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Attentional bias to drug cues is elevated before and during temptations to use heroin and cocaine

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Abstract

Rationale

Relapse is an important problem in substance dependence treatment. When drug users try to abstain from drug use, they often report strong temptations to use drugs. Temptation episodes have commonalities with relapse episodes, and assessment of temptation episodes may help to identify individuals at risk of relapse.

Objectives

This study aims to examine affect and cognition prior to and during temptation episodes by administering self-report and implicit cognitive assessments on a handheld computer (PDA) using Ecological Momentary Assessment.

Methods

Heroin-dependent patients (N = 68) attending a drug detoxification unit completed up to four random assessments (RAs) per day on a PDA for 1 week. They also completed an assessment when they experienced a temptation to use drugs (temptation assessment; TA).

Results

Participants completed 1,482 assessments (353 TAs, 1,129 RAs). The rate of TAs was maximal during the first 2 days. Participants reported higher levels of negative affect, anxiety, and difficulty concentrating, and more positive explicit attitudes to drugs, at TAs compared to RAs. In addition, they exhibited elevated attentional bias to drug cues (assessed using the modified Stroop task) at TAs compared to RAs. Implicit affective associations with drug cues (assessed using the Implicit Association Test) were not different at TAs compared to RAs. Attentional bias was elevated in the 1 h prior to the entry of a temptation episode.

Conclusions

Elevated attentional bias may be a harbinger of temptation episodes. Interventions that target cognitions prior to or during temptation episodes may reduce the probability or severity of a temptation episode.

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Notes

  1. Given that positive affect can be independent of negative affect (e.g., Watson 2000), it could be argued that two affect factors (positive affect and negative affect) might be derived. Exploratory factor analysis did not provide compelling evidence for two factors. If two factors were extracted, positive affect was significantly lower at TAs than RAs, and vice versa for negative affect (ps < 0.01).

  2. Data from two participants were lost due to PDA error, one participant dropped out of the study immediately following the training because he did not comprehend the procedures, and one participant dropped out of treatment prior to completing any assessments. Of the 64 participants, 10 relapsed (n = 9) or dropped out of treatment (n = 1) during the PDA study. Analyses on relapse are not reported in the present paper.

  3. The primary analyses were conducted on data from all available days (n = 414) and assessments (n = 1,482). Secondary analyses were conducted on data derived from days (n = 400) and assessments (n = 1,437) that occurred before reported relapses. These analyses revealed very similar findings and are not reported here.

  4. The current paper focuses on between-assessment differences. A detailed analysis of the associations between craving ratings and implicit cognitions is beyond the scope of the current paper. However, when craving for heroin or cocaine is entered into the model (including day, number of assessments, and Stroop type, but excluding assessment type), the parameter estimates were non-significant (heroin—PE = 2.41, SE = 3.14, p > 0.1; cocaine—PE = 3.74, SE = 3.01, p > 0.1).

  5. One may question whether the drug-related pictures in the IAT could provoke temptations. Of the 529 RAs at which an IAT was administered, 30 (5.7%) were followed by a TA within an hour. For RAs in which a Stroop task was administered, 31 (5.2%) were followed by a TA within an hour. Therefore, most IAT RAs (94.3%) were not followed by a TA, and the post-assessment TA rate was not higher (PE = 0.11, SE = 0.26, p > 0.66, using proc glimmix) following IAT vs. Stroop assessments (the Stroop task did not include pictures).

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Acknowledgement

This study was funded by ZonMw grant 31180001 (Franken) and R01 DA020436-S3 (Waters).

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Correspondence to Andrew J. Waters.

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Waters, A.J., Marhe, R. & Franken, I.H.A. Attentional bias to drug cues is elevated before and during temptations to use heroin and cocaine. Psychopharmacology 219, 909–921 (2012). https://doi.org/10.1007/s00213-011-2424-z

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  • DOI: https://doi.org/10.1007/s00213-011-2424-z

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