Combining approach bias modification with working memory training during inpatient alcohol withdrawal:An open-label pilot trial of feasibility and acceptability

BACKGROUND: According to contemporary neurocognitive models, addiction is maintained by the biasing of information-processing and decision-making systems towards relatively automatic, impulsive, reward-seeking responses to drug-related stimuli, and away from more controlled, deliberative, "reflective" states of processing that could result in decisions to delay or avoid drug use. Cognitive training programs aimed at either countering "impulsive" processing or enhancing "reflective" processing alone have shown promise. However, there has been no attempt to simultaneously target both aspects of processing with a combined training program. We aimed to test the feasibility and acceptability of a novel \u27dual-training\u27 program targeting both processes during residential alcohol withdrawal, and to measure abstinence rates following discharge. METHODS: Thirty-seven patients undergoing alcohol withdrawal at a residential unit participated in this open-label pilot feasibility study. We tested a 4-session program of dual cognitive training targeting both impulsive (approach bias) and reflective (working memory) aspects of processing. Descriptive statistics were used to examine feasibility (training uptake and completion rates) and acceptability (withdrawal from the study; participants\u27 ratings of the tasks). Alcohol abstinence rates were examined 2-weeks post-discharge. RESULTS: Seven participants withdrew after commencing training. Twenty-six (70%) completed the 4-session training protocol, and four completed 3 sessions before discharging. Among participants who provided ratings, nearly all (93%) rated the training as interesting. Most (87%) indicated that they felt it had improved their attention. However, most did not feel it had decreased their craving for alcohol. At 2-weeks post-discharge, 16 (53%) participants reported abstaining from alcohol. For comparison, an earlier pilot trial in the same setting found a 68% abstinence rate with approach bias training alone, and 47% abstinence in a non-training control group. CONCLUSIONS: Dual training during residential alcohol detoxification appears to be both acceptable and feasible, suggesting that future research is warranted to test its effectiveness at reducing likelihood of relapse

Social disadvantage and past treatment among clients entering public alcohol and drug services in two Australian states

© 2015 Elsevier B.V. Background: This study aimed to explore the association between substance use, social disadvantage and past year alcohol and other drug (AOD) treatment among clients entering publically funded AOD services in Victoria and Western Australia, to inform system development. Methods: Participants (n = 781) completed a structured interview on substance use, social circumstances, and past year service use. Results: Most participants were severely AOD dependent and a high proportion were recently homeless, receiving welfare benefits, and with criminal justice issues. Previous AOD treatment was common. Logistic regression analysis showed that past year AOD treatment was more frequent among those receiving welfare benefits, with opioids as their primary drug of concern, and using multiple substances. Conclusion: While AOD dependence characterised this treatment group, social disadvantage independently predicted higher rates of prior AOD service use. Specialist AOD treatment systems need capacity to provide or at least work alongside services designed to address social disadvantage

Cognitive bias modification training during inpatient alcohol detoxification reduces early relapse: a randomized controlled trial

BACKGROUND: Relapse is common in alcohol-dependent individuals and can be triggered by alcohol-related cues in the environment. It has been suggested that these individuals develop cognitive biases, in which cues automatically capture attention and elicit an approach action tendency that promotes alcohol seeking. The study aim was to examine whether cognitive bias modification (CBM) training targeting approach bias could be delivered during residential alcohol detoxification and improve treatment outcomes. METHODS: Using a 2-group parallel-block (ratio 1:1) randomized controlled trial with allocation concealed to the outcome assessor, 83 alcohol-dependent inpatients received either 4 sessions of CBM training where participants were implicitly trained to make avoidance movements in response to pictures of alcoholic beverages and approach movements in response to pictures of nonalcoholic beverages, or 4 sessions of sham training (controls) delivered over 4 consecutive days during the 7-day detoxification program. The primary outcome measure was continuous abstinence at 2 weeks postdischarge. Secondary outcomes included time to relapse, frequency and quantity of alcohol consumption, and craving. Outcomes were assessed in a telephonic follow-up interview. RESULTS: Seventy-one (85%) participants were successfully followed up, of whom 61 completed all 4 training sessions. With an intention-to-treat approach, there was a trend for higher abstinence rates in the CBM group relative to controls (69 vs. 47%, p = 0.07); however, a per-protocol analysis revealed significantly higher abstinence rates among participants completing 4 sessions of CBM relative to controls (75 vs. 45%, p = 0.02). Craving score, time to relapse, mean drinking days, and mean standard drinks per drinking day did not differ significantly between the groups. CONCLUSIONS: This is the first trial demonstrating the feasibility of CBM delivered during alcohol detoxification and supports earlier research suggesting it may be a useful, low-cost adjunctive treatment to improve treatment outcomes for alcohol-dependent patients

Data for wetlandscapes and their changes around the world

Geography and associated hydrological, hydroclimate and land-use conditions and their changes determine the states and dynamics of wetlands and their ecosystem services. The influences of these controls are not limited to just the local scale of each individual wetland but extend over larger landscape areas that integrate multiple wetlands and their total hydrological catchment-the wetlandscape. However, the data and knowledge of conditions and changes over entire wetlandscapes are still scarce, limiting the capacity to accurately understand and manage critical wetland ecosystems and their services under global change. We present a new Wetlandscape Change Information Database (WetCID), consisting of geographic, hydrological, hydroclimate and land-use information and data for 27 wetlandscapes around the world. This combines survey-based local information with geographic shapefiles and gridded datasets of large-scale hydroclimate and land-use conditions and their changes over whole wetlandscapes. Temporally, WetCID contains 30-year time series of data for mean monthly precipitation and temperature and annual land-use conditions. The survey-based site information includes local knowledge on the wetlands, hydrology, hydroclimate and land uses within each wetlandscape and on the availability and accessibility of associated local data. This novel database (available through PANGAEA https://doi.org/10.1594/PANGAEA.907398; Ghajarnia et al., 2019) can support site assessments; cross-regional comparisons; and scenario analyses of the roles and impacts of land use, hydroclimatic and wetland conditions, and changes in whole-wetlandscape functions and ecosystem services.. © 2005 IEEE Computer Society. All rights reserved