Australian researchers have developed a smartphone app that could not only help people recovering from alcohol use disorder to avoid relapsing but also support those who engage in harmful drinking to reduce or avoid alcohol consumption altogether.

The app uses cognitive bias modification, which aims to desensitize people to alcohol cues and retrain the reward system in the brain to seek healthier alternatives.

Cognitive bias modification, also known as approach bias modification, has been used in alcohol treatment for some time, Victoria Manning, PhD, professor in addiction studies at Monash University in Melbourne, told Medscape News Australia.

In residential rehabilitation settings, a 15-minute laptop-based cognitive bias modification program had been used during the acute withdrawal phase, in which patients would use a joystick to push away images of alcoholic drinks so they would become smaller on the screen. Patients would pull images of nonalcoholic stimuli, including soft drinks or juice, toward them.

The approach desensitized users to alcohol cues and reduced the impulse to drink when exposed to those cues. “It’s essentially, at a subconscious level, making that avoidance response associated with that alcohol cue and that approach-response associated with that nonalcohol cue,” said Manning.

Reductions in Drinking Days

She became interested in whether that inpatient intervention could be adapted for the outpatient setting or for daily life. “It’s pretty limited to that treatment-seeking residential population,” Manning said. “If we can get it in a phone, it’s obviously then available 24/7, and people can do the training wherever and whenever they want.”

She also wanted to personalize the alcoholic and nonalcoholic reward stimuli to better reflect individual preferences. “You might only drink wine, and being trained to implicitly or to automatically avoid beer might not be as effective as being trained to avoid wine,” Manning said. “If we also replace the soft drinks with photos of their kids or photos of something they’re saving up for (or a holiday) or a sport, or healthy food, that can reinforce their motivations for drinking less in the first place.”

The result of Manning’s efforts was SWiPE, an alcohol avoidance training app. In an open-label study involving 1309 patients who met the criteria for hazardous drinking, Manning and colleagues found that participants who completed at least two 3-minute sessions per week on the app for 4 weeks had significant reductions in the number of drinking days per week and the number of standard drinks consumed per week (from a mean of around 32 to 24).

The group has since received funding to conduct a larger randomized controlled trial, using a sham version of the app or no app use as controls. The results of that trial, which are under review, point to significant reductions in standard drinks consumed per week and in heavy-drinking days, said Manning.

Responses Differ by Gender

In a qualitative study, researchers found that participants approached the app in various ways. Some used it when they were experiencing cravings, while others had a more structured approach.

“Some people thought that they needed to do it first thing in the morning, and then they’re protected for the day,” Manning said. “Others said, ‘I like to do it during the witching hour or when I know I’m going to leave work and walk past a bar and want to go in for a pint.’”

The qualitative studies also picked up an interesting gender difference; men were more responsive to the gamified aspect of the app, which gives users a score for speed and accuracy. “They were so into beating their score,” Manning said. “Women were more likely to say it was boring and monotonous, but they could see that it was doing something that aligned with their treatment.”

Clinical and forensic psychologist Lynne Magor-Blatch, PhD, based in Queensland, said that alcohol treatment services are always concerned about how patients fare once they leave a residential program and that there was real value in having another tool in the toolbox. “It should be introduced while the person is still in treatment, rather than having them pick it up by choice afterwards, because it needs to be seen as part of continuing care rather than aftercare,” Magor-Blatch told Medscape News Australia.

Desensitization plays an important role in recovery, particularly for patients with trauma, she added. “Particularly with the populations we see coming through treatment…you’re working with the pointy end of people who have those definite dependencies, they have significant trauma histories as well.”

The studies were supported by the Australian National Health and Medical Research Council and Turning Point. Manning and Magor-Blatch reported no relevant financial relationships.