Developing a Digital Therapeutic for Alcohol Reduction – a Pilot Study of Curb, an App for People Who Want to Change Their Relationship With alcohol

Abstract

Aims 1.Evaluate user engagement. 2.Evaluate safety. 3.Evaluate efficacy. a.To reduce drinking. b.To address comorbid symptoms of anxiety and depression. Methods Study Population Participants applied via social media, identifying as individuals seeking to change relationships with alcohol. Inclusion criteria: Aged >18, Alcohol Use Disorder Identification Test (AUDIT) score of 8–16, no history of withdrawal symptoms, or AUDIT score 16–20 but already abstinent for >14 days. Participants who had already been abstinent for >30 days excluded. The Programme Participants given unlimited access to Alma mobile application (app) for 4 weeks. Programme consisted of daily pledge to cut down drinking, drink diary to record alcohol use, weekly feedback on Generalised Anxiety Disorder-7 (GAD-7) scores and Patient Health Questionnaire-9 (PHQ-9) depression scores, unlimited access to mindfulness videos to manage cravings. Statistical analysis Mixed-effects linear regression used for analysis. Results 57 people volunteered for pilot study. 31 eligible to participate. Engagement Progressive weeks of programme showed attrition in user numbers. By end of 4-week programme, 77% (24/31) remained, 58% (18/31) submitted all data. Safety All participants asked if they had experienced no harm or distress from using app. 25 participants answered, 100% (25/25) responded “no”. Efficacy Self-reported capability to reduce drinking significantly increased over time (mean increase from baseline +0.3; p = 0.007). At week 4, 8/17 (47.1%) said that Alma had helped them cut down drinking a lot, and a further 8/17 (47.1%) said it helped them cut down a bit. There was a trend for units drunk on the heaviest drinking day to reduce over time (−0.48 units) and total weekly consumption of units to reduce (−1.01 units), however not statistically significant. There was no trend for drinking days per week to reduce over time. There was a significant reduction in PHQ-9 scores over time (−1.03; p < 0.001) and significant reduction in GAD-7 scores (−0.69; p < 0.001). A total of 22/24 (92%) respondents said they would recommend Alma to friends and family, 1/24 (4%) would not. Conclusion •Relatively high engagement with Alma compared with similar digital products. •Pilot study suggests Alma is acceptable, safe and shows potential efficacy in helping reduce alcohol intake and comorbid anxiety/depression, however interpretation limited by small sample size. •Next steps will be to widen user-base to facilitate larger studies, and gain further insights into factors influencing relapses by studying associations with health-related data from wearable devices and other user inputs.