Approach With Caution: A Pilot Randomised Controlled Trial of Approach Bias Modification for People Undergoing Residential Treatment for Methamphetamine Use Disorder

INTRODUCTION: Less than one-quarter of people who attend residential rehabilitation for methamphetamine use disorder (MUD) remain abstinent for 1 year. Approach bias modification (ApBM), a cognitive training intervention, reduces relapse rates when delivered during residential rehabilitation for alcohol use disorder. However, there has been little research on ApBM for MUD. METHODS: Twenty-four patients with MUD attending four residential treatment services in Melbourne were randomised, between March 2020 and August 2024, to 6 sessions of either ApBM (n = 10) or sham-control training (n = 14). Safety was monitored during the intervention and acceptability was assessed at the end of training. A blinded researcher assessed methamphetamine use, craving, and dependence severity at follow-ups 1 and 3 months after discharge from residential treatment. RESULTS: Three ApBM and five control participants experienced adverse psychological reactions to the training task, resulting in two ApBM and 1 control participants withdrawing. However, participants who completed training generally provided positive acceptability ratings (mean Endorsement and Discomfort Scale scores of 69.13 [SD = 10.93] in the ApBM group and 58.83 [SD = 13.41] in controls). Directions of differences in proportions reporting past-month abstinence at 1-month (ApBM: 5/7 [71%]; controls: 5/11 [46%]) and 3-month follow-ups (ApBM: 4/7 [57%]; controls: 3/9 [33%]) and continuous abstinence at 3-month follow-up (ApBM: 3/7 [43%]; controls: 2/11 [18%]) favoured ApBM; however, these differences did not approach significance in this very small sample. Craving and MUD severity outcomes also did not differ significantly between groups. DISCUSSION AND CONCLUSIONS: Further research on ApBM's efficacy for MUD may be warranted, but safety concerns suggest caution. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12620000072910. Registered on 30 January 2020 (prospectively registered): https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378804&isReview=true.