Attention bias modification in drug addiction: Enhancing control of subsequent habits

Abstract

A relapse in addiction is often precipitated by heightened attention bias to drug-related cues, underpinned by a subcortically mediated transition to habitual/automatized responding and reduced prefrontal control. Modification of such automatized attention bias is a fundamental, albeit elusive, target for relapse reduction. Here, on a trial-by-trial basis, we used electroencephalography and eye tracking with a task that assessed, in this order, drug cue reactivity, its instructed self-regulation via reappraisal, and the immediate aftereffects on spontaneous (i.e., not instructed and automatized) attention bias. The results show that cognitive reappraisal, a facet of prefrontal control, decreased spontaneous attention bias to drug-related cues in cocaine-addicted individuals, more so in those with less frequent recent use. The results point to the mechanisms underlying the disruption of automatized maladaptive drug-related attention bias in cocaine addiction. These results pave the way for future studies to examine the role of such habit disruption in reducing compulsive drug seeking outside the controlled laboratory environment, with the ultimate goal of developing a readily deployable cognitive-behavioral and personalized intervention for drug addiction.

Keywords: EEG; addiction; attention bias; cognitive reappraisal; eye tracking.

Fig. 1.

CR task. After 500 ms of fixation, a picture (drug, threat, or neutral) is presented for 1,500 msec followed by an auditory instruction of “Look” or “Decrease.” After 7,000 msec of picture presentation, either an attention screen (after 75% of the trials) or a “rating screen” (after the remaining 25% of the trials) was shown. During the attention screen, drug, neutral, and threat pictures were randomly presented in three of four quadrants of the screen for 1,500 msec (the fourth quadrant was left blank) (these were pictures not presented during the viewing phase within the same trial). During the “rating screen,” subjects were asked to report their “Liking” and “Wanting” for the content of the preceding image on a scale of 1 to 5 (“1” = Don’t Like/Want it at all; “5” = Like/Want it very much).

Fig. 2.

Event-related potentials waveforms for HC (A and B) and iCUD (C and D). These waveforms reflect an averaged reactivity to each condition, and 0 msec reflects the onset of each picture. Note that “Look” or “Decrease” instruction was provided at 1,500 msec. Graphical representation of LPP amplitudes for the pre- (averaged amplitude during 400 to 1,000 msec) and postinstruction (averaged amplitude during 2,500 to 7,000 msec) phases are also presented (E and F).

Fig. 3.

Average GD (msec) toward drug- and threat-related cues for HC and iCUD. Only iCUD demonstrated a significantly reduced GD to drug-related cues following the “Decrease” instruction relative to the “Look” instruction. *P < 0.05.

Fig. 4.

Increased initial drug-related LPP positively correlated with withdrawal symptoms on the Cocaine Selective Severity Assessment (CSSA) (r_s = 0.379, P = 0.039), such that individuals with cocaine use disorder who exhibited more withdrawal symptoms demonstrated enhanced emotional cue reactivity to drug-related cues prior to the auditory instruction.

Fig. 5.

The reduction in drug-related GD negatively correlated with the frequency of cocaine use in the past 30 d (r_s = −0.388, P = 0.034), such that individuals with cocaine use disorder who used less frequently in that past 30 d demonstrated a greater reduction in GD to drug-related cues in response to the instruction to “Decrease” (versus “Look”) their emotional cue reactivity.