Impact of Visual Masking on Attentional Bias in Cross‐Sectional Clinical and Healthy Populations: Differences in Conscious and Unconscious Processing of Alcohol‐Related Cues

BACKGROUND: Attentional bias (AB) toward substance-related cues is a core cognitive mechanism in alcohol use disorder (AUD) and closely associated with craving and relapse risk. Yet, the extent to which AB reflects automatic bottom-up processes remains unclear. METHODS: This study (N = 107) examined alcohol-related AB in clinical populations (inpatients and outpatients with AUD) and healthy controls (occasional and non-drinkers). Alcohol cues were presented under masked and unmasked conditions in a dot-probe task, and AB was measured via reaction times. Patients also reported alcohol craving and dependence levels. The study assessed whether AB patterns differed between clinical and healthy groups, whether cue awareness modulated attentional processing, and whether alcohol-type preference within the clinical sample influenced AB. Finally, associations between craving, dependence, and AB were explored. RESULTS: As predicted, unmasked alcohol cues elicited significant AB in both inpatient and outpatient groups, but not in healthy controls. No significant AB emerged in masked trials for any subgroup, suggesting that alcohol-related AB is not fully automatic but depends on conscious awareness. Patients reporting current craving showed greater AB than those without craving. However, AB magnitude did not correlate with craving intensity, AUD severity scores, or alcohol-type preference. CONCLUSIONS: These findings indicate that alcohol-related AB in AUD is shaped by conscious processing rather than purely automatic mechanisms, underscoring the role of top-down factors in attentional processes relevant to addiction.