Cognitive Bias Modification - Methamphetamine
The methamphetamine approach-avoidance training (MAAT) trial.
Overview
Less than one quarter of people who attend residential rehabilitation for methamphetamine use remain abstinent for 1 year after treatment. Hence, finding new ways to reduce relapse rates remains important. This pilot trial tested delivering “approach bias modification” (ABM) to people who were attending short-term residential rehabilitation programs at 4 treatment services in Melbourne (Malvern Private Hospital, Ramsay Clinic Albert Road, The Melbourne Clinic, and Wellington House). ABM is a “cognitive bias” training intervention that aims to reduce people’s automatic impulses to approach drug-related stimuli (such as images or objects that remind them of drug use).
Prior to running this trial, we had previously shown that delivering ABM to alcohol withdrawal patients reduced their likelihood of relapse for up to 3 months. We had also tested delivering ABM to methamphetamine withdrawal patients in the same withdrawal treatment settings and found encouraging rates of abstinence from amphetamines in post-discharge follow-ups. However, we found that methamphetamine withdrawal clients had lower rates of completing ABM training than alcohol withdrawal clients, suggesting that this training may be difficult for them to complete so early in their treatment. Hence, in the current trial, we tested delivering ABM to rehabilitation clients, after they had completed their first week of withdrawal. 24 participants were recruited and we randomly assigned them to receive 6 sessions of either ABM or a control version of the training that was not designed to change cognitive biases.
For this trial, we developed a new “personalised” approach to ABM. Prior to starting their first session of ABM, participants rated the personal relevance of methamphetamine-related images (how much each picture reminded them of their own drug use). They also rated the personal relevance of positive images, depicting exercise and other healthy activities; pets; social relationships; and career, education, and financial achievement. For each individual participant in the ABM group, the training only used the 10 most relevant drug images and 10 most relevant positive images. Specifically, participants were trained to repeatedly avoid (push away) methamphetamine-related images and pull positive images towards themselves (approach).
We contacted participants by phone 1 month and 3 months after they left residential treatment to assess outcomes. Rates of abstinence from amphetamines at each follow-up were encouraging. Of the 7 participants in the ABM group who completed follow-ups, 5 (71%) did not consume any illicit amphetamines in the first month after discharge. At the 3-month follow-up, 4 (57%) had been abstinent for all of the past 4 weeks, of whom 3 (43%) had not consumed any amphetamines for the whole 3 months since discharge. These were higher than the proportions reporting abstinence in the control group (5 out of 11 (46%) who completed the 1-month follow-up; 3 out of 9 (33%) reporting past month abstinence at the 3-month follow-up; and 2 out of 11 (18%) reporting complete abstinence since discharge at the 3-month follow-up). However, due to this trial’s very small sample size, these differences were not statistically significant.
Despite these promising results, there were safety concerns. Three participants withdrew from the trial because they found the training (which involved repeatedly viewing methamphetamine-related images) distressing. Another 5 participants reported that at least one of their sessions of training triggered strong craving, though they were able to persist with further sessions. Hence, although the follow-up results encourage further research on ABM’s effectiveness for methamphetamine use, future research would need to develop better ways to manage its safety.
Project team
Turning Point team
Professor Victoria Manning, Dr Joshua Garfield, Professor Dan Lubman, Dr Shalini Arunogiri, Mr Hugh Piercy, Mr Sam Campbell, Dr Paul Sanfilippo, Ms Kristina Vujcic, and Ms Katherine Mroz.
Project partners
Mr Jeff Gavin (Association of Participating Service Users, Self-Help Addiction Resource Centre), Professor Malcolm Hopwood (Ramsay Clinic Albert Road, Melbourne University), Dr Eli Kotler (Malvern Private Hospital), Ms Suzanne George (Malvern Private Hospital), Dr Adegoke Okedara (Ramsay Clinic Albert Road),and Dr Michael Maloney (The Melbourne Clinic).
Participating sites
Turning Point Addiction Medicine Unit, Malvern Private Hospital, Ramsay Clinic Albert Road, and The Melbourne Clinic.
Our funder
National Centre Clinical Research Emerging Drugs (NCCRED; project number NCR2SF10)
Learn more about this project
Pilot projects:
Publications:
- Manning, V., Piercy, H., Garfield, J. B. B., Mroz, K., Campbell, S., Staiger, P., Lum, J., Lubman, D and Verdejo-Garcia (2019) A Feasibility and acceptability of approach bias modification during methamphetamine withdrawal and related methamphetamine use outcomes. Journal of Substance Abuse Treatment, 106; 12-18.
- Garfield, J. B. B., Piercy, H., Arunogiri, S., Lubman, D. I., Campbell, S. C., Sanfilippo, P. G., Gavin, J., Hopwood, M., Kotler, E., George, S., Okedara, G., Piccoli, L. R., & Manning, V. (2021). Protocol for the methamphetamine approach-avoidance training (MAAT) trial, a randomised controlled trial of personalised approach bias modification for methamphetamine use disorder. Trials, 22, 21. DOI: 10.1186/s13063-020-04927-6
This trial has been registered by the Australian New Zealand Clinical Trials Registry (ANZCTR).