Attentional bias for alcohol-related cues in a clinical setting among patients with alcohol use disorder: Evidence from eye movements and reaction times

Background: Alcohol-related attentional bias (AB) is a central mechanism in alcohol use disorder (AUD), yet its temporal dynamics and measurement reliability remain debated. This study investigated the psychometric properties and temporal characteristics of AB in a clinical sample using a multimodal approach. Methods: Patients with AUD (N = 49) completed a visual-probe task at short (200 ms) and long (2000 ms) stimulus-onset asynchronies (SOAs). Reaction times (RT) and eye-tracking (ET) indices were evaluated, including dwell time, fixation count, and first fixation landing position, with internal reliability assessed specifically for AB indices (difference scores) and correlations across modalities. Results: RT-based AB-indices showed moderate split-half reliability at short and good reliability at long SOAs. ET-base AB indices of dwell time and fixation count demonstrated good reliability. Contrary to some prior studies, multimodal measures were interrelated, with significant correlations between dwell time and RT-based AB indices at both SOAs. RTs revealed a biphasic pattern via a significant approach bias at 200 ms and avoidance at 2000 ms. However, ET indices showed no significant effects for dwell time or fixation count. AB correlated with momentary craving, which was generally low in this clinical sample, but not with AUD severity. No significant differences were observed based on alcohol type preference. Conclusions: Manual RTs captured the dynamic pattern of the approach-avoidance time course of AB. Findings support a state-dependent perspective, suggesting AB reflects a fluid motivational state rather than a stable trait. Overall, the results indicate that AB indices can be measured with acceptable reliability, supporting further investigation of attentional processes in AUD.