Addressing Problem Drinking from the Bottom-Up: An Investigation of the Neural and Behavioral Effects of Cognitive Bias Modification (CBM)

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PROJECT SUMMARY/ABSTRACT Heavy/at-risk alcohol use is considered a relevant public health problem given its association with sexual risk behavior, accidents, poor health, and negative life consequences (5,6). Dual process models of alcohol use describe two cognitive systems involved in the maintenance of heavy alcohol use—a top-down control system and bottom-up automatic appetitive system (8-11). Existing evidence-based interventions for alcohol use tend to focus on enhancing individuals' self-control (top-down) skills. Lately researchers have highlighted importance of targeting automatic appetitive cognitive biases that heavy drinkers exhibit. Cognitive Bias Modification (CBM) is one intervention that has shown promising effects on reversing cognitive biases toward alcohol among individuals with alcohol use disorders (19-23). CBM is currently thought to alter cognitive biases that may interfere with implementation of skills-based or motivational interventions and may act best as an adjunct to existing interventions (18). Recent work has begun to look at the neurocognitive mechanisms of action of CBM and has found significant changes in brain systems underlying reward (i.e., NAcc and amygdala) and executive control (i.e., dlPFC, mPFC) (26,27). In line with these findings, this proposed project would investigate the effects of CBM on neurocognitive processes related to alcohol use in a novel sample of heavy/at-risk drinkers. The primary aim of this project is to examine the effects of CBM on neurocognitive processes among heavy/at-risk drinkers interested in changing their alcohol use. As a secondary aim, this project will investigate associations between neural and cognitive changes and changes in alcohol use to better understand how CBM might lead to successful changes in drinking behavior. Heavy/at-risk drinkers (n=40; ages 18-34) will be recruited from the community for this project and phone screened for eligibility. Participants will undergo baseline assessments, a cue-reactivity (CR) and approach avoid task (AAT) during fMRI, web-based intervention for alcohol use, and randomization to CBM or sham training. The first training session (CBM vs. sham) will occur at this time, followed by 4 online sessions over one week. Baseline assessments and fMRI procedures will be repeated at 1-week follow-up and drinking will again be measured online via 1- and 6-month follow-ups. It is hypothesized that the CBM group will exhibit greater changes in BOLD activity compared to the sham group in the above identified regions during CR and AAT tasks and show greater reductions in drinking. In line with NIAAA's priority to “devise effective methods for…treating alcohol abuse and dependence [and] alcohol-related consequences” using a “wide range of scientific areas” this proposed project incorporates both neuroscientific and clinical approaches in attempting to better understand the mechanisms of CBM. This proposed project aims to extend recent findings of such mechanisms in patients with alcohol use disorder to heavy/at-risk drinkers using a primarily web-based intervention. This study would also be the first to investigate associations between BOLD changes and drinking behavior following CBM.