Implementing Approach-Bias Modification as Add-On to Varieties of Clinical Treatment for Alcohol Use Disorders: Results of a Multicenter RCT

Edwin J Schenkel; Mike Rinck; Reinout W Wiers; Eni S Becker; Stephan Muhlig; Robert Schoeneck; Johannes Lindenmeyer

doi:10.1159/000537811

Implementing Approach-Bias Modification as Add-On to Varieties of Clinical Treatment for Alcohol Use Disorders: Results of a Multicenter RCT

Eur Addict Res. 2024;30(2):94-102. doi: 10.1159/000537811. Epub 2024 Mar 19.

Authors

Edwin J Schenkel^{1

2

3}, Mike Rinck³, Reinout W Wiers⁴, Eni S Becker³, Stephan Muhlig⁵, Robert Schoeneck², Johannes Lindenmeyer^{1

2}

Affiliations

¹ Department of Psychology, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany.
² Salus Clinic Lindow, Lindow, Germany.
³ Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
⁴ Department of Psychology, Addiction Development and Psychopathology (ADAPT) Lab, ABC and Yield Research Priority Areas, University of Amsterdam, Amsterdam, The Netherlands.
⁵ Department of Psychology, Chemnitz University of Technology, Chemnitz, Germany.

PMID: 38503273
DOI: 10.1159/000537811

Abstract

Introduction: Abstinence rates after inpatient treatment for alcohol use disorder (AUD) are modest (1-year rate around 50%). One promising approach is to re-train the automatically activated action tendency to approach alcohol-related stimuli (alcohol-approach bias) in AUD patients, as add-on to regular treatment. As efficacy has been demonstrated in well-controlled randomized controlled trials, the important next step is to add alcohol-approach-bias modification (alcohol-ApBM) to varieties of existing treatments for AUD. Therefore, this prospective, multicenter implementation-RCT examined whether adding alcohol-ApBM to regular treatments (various abstinence-oriented treatments including both individual and group-based interventions) would significantly increase abstinence rates compared to receiving regular treatment only, in a variety of naturalistic settings with different therapeutic approaches.

Methods: A total of 1,586 AUD inpatients from 9 German rehabilitation clinics were randomly assigned to receive either ApBM in addition to regular treatment or not. Training satisfaction of patients and therapists was measured after training. Success rates were determined at 3, 6, and 12 months post-treatment.

Results: Return rates of the post-treatment assessments varied greatly between clinics, often being low (18-76%). Nevertheless, ApBM significantly increased success rates after 3 months. After 6 and 12 months, the differences were not significant. ApBM was evaluated mostly positively by patients and therapists.

Discussion/conclusion: ApBM was an effective add-on to regular treatment of AUD at 3 months follow-up, across a variety of AUD treatment settings. However, low return rates for the clinical outcomes reduced the effect size of ApBM considerably. The application of ApBM proved feasible in varying clinical settings, offering the opportunity to modify automatic processes and to promote abstinence.

Keywords: Alcohol dependence; Alcohol-approach bias; Cognitive bias modification; Relapse prevention.

Publication types

Multicenter Study

MeSH terms

Alcohol Drinking
Alcoholism* / therapy
Cognitive Behavioral Therapy* / methods
Humans
Prospective Studies
Randomized Controlled Trials as Topic