Developing digital interventions for a post‐Covid world: A smartphone‐based approach‐avoidance training to reduce alcohol craving

Abstract

Harmful alcohol use is a major public health issue. In‐person treatment has been hindered by the restrictions necessary during the Covid‐19 pandemic. This study examined the effects of an at‐home smartphone‐based cognitive bias modification training in heavy drinkers. Experiment 1 tested the effect of a short 20–30‐min smartphone‐based approach‐avoidance training (AAT) on image‐induced craving at a 1‐day follow‐up. Sixty‐two participants consuming 14+ units of alcohol/week were allocated to either the training or waitlist group. Experiment 2 used an updated version of the same short AAT intervention with a sample of n = 107 participants who consumed 20+ units of alcohol/week. Training effects at 1‐week follow‐up were compared to an active control group. Experiment 1 showed a significant reduction in image‐induced craving for the training group at 1‐day follow‐up. Experiment 2 found that AUDIT weekly scores were significantly reduced at 1‐week follow‐up for the training group, all the while craving for soft drinks remained unchanged. Experiment 1 served as a first proof of concept for the efficacy of the new smartphone‐based AAT training, and experiment 2 suggested that training effects on problem alcohol use hold at 1‐week follow‐up.

Smartphone‐delivered approach bias modification for reducing harmful drinking amongst middle–older age adults: Secondary analyses of a single‐arm pilot study

“…It was particularly interesting to note the requests for a broader, and more age‐inclusive range of in‐app training stimuli, suggesting that the format of the training may need to incorporate subtle adaptations when applied to this age cohort. Although average app ratings on the uMARS were deemed to be ‘acceptable’ (with ratings similar to other smartphone‐delivered ApBM training programs [54]), since the vast majority of participants offered mixed qualitative responses, we recognise the need for ongoing app development and implementation, as guided by iterative user feedback.…”

“…With almost one-third of participants noting that inclusion of personally relevant stimuli encouraged consideration of drinking behaviour in the context of personal goals, the unique inclusion of personalisation, as distinct from previous versions of smartphone-delivered ApBM [56,57], may further serve to sustain engagement and adherence in a middle-older adult cohort endorsing high readiness to change [84]. Unlike previous smartphone ApBM studies exploring the effectiveness of training on drinking outcomes amongst younger individuals [54,57] or a diverse age range [58], current analyses are novel in that they are the first to demonstrate that some non-treatment-seeking middle-to-older adults, who may be at particular risk of problematic alcohol consumption and alcohol-related harms, may stand to gain from this non-pharmacological, personalised, mHealth cognitive training approach. Secondary analyses not only align with earlier research suggesting optimised ApBM outcomes with older age when delivered via computer and joystick [60], they further serve to advance knowledge of standalone multi-session smartphone-delivered ApBM, by demonstrating significant reductions in consumption, craving, and dependence amongst middle-to-older adults specifically.…”

“…Unlike previous smartphone ApBM studies exploring the effectiveness of training on drinking outcomes amongst younger individuals [54, 57] or a diverse age range [58], current analyses are novel in that they are the first to demonstrate that some non‐treatment‐seeking middle‐to‐older adults, who may be at particular risk of problematic alcohol consumption and alcohol‐related harms, may stand to gain from this non‐pharmacological, personalised, mHealth cognitive training approach. Secondary analyses not only align with earlier research suggesting optimised ApBM outcomes with older age when delivered via computer and joystick [60], they further serve to advance knowledge of standalone multi‐session smartphone‐delivered ApBM, by demonstrating significant reductions in consumption, craving, and dependence amongst middle‐to‐older adults specifically.…”

“…Although encouraging, our published findings were on a heterogenous sample, spanning a wide age range (18–75 years), where different alcohol consumption patterns and cultures have been recognised [59]. ApBM research on middle–older adults specifically remains scarce, with mixed findings as to whether older age predicts training success in clinical trials [60, 61], and primarily younger cohorts examined in previous studies of smartphone‐delivered ApBM amongst community samples [54, 55, 57]. There is yet to be an exploration of acceptability and preliminary effectiveness of personalised smartphone‐delivered ApBM amongst middle–older adults in the community.…”

“…Smartphone-delivered ApBM has also recently been explored within community-based samples, with mixed findings to date. Where delivered as a one-off training session [54], or as a series of components of different alcohol interventions (e.g., DrinkLess) [55,56], results have varied, however where delivered as a standalone, multi-session ApBM mHealth app (e.g., 'Breindebaas app'), a single arm pilot found significant reductions in alcohol consumption post-training in non-treatment seeking adults [57].…”