Hans van der Baan ADAPT lab Department of

Hans van der Baan, ADAPT lab, Department of Psychology, University of Amsterdam Breaking Out of the Joint: Cognitive Bias Modification Targeting the Cannabis and Alcohol Consumption of Youth in Juvenile Detention Centers

Cannabis Use in Dutch Youth ¢ ¢ 15 years, general population: £ 21. 3 % has used cannabis £ 11% potentially at risk 17 -18 years, general population: £ 44. 6% has used cannabis £ 18% potentially at risk (Peilstations Study, Trimbos, 2011) ¢ Youth in juvenile detention centers: £ 65% used cannabis during the month prior to incarceration £ 39% indications for drug abuse, largely cannabis (van der Nagel & Kea, 2013) Breaking Out of the Joint 2

Young offenders and Substance (ab)Use ¢ ¢ ¢ Cannabis and alcohol dependence is related to more aggressive and offending behaviour (Lennings et al. , 2003; Arsenault et al. , 2012) and increases the risk of psychopathology (e. g. Degenhardt et al. , 2015) Usage continues during incarceration, particularly cannabis (Cope, 2003; Rao et al, 2016) Most treatment programmes in juvenile detention centres adopt a cognitive behavioural approach, are rarely systematically evaluated and often not evidence based (Koehler, 2013; Trimbos, 2014) Breaking Out of the Joint 3

¢ Young offenders show a higher incidence of characteristics that predict substance use, such as poor working memory (Ellingson et al. , 2014), sensation seeking (Hopley & Brunelle, 2016) ¢ and psychopathology (Vermeiren, 2003). Lower cognitive control increases vulnerability to cognitive biases (van Hemel-Ruiter et al. , 2015) Breaking Out of the Joint 4

Dual Process Models ¢ ¢ Behaviour is a reaction to an in- or external cue Behaviour is chosen via two distinct but interactive and reiterative cognitive processes Explicit (or Reflective) processes (e. g. long-term planning) Implicit (or Impulsive) processes (e. g. immediate gratification) Breaking Out of the Joint 5

Duale Proces Model Motivation, “wanting” other life -goals Reflective Processes Situation / cues - Executive Function, Working Memory, “ability” Rational decision Pros and Cons Perception Motivational orientation Cognitive bias Motor Schemas Behaviour Cognitive bias Associative/Impulsive processes +

Attention Bias Breaking Out of the Joint 7

Approach Bias Breaking Out of the Joint 8

In Addiction: ¢ Frequent, repeated use behaviour strenghtens the biasses, sustaining use behaviour In Young Offenders: ¢ Strong (positive) associations with substance use ¢ Repeated usage damages the developing cognitive control ¢ Teenagers tend to be more impulsive in general and have limited long-term planning capabilities. Breaking Out of the Joint 9

Cognitive Bias Modification (CBM) ¢ ¢ ¢ Cognitive Biasses can be retrained (e. g. Wiers et al. , 2010, Addiction) Previous research showed clinical effects when combined with TAU (e. g. Wiers et al. , 2011, Psychological Science) Applied not just with substance use, but also anxiety, depression and eating disorders (www. impliciet. eu) Breaking Out of the Joint 10

Main research question ¢ Does CBM combined with TAU lead to greater reductions in cannabis and alcohol use in detained young offenders, compared to TAU only? Breaking Out of the Joint 11

Study Consortium for Reatributional E-training Effectiveness and Neuroprediction (SCREEN) Primary researchers: Hans v. d. Baan¹, Esther de Ruigh² Supervisors: prof. dr. Reinout Wiers¹, dr. Bruno Vercheuere¹, dr. Annemat Collot D’Escury-Koenigs¹, prof. dr. Arne Popma², dr. Lucres Nauta² ¢ ¢ ¢ 7 Dutch juvenile detention centres, nation wide from 2014 -2017 600 youth screened Independent study financed with a grant from the Dutch Ministery of Security and Justice ¹University of Amsterdam ²VU University, Amsterdam Breaking Out of the Joint 12

Procedure ¢ ¢ ¢ At T 0 we screened anyone and everyone who wanted to participate (excluding VIC and FOBA) Cannabis use (Cannabis Use Disorder Identification Test – Revised) and alcohol use (Alcohol Use Disorder Identification Test) Users were invited for training based on highest scored substance 6 training sessions of 2 CBM computer tasks Follow up at 12 months Breaking Out of the Joint 13

The Training Tasks ¢ ¢ ¢ Participants did both an AAT and a VPT Either task could be an active training version or a placebo version 2 x 2 design AAT Active VPT Active Placebo ¢ Placebo Stratified randomization (per institute) Breaking Out of the Joint 14

Approach Bias: The Approach / Avoid Task (AAT) Breaking Out of the Joint 15

Approach Bias: The Approach / Avoid Task (AAT) Breaking Out of the Joint 16

Approach Bias: The Approach / Avoid Task (AAT) Breaking Out of the Joint 17

Attentional Bias: The Visual Probe Task (VPT) + Breaking Out of the Joint 18

Sample ¢ ¢ ¢ 186 youth trained 114 retained (not ret. Rained) at 12 -month follow up 91% male, m. Age = 18. 47 82 cannabis trained, 32 alcohol trained No significant differences between retained participants and drop-outs on age, gender, CUDIT or AUDIT scores Breaking Out of the Joint 19

Cognitive Biases ¢ ¢ ¢ At least 70% of trials should be correct (-11 AAT, -1 VPT) One Sample T-tests Significant results for VPT cannabis (M=14. 98, SD=32. 74, t(122)=5. 07, p<. 01) and alcohol (M=10. 51, SD=33. 44, t(48)=2. 20, p=. 03) but none for AAT Breaking Out of the Joint 20

Substance Use After 1 Year ¢ ¢ ¢ Active VPT training vs Placebo training 56% received active alcohol training & 53% received active cannabis training Repeated Measures Factorial Anova Cannabis use decreased significantly (F(1, 79) = 15. 66, p<. 01) between T 0 (M=14. 05, SD=6. 17) and T 9 (M=10. 30, SD=7. 53). No effect of time for alcohol. No main effect of training (active vs placebo) nor an interaction effect for either substance Breaking Out of the Joint 21

Conclusions ¢ ¢ There is an attention bias for cannabis and alcohol in detained youth No approach/avoid bias Cannabis use decreases over time, but the effect is small There is no effect of attentional retraining Breaking Out of the Joint 22

Discussion points ¢ ¢ ¢ Motivation to change substance use and/or do the training tasks is low AAT may have been too complex compared to VPT Substance use patterns are different during incarceration Motivation as a moderator has (not yet) been assessed Combination with Motivational Interviewing Breaking Out of the Joint 23

Thank you for your attention! ¢ Hans van der Baan, ADAPT lab, Department of Psychology, University of Amsterdam ¢ ¢ ¢ h. s. vanderbaan@uva. nl Or check out our website at: www. impliciet. eu Breaking Out of the Joint 24