Tim M. Schoenmakers

Clinical effectiveness of attentional bias modification training in abstinent alcoholic patients

A new training to decrease attentional bias (attentional bias modification training, ABM) was tested in a randomized controlled experimental study with alcohol-dependent patients as an addition to cognitive behavioral therapy. In alcohol dependence, attentional bias has been associated with severity of alcoholism, craving, treatment outcome, and relapse. Forty-three patients with DSM-IV diagnosis of alcohol dependence were randomly assigned to an ABM intervention or control training. The procedure consisted of five sessions in which patients were trained to disengage attention from alcohol-related stimuli (ABM condition) or in which they were trained on an irrelevant reaction-time test (control condition). We measured the effects of ABM on the visual-probe task, with stimuli that were presented in the ABM and with new stimuli. Craving was measured with the Desires for Alcohol Questionnaire. Follow-up data were gathered for overall treatment success, and relapse up to 3 months after the intervention. ABM was effective in increasing the ability to disengage from alcohol-related cues. This effect generalized to untrained, new stimuli. There were no significant effects on subjective craving. For other outcome measures there were indications of clinically relevant effects. Results indicate that ABM among alcohol-dependent patients was effective and that it may affect treatment progression. Large-scale trials are warranted to further investigate this new field.

Compulsive Internet Use: The Role of Online Gaming and Other Internet Applications

PURPOSE Increasing research on Internet addiction makes it necessary to distinguish between the medium of Internet and its specific applications. This study explores the relationship between time spent on various Internet applications (including online gaming) and Compulsive Internet Use in a large sample of adolescents. METHODS The 2007 (N=4,920) and 2008 (N=4,753) samples of a longitudinal survey study among adolescents were used, as well as the 2007-2008 cohort subsample (N=1421). Compulsive Internet Use was predicted from the time spent on the various Internet applications in two cross-sectional multiple linear regression models and one longitudinal regression model in which changes in behavior were related to changes in Compulsive Internet Use. RESULTS In both samples, downloading, social networking, MSN use, Habbo Hotel, chatting, blogging, online games, and casual games were shown to be associated with Compulsive Internet Use. Off these, online gaming was shown to have the strongest association with Compulsive Internet Use. Moreover, changes in online gaming were most strongly associated with changes in Compulsive Internet Use over time for the longitudinal cohort. CONCLUSIONS A clear relationship was shown between online gaming and Compulsive Internet Use. It is further argued that a subgroup of compulsive Internet users should be classified as compulsive online gamers.

Effects of a low dose of alcohol on cognitive biases and craving in heavy drinkers

RationaleHeavy alcohol drinking increases the incentive salience of alcohol-related cues. This leads to increased appetitive motivation to drink alcohol as measured by subjective craving and cognitive biases such as attentional bias and approach bias. Although these measures relate to the same construct, correlations between these variables are often very low. Alcohol consumption might not only increase different aspects of appetitive motivation, but also correlations between those aspects.ObjectivesTo investigate the effect of a low alcohol dose on changes in various measures of appetitive motivation.Materials and methodsTwenty-three heavy social drinkers were tested in 2 sessions, once after receiving an alcohol prime dose and once after receiving a placebo drink. After drink administration, attentional bias was measured with a visual-probe task using concurrent eye movement monitoring. Furthermore, we measured the approach bias with a stimulus response compatibility task and subjective craving with the Desires for Alcohol Questionnaire.ResultsAfter the alcohol prime dose, participants had higher levels of craving and more pronounced attentional bias (faster reaction times to probes that replaced alcohol rather than control pictures, increased maintenance of gaze on alcohol pictures, and a higher percentage of first eye movements directed toward alcohol pictures). Approach bias was not influenced by the alcohol prime dose. The correlation between attentional bias and approach bias was significantly higher after the alcohol than after the placebo drink.ConclusionsA low alcohol dose increased most measures of appetitive motivation for alcohol and increased the interrelation between cognitive measures of this construct.

