Attentional Bias Assessment in Patients with Alcohol Use Disorder: an eye-tracking study

Introduction: Alcohol use disorder (AUD) represents a major general health concern with important consequences for individuals' psycho-social functioning. Many studies suggest that cognitive processes such as attentional bias (AB) are heavily involved in the phases of acquisition, maintenance and relapse precipitation in AUD. AB is described as an implicit selective attention when processing visual information in favor of desired cues, which may elicit craving for alcohol and facilitate drinking-related behaviors. In line with recent studies of the applications of human-computer interaction in the field of psychology, the current study aimed to assess attentional bias towards alcohol-related images using eye-tracking technology. Specifically, we explored the first gaze towards alcohol-related images versus neutral images in patients with short-term and long-term abstinence. Method: 24 outpatients (M-age = 53, SD = 11.65) from the Addictive Behavior Unit of the Hospital Clinic of Barcelona participated in the study. The inclusion criteria were diagnoses of AUD and normal or corrected-to-normal visual acuity. Participants were divided according to their abstinence period, with the cut-off-point being set at four months. Fourteen patients had been abstinent for less than four months (M = 1, SD = 0.96), and 10 for longer than this period (M = 14, SD = 8.17). The self-reported abstinence period was supported by the results of urine analyses performed in all patients. Participants completed the Alcohol Use Disorder Identification Test (M = 19.75, SD = 9.34) and the Visual Attention Task (VAT). The VAT consisted of images related to alcohol consumption versus neutral images such as office objects. The EyeTribe eye-tracking technology was used to record eye movement activity during the VAT. Results: Our data indicated a statistically significant difference between patients with short-term and long-term abstinence regarding their first fixation towards alcohol-related and neutral images. Patients abstinent for less than four months had a tendency to look first at images related to alcohol consumption, whereas patients abstinent for more than four months were more likely to look first at neutral images, regardless of their AUDIT score. Conclusions: Patients with short-term abstinence had a greater AB than patients with long-term abstinence. The first gaze seems to be a sensitive parameter for differentiating between patients with low and high AB. The use of eye-tracking technology suggests that AB is important in clinical assessment and should be addressed in treatment as well as in relapse prevention. We consider that the eye-tracking technology is a promising instrument for assessing current addictive behavior.