An open-label pilot study of the feasibility, acceptability, and effectiveness of approach bias modification (ABM) training for methamphetamine use disorder, as indexed by recruitment rate, ABM training completion rate, participants' ratings of ABM tasks, and abstinence from methamphetamine at 2-week and 3-month follow-ups.

Many people relapse after treatment for dependence on methamphetamine (often known as ‘ice’, ‘meth’). There are likely to be many reasons for this, but one factor that is believed to cause relapse is “approach bias”. “Approach bias” refers to the way in which we are automatically drawn to approach or seek things we find rewarding when we encounter signals (like sights, sounds, smells, or places) that remind us of those things. When people use drugs frequently, they often develop an approach bias related to that drug, so that sights (like seeing drug-related paraphernalia, or people they have used drugs with), places they have used drugs, or other signals automatically spur their desire to approach or seek drugs. Approach bias can be triggered very quickly, and may function at a somewhat subconscious level, so people aren’t even fully aware they’re being influenced by it. This can make it difficult to control. However, in recent years, researchers have developed computerised training programs called “approach bias modification” (ABM), where people repeatedly practice responding to drug-related pictures in a way that can reduce their approach bias. So far, the only large clinical trials of ABM in addiction have been for alcohol and tobacco. Repeated sessions of ABM can reduce the likelihood of relapsing to alcohol use after being treated for alcohol dependence. However, no previous trials have tested ABM for methamphetamine dependence. This project was a small preliminary trial to test whether it was feasible and acceptable to run 4-session programme of ABM training during withdrawal treatment (i.e. ‘detox’), where clients received medical and psychological care and social support while withdrawing from methamphetamine. We found that recruitment for this research was more difficult than we expected. Only 47% of the 99 patients we invited to participate agreed to join the study and commenced ABM training. Of the 47 who commenced ABM training, 62% completed all 4 sessions. This suggested that feasibility was limited during withdrawal treatment. However, acceptability was good among those who did participate. Very few (9%) withdrew due to feeling triggered by the training. While the first session of ABM often caused some increase in cravings, cravings generally reduced over the course of the training. When asked to rate the ABM training, 78% of participants indicated that they ‘agreed’ or ‘strongly agreed’ that the task was interesting, and 36% felt it had reduced their craving for methamphetamine. We also did follow-up interviews 2 weeks and 3 months after participants left withdrawal treatment. We managed to contact 31 participants for the 2-week follow-up and 26 for the 3-month follow-up. A majority of participants reported being abstinent from methamphetamine at each follow-up (61% at the 2-week follow-up and 54% at the 3-month follow-up), which is higher than the usual rates of abstinence seen after withdrawal treatment. However, these findings are based on very small numbers of participants, and many didn’t complete follow-up, so these findings are uncertain and would need to be replicated in a larger study.