Matt Field

Attentional bias in addictive behaviors: A review of its development, causes, and consequences

A wealth of research from the past two decades shows that addictive behaviors are characterized by attentional biases for substance-related stimuli. We review the relevant evidence and present an integration of existing theoretical models to explain the development, causes, and consequences of addiction-related attentional biases. We suggest that through classical conditioning, substance-related stimuli elicit the expectancy of substance availability, and this expectancy causes both attentional bias for substance-related stimuli and subjective craving. Furthermore, attentional bias and craving have a mutual excitatory relationship such that increases in one lead to increases in the other, a process that is likely to result in substance self-administration. Cognitive avoidance strategies, impulsivity, and impaired inhibitory control appear to influence the strength of attentional biases and subjective craving. However, some measures of attentional bias, particularly the addiction Stroop, might reflect multiple underlying processes, so results need to be interpreted cautiously. We make several predictions that require testing in future research, and we discuss implications for the treatment of addictive behaviors.

A Meta-Analytic Investigation of the Relationship between Attentional Bias and Subjective Craving in Substance Abuse.

Theoretical models of addiction suggest that attentional bias for substance-related cues should be associated with self-reported craving. The authors evaluated the strength of the association by performing a meta-analysis on 68 independent data sets from which correlation coefficients between subjective craving and attentional bias indices were derived. Additional stratified analyses were conducted to identify any variables that might moderate the association between craving and attentional bias. The primary meta-analysis indicated a significant, albeit weak (r=.19), association between attentional bias and craving. Stratified analyses revealed that the association was larger for illicit drug and caffeine craving than for alcohol and tobacco craving, larger for direct measures of attention (eye movement measures and event-related potential measures) than for indirect behavioral measures of attentional bias, and larger when craving strength was high than when it was low (all ps<.05). The size of the correlation did not differ among patients in treatment and individuals who were not seeking treatment. These results suggest that attentional bias and craving are related phenomena, although the relationship is generally modest and appears to be moderated by various factors. Theoretical implications are discussed.

Experimental manipulation of attentional bias increases the motivation to drink alcohol

RationaleAttentional bias for alcohol-related cues is associated with the motivation to drink alcohol, possibly because attentional bias increases craving.ObjectivesWe examined whether an experimentally induced attentional bias would influence subjective and behavioural indices of the motivation to drink.MethodsHeavy social drinkers (N=40) completed an attentional training procedure, in which half of the participants were trained to direct their attention towards alcohol-related cues (‘attend alcohol’), and half of the participants were trained to direct their attention away from alcohol-related cues (‘avoid alcohol’). After attentional training, participants rated their urge to drink alcohol, and the amount of beer consumed during a taste test was measured.ResultsThe attentional training procedure produced significant changes in attentional bias in the predicted direction in both experimental groups. Attentional training produced an increase in the urge to drink alcohol in the attend alcohol group, and the attend alcohol group consumed more beer than the avoid alcohol group during the taste test.ConclusionsThese results suggest that a potentiated attentional bias for alcohol-related cues can increase the motivation to drink alcohol. Theoretical and clinical implications are discussed.

Attentional Bias in Drug Dependence: Vigilance for Cigarette-Related Cues in Smokers

Two experiments investigated attentional biases for smoking-related cues in smokers and nonsmokers, using the visual probe task. In Experiment 1, when pictures were displayed for 500 ms, smokers who had made repeated quit attempts showed an attentional bias for smoking-related scenes. Experiment 2 replicated this finding and revealed that when pictures were presented for 2,000 ms, the smoker group as a whole showed vigilance for smoking-related cues, but nonsmokers did not. The findings from the 500-ms exposure condition suggest that initial orienting of attention to smoking cues was associated with repeated unsuccessful attempts at abstinence in smokers. Results are discussed with reference to incentive-sensitization theories of addiction and to component processes of selective attention, such as initial orienting versus maintenance.

Eye movements to smoking-related cues: effects of nicotine deprivation

RationaleAccording to recent theories of addiction, nicotine deprivation may influence biases in the orienting and maintenance of attention on smoking-related cues.ObjectivesWe examined the effect of nicotine deprivation on different aspects of attentional biases for smoking-related cues.MethodsSmokers’ eye movements to smoking-related and control pictures were assessed during a visual probe task under deprived and non-deprived conditions.ResultsWhen deprived, smokers maintained their gaze for longer on smoking-related than control cues, relative to when non-deprived. Deprivation also increased craving and pleasantness ratings of smoking cues. Across both deprived and non-deprived conditions, smokers were more likely to shift their gaze towards smoking cues and were faster to respond to probes replacing smoking cues, relative to non-smoking cues, but these attentional bias measures were not significantly affected by the deprivation manipulation.ConclusionsResults suggest a selective effect of deprivation on the maintenance of attention on smoking-related cues.

