Your team is counting on you: Digital gamification and team motivation in alcohol aftercare

Relapse after inpatient treatment for alcohol dependence is frequent, particularly within the first three months post-discharge. Cognitive Bias Modification (CBM), and specifically alcohol Approach Bias Modification (ABM), has demonstrated benefits in inpatient care, but its efficacy for aftercare remains uncertain.

A two-phase research program was conducted. The pilot study tested the feasibility of a desktop-based, home-delivered ABM. A total of 308 patients were randomized into two intervention groups, differing in reminder intensity, or a control group without any intervention. The main study built on these findings by developing a smartphone-based, gamified ABM using an active control design. A total of 273 active app users were randomized to training or control, and participants were instructed to use the app as often as they liked over a three month period. Gamification features included team competitions, rewards, and peer interaction to enhance engagement.

In the pilot study, adherence proved low (mean 7.7 sessions out of 25 instructed sessions), and reminders did not improve participation. No group-level differences in abstinence were observed. In the main study, engagement was markedly higher: participants completed on average 57 sessions, and nearly half reached the adherence threshold of ≥25 sessions. Among those meeting this threshold, the ABM group achieved significantly higher abstinence rates at one-year follow-up compared to active controls. Feedback indicated general satisfaction, willingness to continue use, and offered suggestions for further app refinement.

Gamification and mobile delivery improved adherence, and sufficient engagement with ABM produced specific and clinically meaningful aftercare benefits at one-year follow-up.