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The Effect of Smartphone-Delivered Approach Bias Modification Training on Relapse Among Patients Leaving Residential
Joshua B B Garfield1,2, Danielle Whelan1,2, Hugh Piercy1,2
1Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.
Purpose:
Approach bias modification (ApBM), a cognitive training intervention that reduces "alcohol approach bias" (impulses to approach alcohol-related stimuli), reduces post-treatment relapse rates when delivered during residential alcohol use disorder (AUD) treatment. However, few residential treatment services provide ApBM to their clients. Smartphone app-delivered ApBM may circumvent barriers to implementation within services by allowing clients to self-administer ApBM after discharge instead. This double-blind RCT tested whether providing a personalised ApBM smartphone app to people discharging from residential AUD treatment increased alcohol abstinence rates.
Participants And Methods:
Participants were recruited while attending residential AUD treatment programs. 171 participants were sent app download instructions following discharge, of whom 134 installed it (61 receiving the ApBM version; 73 sham-training controls), providing only 39% power for primary outcome analysis. App notifications reminded participants to complete training tasks each week for 4 weeks. Alcohol use and other secondary outcomes were measured post-intervention and at 1-month, 3-month, and 6-month follow-ups. The primary outcome was past-month abstinence from alcohol at the 3-month follow-up.
Results:
Abstinence rates at 3-month follow-up were 55% [95% CI: 40%, 70%] in controls and 52% [95% CI: 36%, 67%] in ApBM participants. This difference was non-significant (contrast: -3% [95% CI: -25%, 18%], p = 0.758). All secondary outcomes analyses also found non-significant effects of group. Exploratory post-hoc analyses suggested that duration of residential treatment and number of ApBM sessions completed may moderate ApBM's effects on abstinence.
Conclusion:
Findings did not support the efficacy of post-discharge, personalised, app-delivered ApBM for relapse prevention in residential AUD treatment clients. These findings should be treated with caution due to this trial's low statistical power. Exploratory analyses suggest that future trials may be more likely to find evidence of efficacy for this approach if they focus on clients with shorter admissions and deliver a more sustained, structured ApBM intervention.
