Charles, M; (2013) Attentional bias modification in substitute-prescribed opiate users and control participants. Doctoral thesis , UCL (University College London).

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Abstract

This thesis investigated biases in the implicit processing of substance-related cues in substance users. Part 1, a literature review, assessed the effectiveness of attempts to modify such processes and the wider benefits of doing so. The 12 studies reviewed, addressing between them attentional bias, implicit attitudes and approach bias in either alcohol drinkers or tobacco smokers, suggest that implicit processes are readily modifiable. However, the evidence of wider benefit is less clear. The clinical implications and future research considerations are discussed. Part 2 is an empirical paper, conducted jointly with a fellow trainee clinical psychologist, which assessed the effects of attentional bias modification (ABM) in opiate dependent and non-substance using control participants. Baseline differences in attentional bias (AB) between these groups were assessed, as were the effects of ABM on AB and craving. The role of treatment adherence (i.e. whether or not an individual was using illicit opiates on top of their prescribed substitute) was also explored. Contrary to predictions, there were no baseline group differences in AB, and ABM had no significant effects on AB or craving. However, treatment adherence was an important factor, with differences found between opiate dependent participants using on top, not using on top and control participants on measures of AB, craving and psychopathology. The clinical and research implications of these differences are discussed. Finally, Part 3, the critical appraisal, provides reflections on the entire research process. Some guidance and recommendations are also offered to future researchers covering areas such as the difficulties in recruiting from these clinical populations, and possible alternative approaches to the problem of biases in implicit processes in substance use.

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