This study will explore the feasibility, acceptability, and preliminary effectiveness of a smart phone delivered form of cognitive training intervention (Approach Bias Modification (ABM)) in a non-clinical community sample of middle to older adults (\>55 years) reporting hazardous alcohol use in a pilot randomised controlled trial (RCT). This app is called AAT-APP+
Alcohol use in older adults is of particular concern, with the 55-74 year old cohort most likely to exceed lifetime alcohol risk. Approach Bias Modification (ABM) is a form of computerised cognitive training that is an efficacious intervention for alcohol use disorder. Previous studies are limited in that the stimuli are not personalised, nor are interventions readily accessible to non-treatment seeking problem drinkers. This has led to the development of a world-first, smart phone version of ABM called AAT-APP+ The current study aims to explore the feasibility, acceptability, and preliminary effectiveness of AAT-APP+ in reducing alcohol consumption and cravings in a pilot RCT with a non-clinical community sample of 100 older adults (aged 55+ years) reporting hazardous alcohol use (i.e. a score of 8+ on the AUDIT), recruited via targeted advertising. Participants in active training will upload (or select pre-selected) photos of beverages and meaningful activities, which will form the 'avoid' and 'approach' stimuli, respectively, then complete two training sessions per week for four weeks, with results compared to controls. AAT-APP+ holds promise as an innovate, cost-effective, and remotely accessible adjunctive support tool.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
188
Participants allocated to the intervention group will be required to upload photos of drinks they wish to avoid, as well as activities they wish to engage in more, and be trained to avoid and approach by repeatedly 'swiping' images away from and towards themselves, respectively.
Complete an AAT on a weekly basis for four weeks
Turning Point
Richmond, Victoria, Australia
Change in number of standard drinks past week
Change from baseline in number of standard drinks at 4-weeks
Time frame: Change from baseline standard drinks at 4-weeks
Change in number of drinking days past week
Change from baseline in number of drinking days at 4-weeks
Time frame: Change from baseline drinking days at 4-weeks
Change in number of standard drinks consumed in the past week throughout the 4-week training program
Change from baseline in number of standard drinks at the end of each week of training (i.e. week 1, week 2, week 3)
Time frame: Change from baseline standard drinks consumed in the week prior to training compared to each week of training (i.e. week 1, week 2, week 3).
Change in number of drinking days past week throughout the 4-week training program
Change from baseline in the number of drinking days at the end of each week of training (i.e. week 1, week 2, week 3)
Time frame: Change from baseline number of drinking days in the week prior to training compared to each week of training (i.e. week 1, week 2, week 3).
Change in number of drinking days at follow up
Change from baseline in the number of drinking days at 8-weeks
Time frame: Change from baseline number of drinking days at 8-weeks
Craving Frequency Score (as measured by the Craving Experience Questionnaire, Frequency)
Change from baseline craving, as measured by the Craving Experience Questionnaire, at 4-weeks. The Craving Experience Questionnaire - frequency consists of an 11-point visual analogue scale, anchored 0 = not at all, to 10 = extremely/constantly, assessing craving frequency, whereby higher scores are suggestive of greater craving frequency
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Time frame: Change from baseline craving frequency at 4-weeks
Craving Frequency Score (as measured by the Craving Experience Questionnaire, Frequency, Follow up)
Change from baseline craving, as measured by the Craving Experience Questionnaire, at 8-weeks. The Craving Experience Questionnaire - frequency consists of an 11-point visual analogue scale, anchored 0 = not at all, to 10 = extremely/constantly, assessing craving frequency, whereby higher scores are suggestive of greater craving frequency
Time frame: Change from baseline craving frequency at 8-weeks
Approach-avoidance behaviours (alcohol approach avoidance questionnaire)
Change from baseline in self-report of approach and avoidance towards alcohol, as measured by the alcohol approach avoidance questionnaire, at 4-weeks. This is a 20-item self report measure with two primary dimensions of alcohol craving (i.e. approach and avoidance), where higher scores are suggestive of greater approach or avoidance behaviours (rated on a 9-point scale, 0 = not at all, 8 = very strongly).
