Alcohol-specific inhibition training with high inhibitory demands increased days abstinent at 3-month follow-up in patients with severe alcohol use disorder. Such an improved, inhibitory-demanding, alcohol-specific inhibition training outperformed the standard version of alcohol-specific inhibition training, suggesting an inhibitory working mechanism.

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Alcohol-Specific Inhibition Training in Patients with Alcohol Use Disorder: A Multicenter, Double-Blind, Randomized Clinical Trial Examining Drinking Outcome and Working Mechanisms
Maria Stein, Leila M. Soravia, Raphaela M. Tschuemperlin, Hallie M. Batschelet, Joshua Jaeger, Susanne Roesner, Anne Keller, Juan Martin Gomez Penedo, Reinout W. Wiers, Franz Moggi
Frontiers in psychology 2022.
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DOI: 0.1111/add.16104

Aims For the first time in a clinical sample with alcohol use disorder (AUD), this study compared the effects of two versions of alcohol-specific inhibition training (Alc-IT) on drinking outcomes and on experimental parameters assessing two possible working mechanisms: stimulus devaluation and inhibitory enhancement.

Design Multicentre, double-blind, three-arm, clinical RCT with 3-, 6- and 12-month follow-up comparing standard Alc-IT, improved Alc-IT, and an active control condition.

Setting Three specialized AUD treatment centres in Switzerland.

Participants N = 242 detoxified, recently abstinent patients with severe AUD (18-60 years; 29.8% female).

Intervention and Comparator Both interventions (standard Alc-IT (n=84), improved Alc-IT (n=79)) and the comparator (unspecific inhibition training (n=79)) consisted of six sessions of a modified inhibitory task (Go-NoGo-task) with alcohol-related and neutral stimuli. Both versions of Alc-IT required response inhibition in alcohol-related trials but differed in Go/NoGo-ratios (standard: 50/50; improved: 75/25), with improved Alc-IT posing higher inhibitory demands. The control condition, an unspecific inhibition training, featured alcohol-related pictures in Go- as well as NoGo-trials.

Measurements The primary outcome, percentage of days abstinent, was assessed at 3-month follow-up with a timeline follow-back interview.

Findings The group receiving improved Alc-IT showed a significantly higher percentage of days abstinent at 3-month follow-up compared with the control group (γcontrol= 74.30 ; γimproved= 85.78 ; β = 11.48, 95% confidence interval (CI) [2.57, 20.40] p = .012, adjusted r2 = .062), while for standard Alc-IT no effect significantly different from zero was detected (γstandard= 70.95 ; β = -3.35 , 95%-CI [-12.20, 5.50], p = .457, adjusted r2 = -.04).

Conclusions Alcohol-specific inhibition training with high inhibitory demands increased days abstinent at 3-month follow-up in patients with severe alcohol use disorder. Such an improved, inhibitory-demanding, alcohol-specific inhibition training outperformed the standard version of alcohol-specific inhibition training, suggesting an inhibitory working mechanism.