Stay Focused! Exploring the Compulsive Nature of Alcohol-Related Attentional Bias in Severe Alcohol Use Disorder

Objective: Prominent models postulate that alcohol-related attentional bias (AB), emerging from the overactivation of the reward system, plays a key role in severe alcohol use disorder (sAUD) and is independent from voluntary control. We determined whether AB is indeed compulsive or can be modulated by the control/inhibition system. Method: Patients with sAUD (17 women, 13 men, mean age of 47, White) and matched healthy controls (16 women, 14 men, mean age of 44, White) performed a visual probe task with behavioral (reaction time) and eye-tracking (first fixation location and duration, second fixation location, dwell time) measures. They also performed an avoidance task, requiring to focus on a target by voluntarily inhibiting eye movements toward alcohol/nonalcohol/nonappetitive distractors and measuring overt (break frequency) and covert (fixational eye movements) attentional processes. Results: Patients with sAUD exhibited an avoidance AB indexed by (a) reduced attentional resources dedicated to alcohol-related stimuli, namely, reduced dwell time (p = .040) and second fixation (p = .001) toward these stimuli; (b) increased inhibitory processes, namely, easier inhibition of saccades toward alcohol measured by lower break frequency (p < .001); and (c) covert eye movements posited further away from alcohol. Conclusions: In contradiction with theoretical models, our two tasks did not show any AB toward alcohol in sAUD. Instead, patients exhibited an avoidance AB indexed by increased inhibitory processes as well as reduced overt and covert attentional resources dedicated to alcohol-related stimuli. These results question the theoretical and clinical role of AB, as measured through reliable eye-tracking tasks, in sAUD.