Online App Encourages Abstinence in Alcohol Addiction

(Duc Quang Tran, Pixabay)

5 Nov. 2020. Results from a clinical trial show users of an online abstinence training app are less likely to relapse in alcohol consumption than sham training app users. Findings from the trial, conducted by researchers at Monash University in Melbourne, Australia, appear in yesterday’s issue of the journal JAMA Psychiatry (paid subscription required).

A team from Turning Point, an addiction rehabilitation clinic and research center affiliated with Monash, are developing an app called Swipe designed to train alcohol users to reduce their alcohol consumption. Swipe is based on a technique known as cognitive bias modification that aims to train individuals to ignore or avoid subconscious cognitive biases that promote harmful behaviors, in this case cues feeding impulses to drink. Cognitive bias modification often uses repetitive computerized exercises to train users to ignore or avoid the subconscious cues..

“A lot of the time, people wanting to quit or take a break from alcohol experience a form of internal conflict,” says Victoria Manning, head of research at Turning Point and first author of the paper in institute statement. “They know it’s important not to drink, but at the same time, they really want to have a drink.”

The Swipe app uses cognitive bias modification to reduce the user’s cognitive bias towards alcohol in favor of healthier behaviors. Once loaded on a smartphone, the users upload images of their favorite alcohol drinks or brands, as well as images of non-alcoholic alternatives, such as water or coffee, or healthy activities like exercise or hobbies. The app then requires users to physically push away with a screen swipe, repeated images representing their alcohol consumption, while keeping the non-alcohol or healthy alternatives.

The clinical trial enrolled 300 adult participants at four in-patient alcohol treatment centers in Australia with moderate to severe alcohol use disorder. Trial participants completed a Swipe training session each day for four consecutive days, with participants randomly assigned to receive either a fully functioning program or a sham alternative. For the trial, participants used a video-game version of the app, with a joystick to move the images instead of the smartphone app.

The functioning Swipe program had 40 images of alcoholic beverages and brands, and 40 images of non-alcohol alternatives, presented at a ratio of 95 percent alcohol to 5 percent non-alcohol. The sham program presented the same images, but with a 50/50 split of alcohol to non-alcohol. Participants were then contacted by researchers two weeks after the training to ask about their alcohol use. The authors say the first two weeks following discharge is considered a high-risk period for relapse.

Results show more than half (54%) of participants using the functioning Swipe program remained alcohol free in the two weeks following the training, compared to 43 percent of the sham program users, an 11-point difference, large enough for statistical reliability. Among trial participants who completed all four training sessions and the follow-up session, the difference is 17 points.

Turning Point created the Swipe smartphone app as a tool to reduce day-to-day alcohol dependence, and is currently conducting a field study of the app’s feasibility, enrolling 500 people in Australia concerned about their alcohol consumption. Manning notes that “having low-cost, widely-available, evidence-based interventions available outside of traditional treatment settings will mean more people have access to anonymous and convenient, easy to use support tools when they most need them.”

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