JMIR Publications

ABSTRACT

Background:

Alcohol use is associated with the automatic tendency to approach alcohol, with the retraining of this tendency (cognitive bias modification, CBM) showing therapeutic promise in clinical settings. To improve access to the training and to enhance participants’ engagement, a mobile version of the Alcohol Avoidance Training was developed.

Objective:

The aims of this pilot study were to assess 1) adherence to the m-health application, 2) changes in weekly alcohol use from pre to post training and 3) user experience with regard to the m-health application.

Methods:

A self-selected, non-clinical sample of 1082 participants, experiencing problems associated with alcohol, signed up to use the Alcohol Avoidance Training app, Breindebaas, for three weeks with at least 2 training sessions per week. Each training session consisted of a total of one hundred pictures: 50 of alcoholic beverages, and 50 of non-alcoholic beverages were presented consecutively in a random order, in the center of the touchscreen. Alcoholic beverages were swiped upwards (away from the body), whereas the non-alcoholic beverages were swiped downwards (towards the body). During approach responses, the picture size increased to mimic an approach movement, and conversely picture size decreased during avoidance responses to mimic avoidance. At baseline we assessed sociodemographic characteristics, alcohol consumption, alcohol-related problems, use of other substances, self-efficacy and craving. After three weeks, 410 (38%) participants (post-test responders) completed an online questionnaire evaluating adherence, alcohol consumption and user satisfaction. Three months later, 206 (19%) participants (follow-up responders) filled in a follow-up questionnaire examining adherence and alcohol consumption.

Results:

The 410 post-test responders were older, more commonly female and higher educated than post-test dropouts. Of those who completed the study, 79% were considered adherent having completed 4 or more sessions, while 58% performed the advised 6 training sessions or more. The study showed a significant reduction in alcohol consumption of 7.8 units per week after three weeks (95%CI [6.2,9.4]; P<.001; n=410) and another reduction of 6.2 units at three months for the follow-up responders (95%CI [3.7,8.7]; P<.001; n=206). Post-test responders expressed positive feedback regarding the fast working, simple and user-friendly design of the app. Almost half of the post-test responders reported to have gained more control over their alcohol use. The repetitious and non-personalized nature of the intervention were suggested as points for improvement.

Conclusions:

The current study was one of the first to employ the Alcohol Avoidance Training as a mobile application for problem drinkers. Preliminary findings suggest that a mobile CBM app fulfils a need for problem drinkers and may contribute to a reduction in alcohol use. Replicating these findings in a controlled study is warranted.