Abstract
BackgroundAlcohol accounts for 5.1% of the global burden of disease and injury, and approximately 1 in 10 people worldwide develop an alcohol use disorder. Approach bias modification (ABM) is a computerized cognitive training intervention in which patients are trained to “avoid” alcohol-related images and “approach” neutral or positive images. ABM has been shown to reduce alcohol relapse rates when delivered in residential settings (eg, withdrawal management or rehabilitation). However, many people who drink at hazardous or harmful levels do not require residential treatment or choose not to access it (eg, owing to its cost, duration, inconvenience, or concerns about privacy). Smartphone app–delivered ABM could offer a free, convenient intervention to reduce cravings and consumption that is accessible regardless of time and place, and during periods when support is most needed. Importantly, an ABM app could also easily be personalized (eg, allowing participants to select personally relevant images as training stimuli) and gamified (eg, by rewarding participants for the speed and accuracy of responses) to encourage engagement and training completion.ObjectiveWe aim to test the feasibility and acceptability of “SWIPE,” a gamified, personalized alcohol ABM smartphone app, assess its preliminary effectiveness, and explore in which populations the app shows the strongest indicators of effectiveness.MethodsWe aim to recruit 500 people who drink alcohol at hazardous or harmful levels (Alcohol Use Disorders Identification Test score≥8) and who wish to reduce their drinking. Recruitment will be conducted through social media and websites. The participants’ intended alcohol use goal (reduction or abstinence), motivation to change their consumption, and confidence to change their consumption will be measured prior to training. Participants will be instructed to download the SWIPE app and complete at least 2 ABM sessions per week for 4 weeks. Recruitment and completion rates will be used to assess feasibility. Four weeks after downloading SWIPE, participants will be asked to rate SWIPE’s functionality, esthetics, and quality to assess acceptability. Alcohol consumption, craving, and dependence will be measured prior to commencing the first session of ABM and 4 weeks later to assess whether these variables change significantly over the course of ABM.ResultsWe expect to commence recruitment in August 2020 and complete data collection in March 2021.ConclusionsThis will be the first study to test the feasibility, acceptability, and preliminary effectiveness of a personalized, gamified ABM intervention smartphone app for hazardous or harmful drinkers. Results will inform further improvements to the app, as well as the design of a statistically powered randomized controlled trial to test its efficacy relative to a control condition. Ultimately, we hope that SWIPE will extend the benefits of ABM to the millions of individuals who consume alcohol at hazardous levels and wish to reduce their use but cannot or choose not to access treatment.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000638932p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932pInternational Registered Report Identifier (IRRID)PRR1-10.2196/21278
Highlights
IntroductionAlcohol is estimated to account for 5.1% of the burden of disease and injury, and is associated with health, social, and economic harms that impact the drinker and those around them, including their family, work colleagues, and the broader community [1]
We hope that SWIPE will extend the benefits of Approach bias modification (ABM) to the millions of individuals who consume alcohol at hazardous levels and wish to reduce their use but cannot or choose not to access treatment
Since alcohol-related cues are ubiquitous in Western societies, and nearly impossible to avoid, the craving and cognitive biases that can be elicited by these cues pose a serious challenge for people seeking to reduce or cease their drinking
Summary
Alcohol is estimated to account for 5.1% of the burden of disease and injury, and is associated with health, social, and economic harms that impact the drinker and those around them, including their family, work colleagues, and the broader community [1]. There are numerous factors that may make it difficult for people to reduce or cease their drinking, and recent research suggests that these include learned associations between alcohol and related stimuli, which have a strong influence on behavior at a subconscious level. Stimuli associated with drug use (such as physical and social contexts, sights, sounds, and scents) increasingly capture attention (ie, developing an “attentional bias” [8]), resulting in cue-induced cravings [9]. This incentive sensitization process is purported to lead to the development of “approach bias” (ie, an automatic, impulsive action tendency to approach drug-related cues) [8]. An ABM app could be personalized (eg, allowing participants to select personally relevant images as training stimuli) and gamified (eg, by rewarding participants for the speed and accuracy of responses) to encourage engagement and training completion
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