# Enhancing treatment outcomes among veterans with alcohol use disorder: Clinical and neural markers of adjunctive approach-avoidance training

> **NIH VA I01** · VA SAN DIEGO HEALTHCARE SYSTEM · 2023 · —

## Abstract

Veterans with alcohol use disorders (AUD) would be greatly served by development of effective interventions to
address high relapse rates and difficulty with resuming optimal functional recovery (i.e., re-engaging in
vocational, social, and daily life roles that are critical to maintaining alcohol consumption goals). Approach bias
toward alcohol, an implicit motivational response to alcohol cues observable across behavioral and neural
indicators, is a core feature of AUD that impedes recovery but is not routinely treated in standard care. Treatment
options that target approach bias may improve outcomes by decreasing the appetitive pull of alcohol, so that
individuals are better able to disengage from habitual drinking behaviors in the service of their functional goals
and objectives. Approach Avoidance Training (AAT) is a computer-delivered treatment program that shifts
behavioral and neural indicators of approach bias for alcohol and has been shown to improve drinking-related
outcomes in AUD when used in conjunction with standard care. Given the promise of this intervention for AUD,
there is a critical need to determine if this treatment can be successfully used for Veterans who commonly
present with complex comorbidities, and to pinpoint cognitive and neurobiological processes of change. The
overall objectives of this proposal are to determine whether Alcohol Approach Avoidance Training (AAT)
improves recovery outcomes in Veterans undergoing standard care for AUD with co-occurring conditions, and
to identify the underlying cognitive and neural substrates modified. The central hypothesis is that AAT training
will improve critical recovery outcomes for Veterans and improve behavioral and neural indicators of approach
bias. We will explore whether effects of AAT generalize to related top-down and bottom-up neurocognitive
processes. We will also explore potential predictors of treatment response. The overall objectives will be
addressed in a randomized controlled trial of 136 Veterans completing standard care in our local VA setting with
either AAT or a control condition. Aim 1 will determine if repeatedly practicing avoidance of alcohol cues through
AAT can improve recovery outcomes and hazardous drinking. Aim 2 will determine if AAT modifies approach
bias by measuring this construct with multiple assessment methods (i.e., behavioral, fMRI). Exploratory aims will
examine if AAT modifies inhibition (top-down) and cue reactivity (bottom up) processing, and the extent to which
baseline comorbidity severity, treatment engagement characteristics, or baseline approach bias (behavioral task
reaction times, brain response during fMRI) are associated with clinical outcomes. The project is expected to
determine if AAT shows clinical potential that would warrant expansion to other substances of abuse and a larger
multisite confirmatory efficacy trial in Veterans with AUD. Results of the study will inform the utility of AAT as an
adjunctive AUD treatment for ...

## Key facts

- **NIH application ID:** 10705745
- **Project number:** 5I01RX003793-02
- **Recipient organization:** VA SAN DIEGO HEALTHCARE SYSTEM
- **Principal Investigator:** Jessica Bomyea
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2023
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-10-01 → 2026-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10705745

## Citation

> US National Institutes of Health, RePORTER application 10705745, Enhancing treatment outcomes among veterans with alcohol use disorder: Clinical and neural markers of adjunctive approach-avoidance training (5I01RX003793-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10705745. Licensed CC0.

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