Time frame: Change from baseline approach-avoidance behaviours at 4-weeks
Approach-avoidance behaviours (alcohol approach avoidance questionnaire) at follow up
Change from baseline in self-report of approach and avoidance towards alcohol, as measured by the alcohol approach avoidance questionnaire, at 8-weeks. This is a 20-item self report measure with two primary dimensions of alcohol craving (i.e. approach and avoidance), where higher scores are suggestive of greater approach or avoidance behaviours (rated on a 9-point scale, 0 = not at all, 8 = very strongly).
Time frame: Change from baseline approach-avoidance behaviours at 8-weeks
Approach-avoidance behaviours (approach avoidance task)
Change in alcohol approach/avoidance behaviours from baseline at 4-weeks, as calculated by(\[reaction time for pushing alcohol stimuli\] - \[reaction time for pulling alcohol related stimuli\]) - (\[reaction time for pushing neutral objects\] - \[reaction time for pulling neutral objects\]). Higher positive values indicate a tendency to approach alcohol faster (i.e. faster reaction times for pulling as opposed to pushing), whereas negative values indicate a tendency to avoid alcohol (i.e. slower reactions times for pulling compared to pushing alcohol).
Time frame: Change in alcohol approach/avoidance from baseline at 4-weeks
Change in quality of life, as measured by the Australian Treatment Outcomes Profile Questionnaire
Change in self report of quality of life from baseline, as measured by the quality of life items from the Australian Treatment Outcomes Profile, at 4-weeks. This is a score ranging from 0-10, whereby higher scores are indicative of greater quality of life.
Time frame: Change in quality of life from baseline at 4-weeks
Change in quality of life, as measured by the Australian Treatment Outcomes Profile Questionnaire at follow up
Change in self report of quality of life from baseline, as measured by the quality of life items from the Australian Treatment Outcomes Profile, at 8-weeks. This is a score ranging from 0-10, whereby higher scores are indicative of greater quality of life.
Time frame: Change in quality of life from baseline at 8-weeks
Change in subjective cognitive concerns
Change from baseline in subjective ratings of cognitive concerns, as measured by responses to the question "How concerned are you about changes in your thinking, attention, or memory skills", at 4 weeks. Participants will respond on a 5-point visual analogue scale ranging from 0 = not at all to 5 = extremely concerned, whereby higher scores indicate a greater degree of concern in relation to cognition
Time frame: Change from baseline in subjective cognitive concerns at 4-weeks
Change in subjective cognitive concerns at follow up
Change from baseline in subjective ratings of cognitive concerns, as measured by responses to the question "How concerned are you about changes in your thinking, attention, or memory skills", at 8 weeks. Participants will respond on a 5-point visual analogue scale ranging from 0 = not at all to 5 = extremely concerned, whereby higher scores indicate a greater degree of concern in relation to cognition
Time frame: Change from baseline in subjective cognitive concerns at 8-weeks
Change in number of standard drinks at follow up
Change from baseline in number of drinking days at 8 weeks
Time frame: Change from baseline in number of drinking days at 8 weeks
Change in severity of alcohol dependence, as measured by the Severity of Dependence Scale
Change from baseline in severity of alcohol dependence, as measured by the Severity of Dependence Scale, at 4 weeks. Participants respond to five items on a 4-point scale (each scored from 0-3), with total scores ranging from 0-15 where higher scores indicate greater severity of alcohol dependence.
Time frame: Change in severity of alcohol dependence at 4-weeks
Change in severity of alcohol dependence (SDS) at follow up
Change from baseline in severity of alcohol dependence, as measured by the Severity of Dependence Scale, at 8-weeks. Participants respond to five items on a 4-point scale (each scored from 0-3), with total scores ranging from 0-15 where higher scores indicate greater severity of alcohol dependence.
Time frame: Change in severity of alcohol dependence at 8-weeks