Attentional bias training did not improve outcomes for alcohol or cannabis use disorder

No significant differences emerged between the ABM group and control groups on any measure: substance use, craving, relapse rates, attentional bias, depression, anxiety, or stress, either at post-test or at 6- and 12-month follow-ups. The null results held across all time points.

Multicenter RCT with 169 participants diagnosed with alcohol or cannabis use disorder. Randomly assigned to treatment as usual (TAU) plus attentional bias modification (ABM), TAU plus placebo training, or TAU only. The ABM used a home-delivered, multi-session internet program called the Bouncing Image Training Task. Outcomes assessed at baseline, post-test, 6 months, and 12 months.

Attentional bias (automatic attention toward substance-related cues) has been theorized as a key mechanism in addiction persistence. This well-designed trial found no support for ABM as an add-on treatment, raising questions about whether targeting attention is the right approach.

The failure of ABM to improve addiction outcomes adds to growing skepticism about attentional bias interventions outside the lab. The results may reflect that real-world addiction is driven by factors far more powerful than automatic attentional patterns, or that the specific intervention did not successfully modify bias.

Mixed treatment goals (some pursuing moderation, others abstinence) may have diluted effects. The specific ABM task may not have targeted the right attentional process (engagement vs. disengagement). Home-based delivery reduces compliance monitoring.