Minding the Gap: Leveraging Mindfulness to Inform Cue Exposure Treatment for Substance Use Disorders

Despite extinction-based processes demonstrating efficacy in the animal extinction and human anxiety literatures, extinction for substance use disorders (SUD) has shown poor efficacy (i. e., cue exposure treatment [CET]). Reasons for this lack of success include common threats to extinction, such as renewal and reinstatement. In recent decades, research on mindfulness for SUD has flourished, and a key aspect of these mindfulness-based interventions includes teaching individuals to stay present with whatever experience they have, even if unpleasant, without trying to change/escape/avoid it. Similarly, CET teaches individuals to not escape/avoid conditioned responses (e.g., craving) by engaging in drug use behavior. This paper discusses how mindfulness-based research and practices could positively influence CET through future research (e.g., Could mindfulness practice attenuate renewal? Might mindfulness training + CET enhance the ability to extinguish the most salient or motivational cues?), with the long-term goal of improving SUD treatment.

Postprint BuckfieldSinclairGlautier (2020) Slow associative learning in alcohol dependence and the Alcohol Cue Exposure Treatment Paradox

The published version is available at: https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.15210 AimsTo examine two explanations for the observation that cue-exposure treatment has not been clearly effective in the treatment of alcohol dependence: do alcohol dependent individuals have either 1) slower extinction and/or 2) greater contextual specificity of extinction than non-dependent individuals? DesignIn two exploratory laboratory experiments we used mixed factorial designs with two-group between-subjects factors and within-subjects factors corresponding to performance in different parts of a computer-based learning task.SettingUniversity of Southampton psychology research laboratories and two addiction treatment services in the city of Southampton, UK.ParticipantsExperiment 1: Seventy-four (54 female) undergraduates from the University of Southampton (age M=20.4 years). Experiment 2: One-hundred and two (40 female) participants from the University of Southampton, the local community, and from two Southampton alcohol treatment services (age M=41.3 years). MeasurementsThe Alcohol Use Disorders Identification Test, a 1-week time-line follow-back alcohol consumption questionnaire, the Barratt Impulsiveness Scale (11th Ed), and a computerised learning task. Experiment 2 additionally used the 44-item Big Five Inventory, a drug use history checklist, and the Hospital Anxiety and Depression Scale. FindingsExperiment 1: light and heavy drinkers did not differ significantly in extinction (extinction block x drinking status interaction, p=.761, η_p^2=.005, 95% confidence interval (0,.028)) or on contextual control of extinction (recovery block x drinking status interaction, p=.514, η_p^2=.009, 95% confidence interval (0,.084)). Experiment 2: slower extinction in abstinent alcohol dependent participants compared with light drinkers (extinction block x drinking status interaction, p=.023, η_p^2=.031, 95% confidence interval (0,.069)) but no significant difference on contextual control of extinction (recovery block x drinking status interaction, p=.069, η_p^2=.033, 95% confidence interval (0,.125)). ConclusionAbstinent alcohol dependent people may have slower extinction learning for alcohol-related cues, than non-dependent light drinkers.

Preprint BuckfieldSinclairGlautier (2019) Slow associative learning in alcohol dependence and the Alcohol Cue Exposure Treatment Paradox

There is a revised version at: https://osf.io/nxe9a Cue exposure treatment for alcohol dependence is based on extinction of conditioned responses to alcohol related cues but despite a sound rationale and clear evidence of effectiveness in other conditions, cue exposure has had only limited effectiveness for alcohol dependence. Here we examined two explanations for this observation, namely, that alcohol dependent individuals have either slower extinction or greater contextual specificity of extinction than non-dependent individuals. Two experiments were carried out. Seventy-four (54 female, age M=20.4 years) participants took part in Experiment 1 and 102 (40 female, age M=41.3 years) participants took part in Experiment 2. In both experiments participants completed the Alcohol Use Disorders Identification Test, answered one-week time-line follow-back alcohol consumption questions, filled in the Barratt Impulsiveness Scale (11 th Ed), and participated in a computerised learning task. In Experiment 2 participants additionally completed the 44-item Big Five Inventory, a drug use history checklist, and the Hospital Anxiety and Depression Scale. In Experiment 1 we found no difference in learning task performance on any of Pavlovian acquisition, extinction, response recovery, and context inhibition between light and heavy drinkers. However, in Experiment 2, there was slower extinction in abstinent alcohol dependent participants compared to light drinkers and some evidence that participants with alcohol dependence acquired knowledge of the CS-US pairings more slowly than light drinkers. An exploratory follow-up analysis showed that the observed relationship between learning and dependence was not mediated by group differences on personality nor due to group differences on drug use other than alcohol. We conclude that slow associative learning, especially in extinction, may be a characteristic of alcohol dependence and this finding may provide an explanation for the relatively poor outcomes that have been obtained for alcohol cue-exposure treatment.

Predictors of Smoking Craving During Virtual Reality Exposure

Cue exposure treatment (CET) consists of controlled and repeated exposure to drug-related stimuli in order to reduce cue-reactivity. Virtual reality (VR) has proved to be a promising tool for exposition. However, identifying the variables that can modulate the efficacy of this technique is essential for selecting the most appropriate exposure modality. The aim of this study was to determine the relation between several individual variables and self-reported craving in smokers exposed to VR environments. Forty-six smokers were exposed to seven complex virtual environments that reproduce typical situations in which people smoke. Self-reported craving was selected as the criterion variable and three types of variables were selected as the predictor variables: related to nicotine dependence, related to anxiety and impulsivity, and related to the sense of presence in the virtual environments. Sense of presence was the only predictor of self-reported craving in all the experimental virtual environments. Nicotine dependence variables added predictive power to the model only in the virtual breakfast at home. No relation was found between anxiety or impulsivity and self-reported craving. Virtual reality technology can be very helpful for improving CET for substance use disorders. However, the use of virtual environments would make sense only insofar as the sense of presence was high. Otherwise, the effectiveness of exposure might be affected.