An eye-tracking exploration of the alcohol-related attentional bias in severe alcohol use disorder: Influence of subjective craving and cognitive load

Bollen, Zoé [UCL] Pabst, Arthur [UCL] Masson, Nicolas [UCL] Maurage, Pierre [UCL]

Introduction: Dual-process models consider that the attentional bias towards alcohol-related stimuli plays a key role in the persistence of alcohol use disorder. They postulate that this bias is stable and reflects the over-activation of the reflexive/impulsive system, independently of the activity of the reflective/control one. Our study aims to test these assumptions by investigating (1) the influence that the activity of the reflective system might have on alcohol-related attentional bias, and (2) the stability of the bias following the variation of subjective craving. Method: We recruited 60 patients with severe alcohol use disorder (30 with craving for alcohol at testing time, and 30 without craving) and 30 matched healthy controls. Participants performed a free viewing task with images of alcoholic and non-alcoholic beverages. The task was then combined with an auditory selective attention task with two levels of difficulty, mobilizing cognitive resources and thus taping on the reflective system. Eye movements were recorded using an eye-tracking. Results: Our results show an attentional bias towards alcohol-related stimuli in patients with craving and, conversely, an avoidance bias for alcohol in patients without craving. Healthy subjects did not show any bias towards alcohol. The bias remains stable regardless of the difficulty level of the concurrent cognitive task. Discussion: Attentional bias does not appear to be influenced by cognitive load, confirming the independence of the reflexive and reflective systems. Nevertheless, the direction of the bias appears to be strongly influenced by patients' subjective craving, calling into question the stability of the bias predicted by dual-process models.