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

Abstract

Significance This study assessed whether habitual (drug-related) attentional processes can be disrupted by cognitive reappraisal, an adaptive emotion regulation strategy that is presumed to deploy prefrontal cortex–mediated cognitive control, in cocaine-addicted individuals. The novelty of the current study is in the multimethod integration of outcome measures (i.e., using objective psychophysiological measures such as the late positive potentials and gaze duration but also past behavior) and the focus on the down-regulation of spontaneous attention bias to drug-related cues presented outside of the volitional/motivated self-regulation cognitive reappraisal window, achieved using a task design that maximized robust detection of subtle trial-by-trial perturbations in drug cue reactivity in cocaine-addicted individuals. 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.