***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study aim ed to replicate findings that alcohol consumption and positive implicit beer-related cognitions can be reduced using inhibitory control ( IC ) training , with the addition of an active training control . Frontal EEG asymmetry , an objective psychophysiological index of approach motivation , was used as a dependent measure to examine training outcomes . Participants were r and omly assigned to one of two IC training conditions ( Beer NoGo or Beer Go ) or a Brief Alcohol Intervention ( BAI ) ( i.e. the active training control ) . The IC training tasks consistently paired a stimulus that required a response with images of water ( Beer NoGo ) or images of beer ( Beer Go ) . Alcohol consumption and implicit beer-related cognitions were measured at pre-training , post-training and at one week follow-up . Frontal EEG asymmetry was recorded during a passive image viewing task that presented neutral , healthy , and beer stimuli - at pre-training , post-training and follow-up . Participants in the Beer NoGo and BAI conditions consumed less beer in a taste test immediately after training than Beer Go participants , suggesting that IC training may be as effective as the already established BAI . The taste test findings were in line with the frontal EEG asymmetry data , which indicated that approach motivation for beer stimuli was altered in the expected directions . However , the positive correlation between post-training frontal EEG asymmetry data and taste test consumption was not significant . While there were no significant changes in implicit beer-related cognitions following training , a trending positive relationship between implicit beer-related cognitions at post-training and taste test consumption was reported . Further exploration addressing the limitations of the current study is required in order to clarify the implication s of these findings Rationale Both cue avoidance training ( CAT ) and inhibitory control training ( ICT ) reduce alcohol consumption in the laboratory . However , these interventions have never been directly compared and their mechanisms of action are poorly understood . Objectives We compared the effects of both types of training on alcohol consumption and investigated if they led to theoretically predicted changes in alcohol avoidance ( CAT ) or alcohol inhibition ( ICT ) associations and changes in evaluation of alcohol cues . Methods Heavy drinking young adults ( N = 120 ) were r and omly assigned to one of four groups : ( 1 ) CAT ( repeatedly pushing alcohol cues away with a joystick ) , ( 2 ) sham ( control ) CAT ; ( 3 ) ICT ( repeatedly inhibiting behaviour in response to alcohol cues ) ; or ( 4 ) sham ( control ) ICT .  Changes in reaction times and automatic evaluations of alcohol cues were assessed before and after training using assessment versions of tasks used in training and the implicit association test ( IAT ) , respectively . Finally , participants completed a bogus taste test as a measure of ad libitum alcohol consumption . Results Compared to sham conditions , CAT and ICT both led to reduced alcohol consumption although there was no difference between the two . Neither intervention affected performance on the IAT , and changes in reaction time did not suggest the formation of robust alcohol avoidance ( CAT ) or alcohol inhibition ( ICT ) associations after training . Conclusions CAT and ICT yielded equivalent reductions in alcohol consumption in the laboratory . However , these behavioural effects were not accompanied by devaluation of stimuli or the formation of alcohol avoidance or alcohol inhibition associations BACKGROUND Young adult heavy drinking is an important public health concern . Current interventions have efficacy but with only modest effects , and thus , novel interventions are needed . In prior studies , heavy drinkers , including young adults , have demonstrated stronger automatically triggered approach tendencies to alcohol-related stimuli than lighter drinkers . Automatic action tendency retraining has been developed to correct this tendency and consequently reduce alcohol consumption . This study is the first to test multiple iterations of automatic action tendency retraining , followed by laboratory alcohol self-administration . METHODS A total of 72 nontreatment-seeking , heavy drinking young adults ages 21 to 25 were r and omized to  automatic action tendency retraining  or a  control condition  ( i.e. , " sham training " ) . Of these , 69 ( 54 % male ) completed 4 iterations of retraining or the control condition over 5 days with an alcohol drinking session on Day 5 . Self-administration was conducted according to a human laboratory paradigm design ed to model individual differences in impaired control ( i.e. , difficulty adhering to limits on alcohol consumption ) . RESULTS Automatic action tendency retraining was not associated with greater reduction in alcohol approach tendency or less alcohol self-administration than the control condition . The laboratory paradigm was probably sufficiently sensitive to detect an effect of an experimental manipulation given the range of self-administration behavior observed , both in terms of number of alcoholic and nonalcoholic drinks