Background and Aims: Several randomised controlled trials (RCTs) have demonstrated that delivering approach bias modification (ApBM) during residential alcohol use disorder (AUD) treatment reduces likelihood of post-treatment relapse. However, few studies have examined ApBM′s efficacy for AUD in outpatient settings. We trialled a personalised ApBM smartphone app in individuals receiving outpatient treatment for AUD. Design: We conducted a double-blind RCT. Participants were randomised to receive treatment as usual (TAU) + ApBM or TAU + sham training over a 4-week intervention period. Setting: Participants were recruited from alcohol and other drug treatment services in Melbourne, Australia. Participants: 79 participants (mean age 46.6 years; 45 male, 34 female) installed the app between May 26, 2022 and January 23, 2024. Intervention and Comparator: In the ApBM condition, the app delivered personalised, gamified ApBM. Participants were prompted by notifications to complete at least 2 sessions of ApBM per week for 4 weeks. The Control version prompted participants to complete a weekly sham-training task for 4 weeks. Measurements: Participants self-reported past-week alcohol use via the app at baseline and 4, 8, and 16 weeks after installing the app. We used these data to derive number of standard drinks (defined as 10 grams pure alcohol) consumed (primary outcome), past-week drinking days, and past-week heavy drinking days (days when >5 standard drinks were consumed). Participants also completed questionnaire measures of AUD severity, quality of life, and alcohol craving. Findings: We found a significant time x group interaction for the primary outcome (coefficient: -1.11, 95% CI: [-2.08, 0-.13]; z(78) = -2.22; p=.03,). Past-week standard drinks declined significantly in ApBM participants (reducing by 55% between baseline and the final follow-up), but not controls (non-significant 11% reduction). Time x group interaction effects were non-significant for all secondary outcomes. Conclusions: Personalised smartphone ApBM may help reduce alcohol consumption in AUD outpatients.

The authors have declared no competing interest.

NCT05120856

This study was funded by Alcohol and Drug Research Innovation Agenda (ADRIA), The Victorian Alcohol and Drug Association (VAADA). ADRIA/VAADA played no role in study design or in collection, management, analysis, interpretation, or publication of data.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved by the St Vincent′s Hospital Melbourne Human Research Ethics Committee (HREC)(268/21) and the Monash University HREC (project number: 31260)

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