Approach Bias Modification May Reduce Relapse in Alcohol Use Disorder

The rewarding value of a drug is a key determinant of decision making which contributes to the development of and recovery from addiction.

For patients with alcohol use disorder, approach bias modification (ApBM) may reduce alcohol relapse to a similar extent as sham treatment. These findings from a randomized controlled trial were published in Drug and Alcohol Dependence.

Inpatients (N=300) who received treatment for alcohol withdrawal at 4 sites in Australia between 2017 and 2020 were recruited for this study. Patients were randomly assigned in a 1:1 ratio to receive either ApBM (n=147) or sham training (n=153). The ApBM and sham interventions included responding to alcohol-based and nonalcohol images using a joystick. The ApBM cohort were instructed to push or pull images, and the sham cohort were instructed to move images to the left or right. The effect of the interventions on alcohol cravings was evaluated using the Alcohol Craving Questionnaire-Short Form revised (ACQ-SF-R).

The patient population comprised 57.67% men with a mean age of 43.47 (standard deviation [SD], 10.43) years. Then mean age when alcohol consumption became a problem occurred at 26.29 (SD, 10.57) years, 67.67% of participants underwent previous withdrawal treatment, and ACQ-SF-F total score was 3.88 points (SD, 1.43). More men were randomly assigned to receive sham treatment than the intervention (P =.040).

Compared with baseline, ACQ-SF-R total score (t[261.28], -7.82; P <.001) and compulsivity (t[260.27], -8.06; P <.001), expectancy (t[262.91], -5.83; P <.001), emotionality (t[266.96], -5.08; P <.001), and purposefulness (t[271.03], -2.52; P =.012) subscales decreased significantly following treatment. Compared with controls, only the expectancy subscale differed between cohorts (P =.030).

These results are broadly consistent with previous findings of weak, transient, or non-significant effects of ApBM on alcohol craving in clinical samples.

Significant effects were observed for age (P <.001), image type (P =.007), and the time-by-image type interaction (P =.009).

Participants who were lost to follow-up (n=250) were assumed to have relapsed.

Alcohol use during the first 14 days following discharge was associated with purposefulness (adjusted odds ratio [aOR], 1.35; 95% CI, 1.14-1.60; P <.001), ACQ-SF-R total (aOR, 1.33; 95% CI, 1.09-1.63; P =.005), expectancy (aOR, 1.25; 95% CI, 1.06-1.47; P =.007), compulsivity (aOR, 1.15; 95% CI, 0.95-1.39; P =.005), and cue-induced alcohol craving (aOR, 1.02; 95% CI, 1.003-1.03; P =.019) scores.

The proportion of patients who reported using any anti-craving medications decreased from 40.54% and 47.15% at week 2 to 22.11% and 21.43% at 12 months in the control group and ApBM group, respectively.

The major limitation of this study was the reliance on self-reported alcohol use.

Study authors concluded, “These results are broadly consistent with previous findings of weak, transient, or nonsignificant effects of ApBM on alcohol craving in clinical samples.… As such, we propose that reduced craving is unlikely to be a mechanism that contributes substantially to the relapse prevention efficacy of ApBM, at least when delivered in residential treatment settings.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Garfield JBB, Piccoli LR, Whelan D, et al. The effect of approach bias modification during alcohol withdrawal treatment on craving, and its relationship to posttreatment alcohol use in a randomised controlled trial. Drug Alcohol Depend. 2022;239:109621. doi:10.1016/j.drugalcdep.2022.109621