Elsevier

Drug and Alcohol Dependence

Volume 68, Issue 3, 1 December 2002, Pages 237-243
Drug and Alcohol Dependence

Alcohol attentional bias as a predictor of alcohol abusers’ treatment outcome

https://doi.org/10.1016/S0376-8716(02)00219-3Get rights and content

Abstract

Alcohol abusers’ and non-abusers’ attentional distraction for alcohol-related, concern-related, and neutral stimuli was assessed with the emotional Stroop paradigm. Alcohol abusers (n=14) were tested on admission to inpatient treatment and immediately before discharge, 4 weeks later; non-abusers (n=16) were also tested twice, with a 4-week intervening interval. Alcohol abusers were assessed for alcohol use 3 months after discharge. Unlike control participants and alcohol abusers whose treatment was successful, alcohol abusers whose treatment was unsuccessful (who relapsed or did not maintain post-discharge outpatient contact) had a significant increase in attentional distraction for alcohol stimuli during the 4 weeks of inpatient treatment. Compared to control participants and alcohol abusers who completed the 4 weeks of treatment, those who did not complete treatment (n=9) were highly distracted by concern-related stimuli at treatment admission. The results have implications for understanding the cognitive and motivational processes underlying successful treatment for alcohol abuse.

Introduction

Previous studies have shown that alcohol abusers have an attentional bias for alcohol-related stimuli, which reflects their preoccupation with drinking alcohol (e.g. Bauer and Cox, 1998, Johnsen et al., 1994, Stetter et al., 1995, Stormark et al., 2000). This research has primarily used the emotional Stroop paradigm (Williams et al., 1996) to assess the alcohol attentional bias. This task is a variation of the Stroop (1935) color-naming task, in which participants name the color of ink in which words are written, while attempting to ignore the meaning of the words themselves. When color words and their ink colors are incongruent (e.g. the word ‘red’ written in green ink) participants’ reaction times are dramatically slowed relative to reactive times when the two stimulus dimensions are congruent (e.g. the word ‘red’ written in red ink).

The emotional Stroop task has become a widely accepted paradigm for studying cognitive-emotional processes in psychopathology (Williams et al., 1996). It uses words that are either emotionally relevant or emotionally neutral for the participants being tested. For instance, in the case of alcohol addiction, participants might be asked to color-name alcohol-related words (e.g. ‘bar,’ ‘liquor,’ ‘cocktail’). If they were personally concerned about drinking alcohol, their reaction times would be slower than if they color named emotionally neutral words (e.g. ‘door,’ ‘roof,’ ‘cabinet’). Individuals who are not concerned about drinking alcohol either do not show this attentional bias, or they do so to a lesser extent than do alcohol abusers. The alcohol abusers are presumed to unwittingly attend to the meaning of the words that are personally relevant to them, and their color-naming performance is thereby impaired.

Cox et al. (2000) assessed whether alcohol abusers’ current concerns in other areas of their lives are reflected in their attentional biases, as abusers’ concern for drinking alcohol is known to be. According to motivational theory (Cox and Klinger, 1988, Cox and Klinger, 1990), concern-related attentional biases are important to establish. For instance, if alcohol abusers can be distracted by compelling, positive concerns in other areas of their lives, they might have a better chance of relinquishing their concern about drinking alcohol. If, on the other hand, their lives are burdened by negative concerns, which they see little chance of resolving, they are likely to be unmotivated to reduce their use of alcohol. Cox et al. (2000) used a modified version of the emotional Stroop task, with a category of ‘concern-related’ words, along with alcohol-related and neutral words. The concern-related words were selected to represent the individual participants’ current concerns in various areas of their lives, apart from their concern about drinking alcohol. To identify the individualized concerns, 1 week prior to the experiment each participant was administered the motivational structure questionnaire (Klinger et al., 1995). In turn, stimuli related to each participant's current concerns were devised for presentation during the laboratory cognitive task. Results indicated that the alcohol abusers, unlike the non-abusers, showed greater attentional distraction for alcohol-related than concern-related words. Other research using various laboratory paradigms has shown that alcohol non-abusers attend to stimuli related to their current concerns (Nikula et al., 1993, Riemann and McNally, 1995). Additional research is now needed to determine if alcohol abuses (like non-abusers) can be distracted by concern-related stimuli and whether or not this distraction is related to alcohol abusers’ recovery.

The present study tested alcohol abusers and non-abusers with an emotional Stroop task, using alcohol, concern-related, and neutral stimuli. The abusers were tested upon their entry into inpatient treatment and then just prior to their discharge 4 weeks later. The non-abusers were also tested on two occasions, separated by a 4-week interval. Additionally, the alcohol abusers were contacted 3 months following discharge for evaluation of their treatment outcome. The study was designed to test these hypotheses: (a) alcohol abusers and non-abusers would show different patterns of distraction by the alcohol-related and concern-related stimuli. (b) Alcohol abusers’ (but not non-abusers’) attentional bias for alcohol-related stimuli would increase across time (as the alcohol abusers remained abstinent from alcohol). (c) The greater the increase in alcohol abusers’ attentional distraction for alcohol across time, the more likely they would be to relapse following treatment. Predictions about attentional bias for concern-related stimuli were less clear-cut, because they depended on whether participants’ current concerns were positive (i.e. related to attractive goals that could replace alcohol) or negative (i.e. related to burdensome elements in the person's life).

Section snippets

Participants

There were two groups of participants, an experimental group of alcohol abusers and a control group of non-abusers. All participants in the experimental group met DSM-IV (American Psychiatric Association, 1994) criteria for alcohol dependence. One alcohol abuser who volunteered to participate was excluded because of a history of psychiatric problems. A total of 26 experimental and 20 control participants were tested initially at Time 1. Three of the experimental participants’ electronic data

Results

The AAAI index from the KAT was converted to weekly units of alcohol, which confirmed that the alcohol abusers (mean=257.4, SD=298.2) consumed more alcohol than the non-abusers (mean=21.9, SD=18.7). Nevertheless, participants in the control group were, on average, heavy social drinkers. Females in the control group drank a mean of 14.0 units (SD=7.1) of alcohol per week; males drank a mean of 19.9 units (SD=5.1) units.

Each participant's mean concern-relatedness rating was calculated for the

Discussion

From a cognitive-motivational perspective, there are several findings of the present study that have significant implications for understanding the cognitive processes that underlie recovery from alcohol abuse. First, the study identified attentional processes that distinguished alcohol abusers whose treatment was successful from those whose treatment was unsuccessful. Specifically, alcohol abusers who would succeed with treatment showed a pattern of attentional distraction for alcohol stimuli

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