Should we train alcohol-dependent patients to avoid alcohol?

Spruyt et al. (2013) report an interesting study in which they compared an alcohol approach-bias, as measured with the Relevant-feature Stimulus Response Compatibility task (R-SRC) in 40 abstaining alcohol-dependent patients and 40 non-dependent controls. While controls had an approach-bias for alcohol as compared to matched control-pictures like water, alcohol-dependent patients showed a relative avoidance bias for alcohol. In the patients group, an avoidance-bias was associated with an increased risk for relapse 3 months later. The authors discuss the relationship of these findings with our training-results, in which alcohol-dependent patients trained to avoid alcohol did better at a 1-year follow-up: "Although initial findings suggest that alcohol-avoidance training could help reduce relapse rates in abstaining alcohol-dependent patients (Wiers et al., 2011), it is still unclear whether changes in automatically approach/avoidance tendencies are directly responsible for the observed changes in treatment outcome. Our findings suggest that actually inducing an avoidance orientation toward alcohol might have harmful effects, at least in a clinical population.