Approach Bias Modification for Reducing Co-Occurring Alcohol and Cannabis Use Among Treatment-seeking Adolescents: Protocol of a Randomized Controlled Trial

Overview

Journal Contemp Clin Trials Commun

Date 2025 Feb 13

PMID 39944963

Authors

Austin M Hahn

Erin Corcoran

Carla Kmett Danielson

Affiliations

Soon will be listed here.

Abstract

Alcohol and cannabis are the first and second most used substances among adolescents. Adolescence is a period of considerable development, making the adolescent brain particularly vulnerable to negative effects of alcohol and cannabis use. Developing and testing interventions that target both alcohol and cannabis use during adolescence are vital to decreasing costly consequences. Biases in cognitive processing of drug-related stimuli play an important role in the development and maintenance of problematic substance use. The Approach-Avoidance Task (AAT) is a computerized program, effective in assessing implicit approach biases for both alcohol and cannabis, in which participants make approach or avoidance movements in response to an irrelevant feature of an image presented on a screen (e.g., push when in portrait, pull when in landscape). A modified version of the AAT is also used as an approach bias modification (ApBM) intervention, to retrain participants' implicit biases toward or away from stimuli by presenting the target stimuli predominantly in one format (e.g., push or pull). Despite research demonstrating the effectiveness of AAT interventions to reduce problematic alcohol and cannabis use, there is a dearth of research examining this intervention among adolescents. This protocol paper describes a NIDA-funded randomized control trial (RCT) to evaluate an integrated mobile ApBM intervention to target co-occurring alcohol and cannabis use among treatment-seeking adolescents. Outcomes will be measured from pre-treatment through a three-month follow-up. The sampling procedures, assessment protocol, description of the intervention, and planned statistical approaches to evaluating outcomes are detailed. Clinical and research implications of this work are also discussed.

References

Swendsen J, Burstein M, Case B, Conway K, Dierker L, He J . Use and abuse of alcohol and illicit drugs in US adolescents: results of the National Comorbidity Survey-Adolescent Supplement. Arch Gen Psychiatry. 2012; 69(4):390-8. PMC: 3746542. DOI: 10.1001/archgenpsychiatry.2011.1503. View

Boffo M, Smits R, Salmon J, Cowie M, de Jong D, Salemink E . Luck, come here! Automatic approach tendencies toward gambling cues in moderate- to high-risk gamblers. Addiction. 2017; 113(2):289-298. DOI: 10.1111/add.14071. View

Cacioppo J, Priester J, Berntson G . Rudimentary determinants of attitudes. II: Arm flexion and extension have differential effects on attitudes. J Pers Soc Psychol. 1993; 65(1):5-17. DOI: 10.1037//0022-3514.65.1.5. View

Stacy A, Wiers R . Implicit cognition and addiction: a tool for explaining paradoxical behavior. Annu Rev Clin Psychol. 2010; 6:551-75. PMC: 3423976. DOI: 10.1146/annurev.clinpsy.121208.131444. View

Casey B, Jones R, Hare T . The adolescent brain. Ann N Y Acad Sci. 2008; 1124:111-26. PMC: 2475802. DOI: 10.1196/annals.1440.010. View

MacArthur G, Smith M, Melotti R, Heron J, MacLeod J, Hickman M . Patterns of alcohol use and multiple risk behaviour by gender during early and late adolescence: the ALSPAC cohort. J Public Health (Oxf). 2012; 34 Suppl 1:i20-30. PMC: 3284864. DOI: 10.1093/pubmed/fds006. View

Boffo M, Zerhouni O, Gronau Q, van Beek R, Nikolaou K, Marsman M . Cognitive Bias Modification for Behavior Change in Alcohol and Smoking Addiction: Bayesian Meta-Analysis of Individual Participant Data. Neuropsychol Rev. 2019; 29(1):52-78. PMC: 6499757. DOI: 10.1007/s11065-018-9386-4. View

Janssen T, Larsen H, Vollebergh W, Wiers R . Longitudinal relations between cognitive bias and adolescent alcohol use. Addict Behav. 2014; 44:51-57. DOI: 10.1016/j.addbeh.2014.11.018. View

Eberl C, Wiers R, Pawelczack S, Rinck M, Becker E, Lindenmeyer J . Implementation of approach bias re-training in alcoholism-how many sessions are needed?. Alcohol Clin Exp Res. 2013; 38(2):587-94. DOI: 10.1111/acer.12281. View

10.

Belendiuk K, Riggs P . Treatment of Adolescent Substance Use Disorders. Curr Treat Options Psychiatry. 2014; 1(2):175-188. PMC: 4023344. DOI: 10.1007/s40501-014-0016-3. View

11.

Jacobus J, Taylor C, Gray K, Meredith L, Porter A, Li I . A multi-site proof-of-concept investigation of computerized approach-avoidance training in adolescent cannabis users. Drug Alcohol Depend. 2018; 187:195-204. PMC: 6053264. DOI: 10.1016/j.drugalcdep.2018.03.007. View

12.

Zhang M, Ying J, Song G, Fung D, Smith H . Mobile Phone Cognitive Bias Modification Research Platform for Substance Use Disorders: Protocol for a Feasibility Study. JMIR Res Protoc. 2018; 7(6):e153. PMC: 6019844. DOI: 10.2196/resprot.9740. View

13.

Wiers R, Pan T, Van Dessel P, Rinck M, Lindenmeyer J . Approach-Bias Retraining and Other Training Interventions as Add-On in the Treatment of AUD Patients. Curr Top Behav Neurosci. 2023; . DOI: 10.1007/7854_2023_421. View

14.

Winters K, Lee C . Likelihood of developing an alcohol and cannabis use disorder during youth: association with recent use and age. Drug Alcohol Depend. 2007; 92(1-3):239-47. PMC: 2219953. DOI: 10.1016/j.drugalcdep.2007.08.005. View

15.

Wiers R, Boffo M, Field M . What's in a Trial? On the Importance of Distinguishing Between Experimental Lab Studies and Randomized Controlled Trials: The Case of Cognitive Bias Modification and Alcohol Use Disorders. J Stud Alcohol Drugs. 2018; 79(3):333-343. View

16.

Jacobus J, Squeglia L, Bava S, Tapert S . White matter characterization of adolescent binge drinking with and without co-occurring marijuana use: a 3-year investigation. Psychiatry Res. 2013; 214(3):374-81. PMC: 3900025. DOI: 10.1016/j.pscychresns.2013.07.014. View

17.

Sheeran P, Klein W, Rothman A . Health Behavior Change: Moving from Observation to Intervention. Annu Rev Psychol. 2016; 68:573-600. DOI: 10.1146/annurev-psych-010416-044007. View

18.

Manning V, Piercy H, Garfield J, Lubman D . Personalized Approach Bias Modification Smartphone App ("SWIPE") to Reduce Alcohol Use Among People Drinking at Hazardous or Harmful Levels: Protocol for an Open-Label Feasibility Study. JMIR Res Protoc. 2020; 9(8):e21278. PMC: 7455870. DOI: 10.2196/21278. View

19.

Wiers R, Rinck M, Kordts R, Houben K, Strack F . Retraining automatic action-tendencies to approach alcohol in hazardous drinkers. Addiction. 2010; 105(2):279-87. DOI: 10.1111/j.1360-0443.2009.02775.x. View

20.

Sobell L, Brown J, Leo G, Sobell M . The reliability of the Alcohol Timeline Followback when administered by telephone and by computer. Drug Alcohol Depend. 1996; 42(1):49-54. DOI: 10.1016/0376-8716(96)01263-x. View