There's growing evidence that a new smartphone-delivered "approach bias modification" app is a valuable tool for treating alcohol dependence.

That's why researchers are turning their attention to how people experience and engage with this type of intervention.

“While our understanding continues to grow of how and in what settings the intervention works, we know less about how people interact with and interpret the app,” explains Professor Victoria Manning, Turning Point’s Head of Research and Workforce Development, and Professor in Addiction Studies, Monash University.

To address this gap, the researchers' new study, published in Addiction Science and Clinical Practice, employs an “evidence-making intervention” approach to examine what works, for whom, and in what contexts when using the app alongside other treatments for alcohol dependence.

The result?

“By examining the narratives of participants, we now have a better understanding of diverse experiences of the app in real-world treatment contexts for alcohol dependence,” Prof Manning explains.

What is approach bias modification?

Approach Bias Modification is a cognitive training task delivered via a smartphone app. It aims to reduce automatic, impulsive responses to alcohol-related cues.

It is already recommended as a supplementary intervention during residential treatment for alcohol dependence and is showing promising results for outpatient care.

Sessions are completed twice a week for 4 weeks and involve a gamified ‘swiping’ task that aims to retrain automatic impulses that drive people to drink alcohol.

During each session, participants practice avoiding, by ‘swiping away’ personalised images of alcohol that they tend to consume. They also pull towards themselves positive, goal‑aligned images that they’ve selected.

As one participant reflected, the app has the potential to change our relationship with alcohol:

“it makes you think, well, no, real life is the priority thing, and drinking is a secondary thing, so to speak. So, in that context, it tries to break that cycle … It sort of helped – the app, or just the whole process … made me think, well there’s other, more important priorities.”

Useful when part of a daily routine

One of the clearest themes was how easily the app fits into daily life. “Many participants incorporated the app into their daily schedules, predominantly in the morning or evening,” Prof Manning says.

Some used it at night to reflect on their day. Others used it when they anticipated thinking about drinking, felt concerned about their use or expected cravings to arise.

Recognising how its frequent and repetitive nature could reinforce positive changes, participants likened it to building a routine or positive habit.

“We’d expected people to use the app to counter or modify drinking habits,” Prof Manning explains. “We didn’t expect that people would use it to generate new recovery-oriented habits.”

As these participants explain:

“I found that when I was looking at the pictures of the alcohol, it wasn’t actually making me want to drink alcohol, but when I was looking at the positive images that I had chosen, it was making me want to go and participate in those positive experiences.”

“[The app] trains your mind to actually understand that there’s a difference between how much you drink and how much you should enjoy life and the options there. So providing alternatives to actually having a drink by actually using different images that shows you either doing sport or being out and about.”

Women and men responded differently to gamified elements

The study also uncovered some interesting gender differences.

Some men focused on gamification elements. For these participants, scoring, speed and beating their previous scores were more important than the app’s therapeutic purpose.

In contrast, female participants more often commented on its repetitive nature, sometimes finding it boring and monotonous.

“In future iterations, we will apply these insights to consider gendered engagement styles to maximise engagement and ultimately the effectiveness of training,” Prof Manning says.

A complement to other addiction treatment and supports

Participants consistently described the app as a useful complement to concurrent treatments, such as counselling. They saw it as a “tool in a toolbox”, helping them manage cravings, retrain subconscious biases and stay connected to their recovery goals.

“Integrating this low-cost and easy-to-use intervention into clinical care has the potential to increase engagement and improve treatment outcomes overall,” Prof Manning says.

What next?

Future studies will also explore how user‑experience factors – such as perceived usefulness, boredom or sense of reward – predict actual engagement and outcomes.

“We want to understand in future trials whether different engagement styles, such as treating the app like a competitive game versus a therapeutic tool, influence its effectiveness,” Prof Manning says.

“These findings highlight the importance of co‑design when developing future approach bias modification apps,” she adds.

“Rather than functioning as a single tool, the app can serve different purposes depending on how people choose to use it.”

Read the paper: “A tool in a toolbox”: patient engagement with a gamified and personalised approach bias modification app to reduce harmful alcohol consumption – a qualitative study

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