Less than meets the eye: Reappraising the clinical relevance of attentional bias in addiction

Recent years have seen an explosion of interest in attentional bias in addiction, particularly its clinical relevance. Specifically, numerous articles claimed to demonstrate either that (1) attentional bias measured in treatment settings could predict subsequent relapse to substance use, or (2) direct modification of attentional bias reduced substance use and improved treatment outcomes. In this paper, we critically evaluate empirical studies that investigated these issues. We show that the evidence regarding both of these claims is decidedly mixed, and that many of the studies that appear to yield positive findings have serious methodological and statistical limitations. We contend that the available literature suggests that attentional bias for drug cues fluctuates within individuals because it is an output of the underlying motivational state at that moment in time, but there is no convincing evidence that it exerts a causal influence on substance use. Future research should make use of experience sampling methodology to characterise the clinical significance of fluctuations in attentional bias over time.

The (co-)occurrence of problematic video gaming, substance use, and psychosocial problems in adolescents

Abstract Aims: The current study explored the nature of problematic (addictive) video gaming (PVG) and the association with game type, psychosocial health, and substance use. Methods: Data were collected using a paper and pencil survey in the classroom setting. Three samples were aggregated to achieve a total sample of 8478 unique adolescents. Scales included measures of game use, game type, the Video game Addiction Test (VAT), depressive mood, negative self-esteem, loneliness, social anxiety, education performance, and use of cannabis, alcohol and nicotine (smoking). Results: Findings confirmed problematic gaming is most common amongst adolescent gamers who play multiplayer online games. Boys (60%) were more likely to play online games than girls (14%) and problematic gamers were more likely to be boys (5%) than girls (1%). High problematic gamers showed higher scores on depressive mood, loneliness, social anxiety, negative self-esteem, and self-reported lower school performance. Nicotine, alcohol, and cannabis using boys were almost twice more likely to report high PVG than non-users. Conclusions: It appears that online gaming in general is not necessarily associated with problems. However, problematic gamers do seem to play online games more often, and a small subgroup of gamers – specifically boys – showed lower psychosocial functioning and lower grades. Moreover, associations with alcohol, nicotine, and cannabis use are found. It would appear that problematic gaming is an undesirable problem for a small subgroup of gamers. The findings encourage further exploration of the role of psychoactive substance use in problematic gaming.

I didn’t feel like drinking but I don’t know why: the effects of evaluative conditioning on alcohol-related attitudes, craving and behavior

The goal of the present research was to test the value of evaluative conditioning (EC) to unobtrusively change alcohol-related attitudes and drinking behavior. In the EC paradigm, participants had to spot an irrelevant target picture in a series of trials in which many different stimuli were presented. In the experimental condition, beer-related pictures (CSs) were consistently paired with negative words and pictures (USs) in a number of trials. In the control condition, participants were exposed to the same stimuli, but without the critical alcohol-negative pairings. After the EC task, participants participated in an allegedly second experiment in which we measured beer-related attitudes, craving for beer, and actual drinking behavior both during a bogus taste test and during the week following the experiment. Compared to participants in the control condition, participants in the experimental condition showed more negative attitudes toward beer, experienced less craving for beer, and consumed less beer both in the lab during the taste test and outside the lab during the week following the manipulation. These findings suggest that unhealthy drinking behavior may be targeted through EC procedures.

How economic crises affect alcohol consumption and alcohol-related health problems: A realist systematic review

Economic crises are complex events that affect behavioral patterns (including alcohol consumption) via opposing mechanisms. With this realist systematic review, we aimed to investigate evidence from studies of previous or ongoing crises on which mechanisms (How?) play a role among which individuals (Whom?). Such evidence would help understand and predict the potential impact of economic crises on alcohol consumption. Medical, psychological, social, and economic databases were used to search for peer-reviewed qualitative or quantitative empirical evidence (published January 1, 1990-May 1, 2014) linking economic crises or stressors with alcohol consumption and alcohol-related health problems. We included 35 papers, based on defined selection criteria. From these papers, we extracted evidence on mechanism(s), determinant, outcome, country-level context, and individual context. We found 16 studies that reported evidence completely covering two behavioral mechanisms by which economic crises can influence alcohol consumption and alcohol-related health problems. The first mechanism suggests that psychological distress triggered by unemployment and income reductions can increase drinking problems. The second mechanism suggests that due to tighter budget constraints, less money is spent on alcoholic beverages. Across many countries, the psychological distress mechanism was observed mainly in men. The tighter budget constraints mechanism seems to play a role in all population subgroups across all countries. For the other three mechanisms (i.e., deterioration in the social situation, fear of losing ones job, and increased non-working time), empirical evidence was scarce or absent, or had small to moderate coverage. This was also the case for important influential contextual factors described in our initial theoretical framework. This realist systematic review suggests that among men (but not among women), the net impact of economic crises will be an increase in harmful drinking. Such a different net impact between men and women could potentially contribute to growing gender-related health inequalities during a crisis.