and measures of drinking topography . CONCLUSIONS Automatic action tendency retraining was ineffective among heavy drinking young adults without motivation to change their drinking . Details of the retraining procedure may have contributed to the lack of a significant effect . Despite null primary findings , the impaired control laboratory paradigm is a valid laboratory-based measure of young adult alcohol consumption that provides the opportunity to observe drinking topography and self-administration of nonalcoholic beverages ( i.e. , protective behavioral strategies directly related to alcohol use ) There is preliminary evidence that approach avoid training can shift implicit alcohol associations and improve treatment outcomes . We sought to replicate and extend those findings in US undergraduate social drinkers ( Study 1 ) and at-risk drinkers ( Study 2 ) . Three adaptations of the approach avoid task ( AAT ) were tested . The first adaptation – the approach avoid training – was a replication and targeted implicit alcohol approach associations . The remaining two adaptations – the general identity and personalized identity trainings – targeted implicit drinking identity associations , which are robust predictors of hazardous drinking in US undergraduates . Study 1 included 300 undergraduate social drinkers . They were r and omly assigned to real or sham training conditions for one of the three training adaptations , and completed two training sessions , spaced one week apart . Study 2 included 288 undergraduates at risk for alcohol use disorders . The same training procedures were used , but the two training sessions occurred within a single week . Results were not as expected . Across both studies , the approach avoid training yielded no evidence of training effects on implicit alcohol associations or alcohol outcomes . The general identity training also yielded no evidence of training effects on implicit alcohol associations or alcohol outcomes with one exception ; individuals who completed real training demonstrated no changes in drinking refusal self-efficacy whereas individuals who completed sham training had reductions in self-efficacy . Finally , across both studies , the personalized identity training yielded no evidence of training effects on implicit alcohol associations or alcohol outcomes . Despite having relatively large sample s and using a well-vali date d training task , study results indicated all three training adaptations were ineffective at this dose in US undergraduates . These findings are important because training studies are costly and labor-intensive . Future research may benefit from focusing on more severe population s , pairing training with other interventions , increasing training dose , and increasing gamification of training tasks CONTEXT Alcohol dependence treatment may include medications , behavioral therapies , or both . It is unknown how combining these treatments may impact their effectiveness , especially in the context of primary care and other nonspecialty setting s. OBJECTIVES To evaluate the efficacy of medication , behavioral therapies , and their combinations for treatment of alcohol dependence and to evaluate placebo effect on overall outcome . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial conducted January 2001-January 2004 among 1383 recently alcohol-abstinent volunteers ( median age , 44 years ) from 11 US academic sites with Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , diagnoses of primary alcohol dependence . INTERVENTIONS Eight groups of patients received medical management with 16 weeks of naltrexone ( 100 mg/d ) or acamprosate ( 3 g/d ) , both , and /or both placebos , with or without a combined behavioral intervention ( CBI ) . A ninth group received CBI only ( no pills ) . Patients were also evaluated for up to 1 year after treatment . MAIN OUTCOME MEASURES Percent days abstinent from alcohol and time to first heavy drinking day . RESULTS All groups showed substantial reduction in drinking . During treatment , patients receiving naltrexone plus medical management ( n = 302 ) , CBI plus medical management and placebos ( n = 305 ) , or both naltrexone and CBI plus medical management ( n = 309 ) had higher percent days abstinent ( 80.6 , 79.2 , and 77.1 , respectively ) than the 75.1 in those receiving placebos and medical management only ( n = 305 ) , a significant naltrexone x behavioral intervention interaction ( P = .009 ) . Naltrexone also reduced risk of a heavy drinking day ( hazard ratio , 0.72 ; 97.5 % CI , 0.53 - 0.98 ; P = .02 ) over time , most evident in those receiving medical management but not CBI . Acamprosate showed no significant effect on drinking vs placebo , either by itself or with any combination of naltrexone , CBI , or both . During treatment , those receiving CBI without pills or medical management ( n = 157 ) had lower percent days abstinent ( 66.6 ) than those receiving placebo plus medical management alone ( n = 153 ) or placebo plus medical management and CBI ( n = 156 ) ( 73.8 and 79.8 , respectively ; P<.001 ) . One year after treatment , these between-group effects were similar but no longer significant . CONCLUSIONS Patients receiving medical management with naltrexone , CBI , or both fared better on drinking outcomes , whereas acamprosate showed no evidence of efficacy , with or without CBI . No combination produced better efficacy than naltrexone or CBI alone in the presence of medical management . Placebo pills and meeting with a health care professional had a positive effect above that of CBI during treatment . Naltrexone with medical management could be delivered in health care setting s , thus serving alcohol-dependent patients who might otherwise not receive treatment . