Researchers at the University of Wales say they have designed a computer program that can help alcohol abusers drink less.
Excessive drinkers are easily distracted by the alcohol-related cues we see every day, says Miles Cox, professor of the psychology of addictive behaviors at the University of Wales, Bangor. These include such everyday sights as bottles in a liquor-store window and the word “beer” on a sign outside a tavern. Light drinkers or abstainers can pass by these images with little thought, says Cox. But just as a person with an overly developed sweet tooth might linger in front of a bakery window, alcohol abusers can’t ignore the cues they see. They “start thinking how good a drink would taste, then how good it would make them feel,” he says, and they might end up drinking.
“This idea goes back to the days of Pavlov,” says Damaris Rohsenow, associate director of the Center for Alcohol and Addiction Studies at Brown Medical School. Drinkers learn that alcohol rewards them with the pleasurable effects of intoxication. Over time, they link memories of good feelings with cues – pictures, smells, and even the feel of a wet glass in the hand. Eventually the cues can dredge up memories that lead to cravings, she says.
Brain-imaging studies back up this theory, says Raymond Anton of the Alcohol Research Center at the Medical University of South Carolina, who runs functional MRI tests on alcohol abusers. When shown pictures of alcohol, abusers show increased activity in brain areas associated with memory and reward – areas also thought to control cravings for alcohol and other addictive substances. Social drinkers and nondrinkers do not show increased brain activity in these areas.
Just as these responses can be conditioned, they can also be de-conditioned, reasons Cox. His computer program, developed with colleague Javad Fadardi, helps abusers deal with the sight of alcohol, since it’s often the first cue they experience in daily life. The program presents a series of pictures, beginning with an alcohol bottle inside a thick, colored frame. As fast as they can, users must identify the color of the frame. As users get faster, the test gets harder: the frame around the bottles becomes thinner. Finally, an alcohol bottle appears next to a soda bottle, both inside colored frames. Users must identify the color of the circle around the soda. The tasks teach users to “ignore the alcohol bottle” in increasingly difficult situations, says Cox.
Such tests have long been used to study attention phenomena in alcohol abusers, but they have never been used for therapy, says Cox. His group adapted the test for this new purpose by adding elements of traditional therapy. Before the tests, users set goals on how quickly they want to react; a counselor makes sure the goals are achievable. After each session, users see how well they did. The positive feedback boosts users’ motivation and mood, Cox says.
In an initial study funded by the U.K.’s Economic and Social Research Council, Cox’s group tested the program on about 100 excessive drinkers, who averaged 72 units of alcohol a week. (One unit of alcohol is roughly equivalent to a glass of red wine.) Subjects were not in treatment, were not seeking treatment, and did not know they were going to receive treatment, but all expressed a desire to drink less. Cox’s group took baseline data on the drinkers’ alcohol consumption, their confidence their in ability to resist alcohol, the extent to which they were distracted by alcohol-related cues, and other measures.
During a one-month waiting period before treatment, subjects showed no change, indicating that their mere desire to cut back didn’t affect their attention to alcohol or their drinking habits.
Then, over four weeks, the drinkers played four 40-minute sessions of the alcohol-bottle “game.” That amounted to 2,000 repetitions of the alcohol-ignoring tasks.