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Learning to resist the urge: Inhibition training in abstinent alcohol dependent patients

English title Learning to resist the urge: Inhibition training in abstinent alcohol dependent patients
Applicant Stein Maria
Number 159286
Funding scheme Project funding (Div. I-III)
Research institution Abteilung Psychiatrische Neurophysiologie Universitätsklinik und Poliklinik für Psychiatrie
Institution of higher education University of Berne - BE
Main discipline Psychology
Start/End 01.09.2016 - 31.10.2019
Approved amount 200'999.00
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All Disciplines (2)

Discipline
Psychology
Neurology, Psychiatry

Keywords (9)

Event related potentials; outcome predictors; clinical outcome; Alcohol use disorders; implicit association; training; cortisol; randomized controlled trial; inhibition

Lay Summary (German)

Lead
Computergestützte Trainingsverfahren können die Behandlung von Alkoholabhängigkeit wirkungsvoll ergänzen. Das Projekt untersucht, ob ein solches Training den Therapieerfolg bei stationärer Behandlung alkoholabhängiger Patienten erhöht.
Lay summary

Titel des Forschungsprojektes

Lernen, dem Alkohol zu widerstehen: Inhibitionstraining für Patienten mit einer Alkoholabhängigkeit
 

Inhalt und Ziele des Forschungsprojektes

Im Projekt wird die Wirkung eines computergestützten Inhibitionstrainings untersucht. Dabei üben alkoholabhängige Patienten, ihre Reaktionen auf alkoholbezogene Reize (z.B. Alkoholreklamen) zu kontrollieren.

Hauptziel ist, den Einfluss des Trainings auf die Häufigkeit und die Intensität des Alkoholkonsums während und nach der Behandlung zu untersuchen. Zusätzlich wird noch der Frage nachgegangen, ob die Tageszeit des Trainings einen Einfluss auf den Behandlungseffekt hat, denn körpereigenes Cortisol, das v.a. am Morgen gebildet wird, könnte den Lerneffekt verstärken. Ausserdem wird die Hirnaktivität der Patienten vor und nach dem Training untersucht, um festzustellen, welche neurophysiologischen Prozesse durch das Training verändert werden und wie deren Bezug zum Behandlungserfolg ist.

Wissenschaftlicher und gesellschaftlicher Kontext des Forschungsprojektes

Alkoholabhängigkeit ist eine der am weitesten verbreiteten psychischen Störungen mit beträchtlichem Schadenpotenzial. Neurowissenschaftliche Forschung zeigte, dass bei alkoholabhängigen Patienten alkoholbezogene Reize automatisch eine zu starke Anreizwirkung auslösen, die zum Grossteil auf unbewussten Prozessen beruht und dass ausserdem die Kontrollprozesse (z.B. die Inhibition) zu schwach sind. Trainingsverfahren, die diese Anreizwirkung schwächen oder die Kontrolle stärken, können die Rückfallverhütung bei Alkoholabhängigkeit wirkungsvoll ergänzen. 

Direct link to Lay Summary Last update: 21.05.2015

Responsible applicant and co-applicants

Employees

Abstract

Alcohol use disorders (AUD) lead to significant burden of disease on an individual as well as a societal level. Furthermore, therapeutic interventions still need to be improved in order to achieve higher success rates. Most current conceptualizations postulate an enhanced automatic reaction to alcoholic cues and an impaired inhibitory control as relevant processes in the development, maintenance, and treatment of AUD. Complementing traditional cognitive behavioral relapse prevention strategies, novel computerized training interventions aim to directly interfere with implicit processes involved in addictive behaviors.For three reasons, a novel alcohol-specific inhibition-training seems to be a promising new intervention: First, this training intervention effectively reduced drinking behavior and implicit attitudes towards alcohol in a heavy drinking student population (Houben, Nederkoorn et al. 2011; Houben, Havermans et al. 2012). Second, recent neurophysiological findings suggest that alcohol-specific inhibition (tested with Go-NoGo-tasks in an alcohol-related context) demand additional neuronal resources in AUD patients. Such a training thus recruits a network which is probably impaired in AUD patients (Petit, Kornreich et al. 2012; Stein, Fey et al. 2012). According to these findings, an alcohol-specific inhibition-training targets crucial neuronal processes, whose improvement may lead to modification of highly relevant clinical variables. Third, this short, computerized training is very easy to implement in inpatient and outpatient settings as neither expensive equipment nor specially trained staff is needed. It might thus be an adequate and cost-effective add-on to traditional treatment and may enhance clinical outcome of AUD. The proposed study now tests this training for the first time in a patient population. In the present project, 240 recently abstinent patients with AUD attending an inpatient treatment program will be randomly assigned to one of two alcohol-specific inhibition-training groups (varying in Go/NoGo-ratio) or to a control condition. Besides the effects on drinking behavior and implicit attitudes, we expect the training to influence neurophysiological reactivity to alcohol related stimuli. A subgroup of patients will therefore additionally undergo EEG recording so that the neurophysiological effects of the training can be assessed and related to clinical outcome. Furthermore, since training effects rely on learning processes, the influence of endogenous cortisol level (a consolidation-enhancer which peaks in the morning) on training outcome will be examined by the variation of daytime of the training. All patients’ inhibitory control and implicit associations towards alcohol will be measured before and after training. The training effects will be examined on proximal outcome variables at discharge from inpatient treatment (e.g. implicit associations, inhibitory control, abstinence related self-efficacy, action-oriented motivation to change alcohol use) and on distal outcome variables at 3- and 12-months follow-up (e.g. percent abstinent days (primary outcome), percent heavy drinking days).For the first time the planned project will investigate the therapeutic potential of an alcohol-specific inhibition-training as a therapeutic supplement in a patient population. In doing so, it will additionally investigate the impact of variables such as daytime and Go/NoGo-ratio on training efficacy and elucidate the underlying neurophysiological mechanisms of the training. The project will thus significantly contribute to the improvement of evidence based treatment of AUD.
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