive correspondence could potentially modify craving assessments in addiction medicine.
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    • "Field, Schoenmakers, & Wiers, 2008; Sharma, Albery, & Cook, 2001), cannabis use (Field, Eastwood, Bradley, & Mogg, 2006) and nicotine use (Mogg, Field, & Bradley, 2005). Longitudinal designs have also demonstrated the association between attentional bias and risk of subsequent relapse in alcohol abusers (Cox, Hogan, Kristian, & Race, 2002), tobacco smokers (Waters, Shiffman, Bradley, & Mogg, 2003), heroin users (Marissen et al., 2006) and cocaine users (Carpenter, Schreiber, Church, & McDowell, 2006). "
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    ABSTRACT: Background: Over the last twenty years metacognitive theory has provided a novel framework, in the form of the Self-Regulatory Executive Function (S-REF) model, for conceptualizing psychological distress (Wells & Matthews, 1994, 1996). The S-REF model proposes that psychological distress persists because of unhelpful coping styles (e.g. extended thinking and thought suppression) which are activated and maintained as a result of metacognitive beliefs. Objective: This paper describes the S-REF model and its application to addictive behaviors using a triphasic metacognitive formulation. Discussion: Evidence on the components of the triphasic metacognitive formulation is reviewed and the clinical implications for applying metacognitive therapy to addictive behaviors outlined.
    Addictive Behaviors 05/2015; 44:9-15. DOI:10.1016/j.addbeh.2014.08.002 · 2.76 Impact Factor
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    • "Attentional bias (AB) – where disorder-related stimuli become the focus of one's attention – has been consistently demonstrated for substance-related stimuli in substance users relative to non-users (Field & Cox, 2008; Wiers & Stacy, 2006). Furthermore, AB is associated with craving in addiction (Field, Eastwood, Bradley, & Mogg, 2006), is positively correlated with frequency of substance use (Morgan, Freeman, Schafer, & Curran, 2010; Morgan, Rees, & Curran, 2008) and has been linked to relapse in individuals abstaining from substance use (Cox, Hogan, Kristian, & Race, 2002; Marissen et al., 2006). Consequently, AB features as a key component of many recent theoretical models of addiction (Franken, 2003; Ryan, 2002; Wiers & Stacy, 2006), where it is awarded a central role in the development and maintenance of substance use. "
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    ABSTRACT: Attentional bias (AB) is implicated in the development and maintenance of substance dependence and in treatment outcome. We assessed the effects of attentional bias modification (ABM), and the relationship between AB and treatment adherence in opiate dependent patients. An independent groups design was used to compare 23 opiate dependent patients with 21 healthy controls. Participants completed an AB task before either a control or an ABM task designed to train attention away from substance-related stimuli. Pre- and post-ABM AB and craving were assessed to determine any changes. Relationships between treatment adherence ('using on top' of prescribed opiates or not) and AB, craving and psychopathology were also examined. There was no baseline difference in AB between patients and controls, and no significant effect of ABM on AB or substance craving. However, treatment adherent patients who did not use illicit opiates on top of their prescribed opiates had statistically significantly greater AB away from substance-related stimuli than both participants using on top and controls, and reported significantly lower levels of craving than non-treatment adherent patients. Whilst we did not find any significant effects of ABM on AB or craving, patients who were treatment adherent differed from both those who were not and from controls in their attentional functioning and substance craving. These findings are the first to suggest that AB may be a within-treatment factor predictive of adherence to pharmacological treatment and potentially of recovery in opiate users. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Addictive behaviors 03/2015; 46:100-105. DOI:10.1016/j.addbeh.2015.03.017 · 2.76 Impact Factor
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