Supplemental Material for Does Comorbid Anxiety or Depression Moderate Effects of Approach Bias Modification in the Treatment of Alcohol Use Disorders?

BACKGROUND Background: Approach Bias Modification (ApBM), a computerised cognitive intervention which trains people to “avoid” alcohol-related images and “approach” neutral/non-alcohol images, reduces the likelihood of relapse when administered during residential alcohol treatment. However, most individuals experiencing alcohol problems do not require, do not seek, or cannot access residential treatment. Smartphone-delivered ApBM could offer an easily-accessible intervention to reduce alcohol consumption which can be personalised (e.g., allowing selection of personally-relevant alcohol and positive training images) and gamified to optimise engagement. OBJECTIVE Objective: We examined the feasibility, acceptability and preliminary effectiveness of “SWiPE”, a gamified, personalised alcohol ApBM smartphone app, and explored alcohol consumption and craving outcomes, in people drinking at hazardous levels (AUDIT score of 8+) who wanted to reduce their alcohol use. METHODS Methods: We conducted an open-label trial in which frequency and quantity of alcohol consumption, severity of alcohol dependence, and craving were measured prior to participants downloading SWiPE. Participants (n=1309) were instructed to complete at least 2 sessions per week for 4 weeks. Recruitment and completion rates were indicators of feasibility. Functionality, aesthetics, and quality ratings were indicators of acceptability. Participants were prompted to report frequency and quantity of alcohol consumption each week during training, and 1-month after training, and completed measures of craving and dependence after 4-weeks of training. RESULTS Results: We recruited 1309 participants (mean age 47.0 years (SD 10.0); 57.9% female; mean AUDIT score 21.8 (SD 6.5)) over a 6-month period. Participants completed a median of 5 sessions (IQR 2-9), 409 (31.2%) completed at least 8 sessions and 455 (34.8%) completed the post-training survey. Mean Mobile Application Rating Scale scores were 4.4 (SD 0.5) for functionality, 4.2 (SD 0.5) for aesthetics and 3.4 (SD 0.8) for subjective quality. Among those who completed post-training assessment, mean past-week drinking days reduced from 5.1 (SD 2.0) pre-training to 4.2 (SD 2.3) in week 4 (t454=7.87; P<.001). Mean past-week standard drinks reduced from 32.8 (SD 22.1) to 24.7 (SD 20.1; t454=8.58; P<.001). Mean Craving Experience Questionnaire frequency scores reduced from 4.5 (SD 2.0) to 2.8 (SD 1.8; t435=19.39; P<.001). Severity of Dependence scores reduced from 7.7 (SD 3.0) to 6.0 (SD 3.2; t435=12.44; P<.001). In the 254 (19.4%) participants who completed a 1-month follow-up, mean past-week drinking days was 3.9 (SD 2.5) and mean standard drinks was 23.9 (SD 20.7), both significantly lower than at baseline (P<0.001). CONCLUSIONS Conclusion: The findings suggest SWiPE is feasible, acceptable and may be effective at reducing alcohol consumption and craving in a predominantly non-treatment seeking sample of adult Australians drinking at hazardous levels. SWiPE’s efficacy, relative to a control condition, now needs establishing in a randomised controlled trial. Smartphone-delivered personalised ApBM has the potential to be a highly scalable, widely-accessible support tool for reducing alcohol use.

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Personalized Approach Bias Modification Smartphone App (“SWIPE”) to Reduce Alcohol Use Among People Drinking at Hazardous or Harmful Levels: Protocol for an Open-Label Feasibility Study (Preprint)

10.2196/preprints.21278 ◽

2020 ◽

Author(s):

Victoria Manning ◽

Hugh Piercy ◽

Joshua Benjamin Bernard Garfield ◽

Dan Ian Lubman

Keyword(s):

Alcohol Use ◽

Controlled Trial ◽

Smartphone App ◽

Motivation To Change ◽

Open Label ◽

Approach Bias ◽

Alcohol Relapse ◽

Personalized Approach ◽

Clinical Trials Registry ◽

Bias Modification

BACKGROUND Alcohol 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. OBJECTIVE We 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. METHODS We 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. RESULTS We expect to commence recruitment in August 2020 and complete data collection in March 2021. CONCLUSIONS This 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. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000638932p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p INTERNATIONAL REGISTERED REPORT PRR1-10.2196/21278

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