Accepted for/Published in: JMIR Formative Research
Date Submitted: Dec 3, 2025
Date Accepted: Aug 24, 2026
A Problem-Solving Therapy with Apple Watch Support for College Students with Alcohol Use Disorder Symptoms: Pilot Randomized Controlled Trial
ABSTRACT
Background:
Background:
Alcohol Use Disorder (AUD) involves impaired ability to stop or control alcohol use despite adverse consequences and represents a major public health problem. While AUD is the most prevalent in college students, integrated evidence-based treatments for this population are lacking.
Objective:
Objectives: The objective of our study was to test the feasibility and acceptability of a newly developed behavioral intervention, Problem-Solving Therapy and Apple Watch (PST-APPLE) and to preliminarily investigate the effectiveness of PST-APPLE among college students with symptoms of AUD.
Methods:
Methods:
Participants were recruited through online advertisement and on campus at the universities in the Chicago area between May and September 2024. They were randomized in a 1:1 ratio using block randomization to intervention (PST-APPLE: 12 individuals) or control group (education only: 14 individuals), with the data analyst blinded to treatment assignment. Participants in the intervention group completed 12 weeks of PST-APPLE intervention, delivered remotely via Zoom videoconferences and interactions with Apple Watch. Participants in the control group were asked to watch a 20-min abstinence motivation video, then participated in a 30-minute group discussion via Zoom. All participants completed follow-up assessments at 3 months. Outcome included alcohol related problems (AUDIT and RAPI), and drinking motivation (DMQR).
Results:
Results:
We enrolled 26 participants aged 18-25. The mean age was 22.5 years (SD = 2.20). We found reduced scores between pre- and post-intervention measures in the intervention group, by paired t-tests and baseline-adjusted ANCOVA analyses, including reduced alcohol misuse and problems (AUDIT and RAPI scores) and reduced Drinking Motives Questionnaire Revised (DMQR) social and coping motivations scores. Compared with the control group, the intervention group showed a reduction in alcohol use (AUDIT; -4.70, 95% CI -8.69, -0.70; p = .023) and DMQR social (-0.85, 95% CI -1.51, -0.18; p = .015) and coping motivations scores (-0.75, 95% CI -1.47, -0.04; p = .039).
Conclusions:
Conclusions:
Our study findings indicate that PST-APPLE intervention is feasible, acceptable, and shows hypothesis-generating among college students with AUD. While findings are promising, this pilot study was not powered for definitive efficacy testing. A fully powered randomized controlled trial is needed to confirm these effects. Future studies could translate PST-APPLE to other wrist-worn electronic devices/watches that capture physiological data (e.g., Fitbit, Samsung Galaxy Watch), to increase reach and scalability, particularly among younger adults and digitally literate populations. Clinical Trial: This Pilot Study is registered at ClinicalTrials.gov # NCT06333288.
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