Accepted for/Published in: JMIR Formative Research
Date Submitted: Aug 25, 2022
Date Accepted: Sep 28, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effectiveness of the serious game SALIENCE in reducing craving and approach avoidance bias in alcohol use disorder: a randomized controlled trial
ABSTRACT
Background:
Alcohol use disorder has become a major global health problem. Therapy of this disease is still a great challenge. Recently, it has become increasingly evident that computer-based training is a valuable addition to the treatment of addictive disorders.
Objective:
This study aims to evaluate the web-based serious game “SALIENCE” as an add-on therapy for alcohol use disorder. It combines the cue-exposure therapy approach with elements of decision-making training, enhanced by virtual reality. The effects of SALIENCE training on levels of craving, attention, and cognitive bias are investigated.
Methods:
In a randomized controlled trial, 49 individuals with AUD (mean age 44.04 years; 34.7 % females) undergoing three weeks of extended alcohol detoxification program were investigated. Participants answered questionnaires related to alcohol consumption and craving, and completed neuropsychological tasks at the beginning of the study and two weeks after to evaluate levels of attention and cognitive biases. During the two-week period, 27 of the participants additionally performed the SALIENCE training for 30 minutes three times a week with a total amount of six sessions.
Results:
We observed a significant decrease in both groups in craving (F (1.00, 47.00) = 4.31; p = .043), attention (F (1.00, 47.00) = 79.20; p = <.001) and alcohol approach bias (F (1.00, 47.00) = 5.11; p = .028). Additionally, there was a significantly greater decrease in craving (β = 4.12; t (36) = 2.34; p =.025) and alcohol approach bias (β = 580.81; t (36) = 2.62; p =.013) with the SALIENCE intervention. Especially participants with lower drinking in negative situations reduced their craving (β = 0.38; t (36) = 3.01; p =.005) and their alcohol approach bias (β = 43.98; t (36) = 2.77; p =.009) more than people with higher drinking in negative situations.
Conclusions:
Besides a general decrease in craving, attention, and alcohol approach bias in both groups across the study period, SALIENCE training as add-on therapy resulted in a larger reduction in craving and alcohol approach bias than without. Notably, individuals who rarely consume alcohol due to negative affect profited the most from SALIENCE training. In addition to the beneficial effect of SALIENCE training, these findings highlight the relevance of individualized therapy for AUD, adapted to personal circumstances such as drinking motivation. Clinical Trial: ClinicalTrials.gov NCT03765476; https://clinicaltrials.gov/show/ NCT03765476
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