Video Game Addiction Test: Validity and Psychometric Characteristics

The study explores the reliability, validity, and measurement invariance of the Video game Addiction Test (VAT). Game-addiction problems are often linked to Internet enabled online games; the VAT has the unique benefit that it is theoretically and empirically linked to Internet addiction. The study used data (n=2,894) from a large-sample paper-and-pencil questionnaire study, conducted in 2009 on secondary schools in Netherlands. Thus, the main source of data was a large sample of schoolchildren (aged 13-16 years). Measurements included the proposed VAT, the Compulsive Internet Use Scale, weekly hours spent on various game types, and several psychosocial variables. The VAT demonstrated excellent reliability, excellent construct validity, a one-factor model fit, and a high degree of measurement invariance across gender, ethnicity, and learning year, indicating that the scale outcomes can be compared across different subgroups with little bias. In summary, the VAT can be helpful in the further study of video game addiction, and it contributes to the debate on possible inclusion of behavioral addictions in the upcoming DSM-V.

Online Social Networking in Adolescence: Patterns of Use in Six European Countries and Links With Psychosocial Functioning

PURPOSE Online communication tools, such as social networking sites (SNS), have been comprehensively embraced by adolescents and have become a dominant daily social practice. Recognizing SNS as a key context of adolescent development, this study aimed to investigate associations between heavier SNS use, and adolescent competencies and internalizing problems. METHODS Data was collected in six European countries: Greece, Spain, Poland, the Netherlands, Romania, and Iceland. Participants were 10,930 adolescents aged 14-17 years (F/M: 5,719/5,211; mean age 15.8 ± .7 years); 62.3% were aged 14-15.9 years and 37.7% were aged 16-17.9 years. Participants reported on their use of online communication tools, and their general competencies and internalizing problems (Youth Self Report). RESULTS SNS are both ubiquitous--used by 70% of adolescents--and engaging, given that 40% of users spend 2 or more hours daily on SNS (labeled heavier SNS use). Heavier SNS use was associated with more internalizing problems, and the relation was consistently more pronounced among younger adolescents. Moreover, heavier SNS use was associated with lower academic performance and lower activities scores, especially for younger adolescents. In contrast, among older adolescents heavier SNS use was positively associated with offline social competence. CONCLUSIONS Although heavier SNS use is associated with higher social competence for older adolescents, it is also associated with increased internalizing problems and diminished competencies in academics and activities, especially for younger adolescents. Age, capturing developmental differences in social and regulatory skills, appears to moderate the effects of heavier SNS use on adolescent functioning.

Video game addiction and social responsibility

In recent years, several studies have demonstrated that at least a small group of gamers has trouble controlling their online video game playing. Excessive amounts of time spent on playing online video games can be severely disruptive to school, work, and “real life” social contacts. It seems that online games, especially multiplayer online role playing games, are more often associated with video game addiction. Drawing parallels to other industries–such as gambling–which are heavily regulated, the issue of social responsibility of the video game industry is explored. Presently, online video game publishers provide neither referral services nor customer care with regards to video game addiction. In our opinion, a dual approach is necessary. Firstly, consumers should be informed about potential addiction risks that can be attributed to playing online video games. Secondly, game publishers should implement proper referral services. Providing customer care and referral services might be in the best interest of the video game industry at this point, as it may very well prevent revenue restricting governmental intervention. Therefore, taking action on the issue of social responsibility will benefit both the customer–who will be informed and properly referred–and the game industry alike.