Attentional and evaluative biases for smoking cues in nicotine dependence: component processes of biases in visual orienting

The present study investigated attentional and evaluative biases for smoking-related cues in cigarette smokers and non-smokers. Using a visual probe task, we manipulated the presentation conditions of the stimuli to examine: (1) whether smokers have a bias to allocate attention towards smoking-related pictures that appear below the threshold of conscious awareness; and (2) whether attentional biases for smoking-related pictures that appear above the threshold of awareness operate both in initial orienting and in the maintenance of attention. We also obtained explicit and implicit measures of the valence of the smoking-related pictures from pleasantness ratings and from behavioural responses on a stimulus–response compatibility (SRC) task. Results showed that smokers, but not non-smokers, had an attentional bias for smoking-related pictures which had been presented at two exposure durations (200 and 2000 ms). The bias was not found in a brief (17 ms) masked exposure condition, so there was no evidence that it operated preconsciously. Smokers also showed greater preferences for smoking-related than control cues, compared with non-smokers, on both the explicit and implicit indices of stimulus valence. Results are discussed with reference to incentive and cognitive models of addiction.

Attentional and approach biases for smoking cues in smokers: an investigation of competing theoretical views of addiction

RationaleDifferent theories of addiction make conflicting predictions about whether attentional and approach biases for smoking-related cues are enhanced, or reduced, as a function of the level of nicotine dependence.ObjectiveThese theoretical views were evaluated by examining cognitive biases in smokers.MethodsWe monitored the eye movements of 41 smokers (predominantly young adults, who smoked from one to 40 cigarettes per day) as they completed a visual probe task in which smoking-related and matched control pictures were presented. Participants also completed a stimulus-response compatibility task, which measured the tendency to approach smoking-related cues, and a rating task.ResultsSmokers with lower levels of nicotine dependence showed greater maintained attention and faster approach responses to smoking-related cues. Longer gaze times for smoking cues were associated not only with lower levels of nicotine dependence, but also with higher levels of craving.ConclusionsOverall, the results seem consistent with an integrated ‘incentive-habit’ model of addiction.

Acute Alcohol Effects on Inhibitory Control and Implicit Cognition: Implications for Loss of Control Over Drinking

Alcohol impairs inhibitory control, and it alters implicit alcohol cognitions including attentional bias and implicit associations. These effects are seen after doses of alcohol which do not lead to global impairments in cognitive performance. We review studies which demonstrate that the effects of alcohol on inhibitory control are associated with the ability of alcohol to prime alcohol-seeking behavior. We also hypothesize that alcohol-induced changes in implicit alcohol cognitions may partially mediate alcohol-induced priming of the motivation to drink. Based on contemporary theoretical models and conceptualizations of executive function, impulsivity, and the motivational salience of alcohol-related cues, we speculate on other aspects of cognition that may underlie alcohols effects on alcohol seeking. Inconsistencies in existing research and priorities for future research are highlighted, including dose effects and the potential interactions between chronic heavy drinking and the acute effects of alcohol on these cognitive processes.

Experimental manipulation of attentional biases in heavy drinkers: do the effects generalise?

RationaleIn heavy drinkers, training attention towards alcohol cues increases alcohol craving, but it is not clear if effects of ‘attentional training’ generalise to novel stimuli and measurement procedures.ObjectivesWe investigated possible generalisation of attentional training to novel alcohol cues and other methods of measuring cognitive bias.Materials and methodsA modified visual probe task was used to train participants to direct their attention either towards (‘attend alcohol’ group) or away from (‘avoid alcohol’ group) alcohol cues; attentional bias was not manipulated in a control group (total N = 60). After attentional training, we measured cognitive bias (using visual probe, modified Stroop, flicker-induced change blindness and stimulus–response compatibility tasks), alcohol craving and alcohol consumption.ResultsAttentional bias for alcohol cues increased in the ‘attend alcohol’ group, and this effect generalised to novel stimuli, but not to other cognitive bias tasks. In the ‘avoid alcohol’ group, attentional bias was reduced for the stimuli that were used during attentional training, but these effects did not generalise to different stimuli or cognitive bias tasks. Alcohol craving increased among participants in the ‘attend alcohol’ group, but only among participants who were aware of the experimental contingencies during attentional training. There were no group differences in alcohol consumption.ConclusionsThe effects of attentional training show limited generalisation to different alcohol cues and methods of measuring cognitive bias. Experimentally increased attentional bias seems to increase subjective craving, but only among participants who are aware of the experimental contingencies that were in place during attentional training.

Risk-taking but not response inhibition or delay discounting predict alcohol consumption in social drinkers

Impulsivity and risk-taking are multi-dimensional constructs that have been implicated in heavy drinking and alcohol problems. Our aim was to identify the specific component of impulsivity or risk-taking that explained the greatest variance in heavy and problem drinking among a sample of young adults recruited from a university population. Participants (N=75) completed a test battery comprising two commonly used response inhibition tasks (a Go/No-Go task and a Stop signal task), a delay discounting procedure, and the Balloon Analogue Risk Task (BART) as a measure of risk-taking. Participants also completed the Barratt Impulsivity Scales (BIS) as a measure of trait impulsivity. In a hierarchical multiple regression model, risk-taking was identified as the only behavioural measure that predicted alcohol use and problems. In a secondary analysis, we demonstrated that risk-taking predicted unique variance in alcohol use and problems over and above that explained by trait impulsivity. Results suggest that among young adults, a behavioural measure of risk-taking predicts variance in alcohol consumption and alcohol problems, even when individual differences in trait impulsivity are statistically controlled. However, behavioural measures of response inhibition and delay discounting do not predict unique variance in alcohol use in young adult social drinkers.