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00006206 BACKGROUND Alcoholism is a progressive neurocognitive developmental disorder . Recent evidence shows that computerized training interventions ( Cognitive Bias Modification , CBM ) can reverse some of these maladaptively changed neurocognitive processes . A first clinical study of a CBM , called alcohol-avoidance training , found that trained alcoholic patients showed less relapse at one-year follow-up than control patients . The present study tested the replication of this result , and questions about mediation and moderation . METHODS 509 alcohol-dependent patients received treatment as usual ( primarily Cognitive Behavior Therapy ) inpatient treatment .  Before and after treatment , the implicit approach bias was measured with the Alcohol Approach-Avoidance Task . Half of the patients were r and omly assigned to CBM  , the other half received  treatment as usual only . Background variables , psychopathology and executive control were tested as possible moderating variables of CBM . One year after treatment , follow-up data about relapse were collected . RESULTS The group receiving CBM  developed alcohol-avoidance behavior and reported significantly lower relapse rates at one-year follow-up . Change in alcohol-approach bias mediated this effect . Moderation analyses demonstrated that older patients and patients with a strong approach-bias at pretest profited most from CBM . CONCLUSIONS CBM is a promising treatment add-on in alcohol addiction and may counter some of the maladaptive neurocognitive effects of long-term alcoholism To examine the impact of a computer-delivered , home-based , alcohol-specific attention modification program ( AMP ) , 41 heavy drinking college students were r and omly assigned to AMP or an attention control condition ( ACC ) . Participants selected 10 alcohol-related words most relevant to their own drinking experience as well as 10 neutral words not related to alcohol . These personalized stimuli were used in an attention retaining program based upon the probe detection paradigm twice weekly for 4 weeks . Participants in the AMP condition reported decreased drinking , whereas those in the ACC condition reported no change in their drinking . These preliminary data suggest that a computer-delivered , home-delivered , attention-retraining for alcohol treatment may be an inexpensive and efficacious adjunct to st and ard alcohol treatments Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Cognitive bias modification ( CBM ) can be used to retrain automatic approach tendencies for alcohol . We investigated whether changing cortical excitability with transcranial direct current stimulation ( tDCS ) could enhance CBM effects in hazardous drinkers . We also studied the underlying mechanisms by including behavioral ( craving , implicit associations , approach tendencies ) and electrophysiological ( event-related potentials ) measurements . METHODS The analytical sample consisted of 78 hazardous drinkers ( Alcohol Use Disorders Identification Test > 8) r and omly assigned to 4 conditions in a 2-by-2 factorial design ( control/active CBM and sham/active tDCS ) . The intervention consisted of 3 sessions of CBM , specifically alcohol approach bias retraining , combined with 15 minutes 1 mA tDCS over the left dorsolateral prefrontal cortex . There was a pre- and post assessment before and after the intervention that included experimental tasks ( Approach Avoidance Task , Implicit Association Task ) and an electroencephalogram with an oddball and cue-reactivity task . RESULTS tDCS decreased cue-induced craving ( but not overall craving ) on post assessment . CBM did not induce an 
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Results : While AtBM seems to influence attentional bias , its effects on drinking behavior are inconsistent .
As for ApBM , the best effects on drinking behavior are obtained in clinical sample s. Effects of ApBM on approach bias are mixed .
Interestingly , those clinical RCTs which investigated ApBM effects on bias change as well as on drinking outcome , reported consistent effects in both measures ( i.e. either effects on bias and drinking or no effects ) .
Studies on IT are limited to non- clinical sample s and show inconsistent effects on drinking behavior .
Conclusions about the overall influence of drinking behavior severity are hampered by the non-uniform use of sample descriptions .
Conclusions : In clinical sample s , ApBM has shown more consistent beneficial effects , while evidence on AtBM is more inconsistent , and data on IT still lacks important information .
Conclusions about the influence of drinking behavior severity would be facilitated by a uniform use of clearly defined sample descriptions