Your team is counting on you: Digital gamification and team motivation in alcohol aftercare

BACKGROUND: Relapse after inpatient treatment for alcohol dependence is frequent, particularly within the first three months post-discharge. Cognitive Bias Modification (CBM), and specifically alcohol Approach Bias Modification (ABM), has demonstrated benefits in inpatient care, but its efficacy for aftercare remains uncertain. METHODS: A two-phase research program was conducted. The pilot study tested the feasibility of a desktop-based, home-delivered ABM. A total of 308 patients were randomized into two intervention groups, differing in reminder intensity, or a control group without any intervention. The main study built on these findings by developing a smartphone-based, gamified ABM using an active control design. A total of 273 active app users were randomized to training or control, and participants were instructed to use the app as often as they liked over a three month period. Gamification features included team competitions, rewards, and peer interaction to enhance engagement. RESULTS: In the pilot study, adherence proved low (mean 7.7 sessions out of 25 instructed sessions), and reminders did not improve participation. No group-level differences in abstinence were observed. In the main study, engagement was markedly higher: participants completed on average 57 sessions, and nearly half reached the adherence threshold of ≥25 sessions. Among those meeting this threshold, the ABM group achieved significantly higher abstinence rates at one-year follow-up compared to active controls. Feedback indicated general satisfaction, willingness to continue use, and offered suggestions for further app refinement. CONCLUSIONS: Gamification and mobile delivery improved adherence, and sufficient engagement with ABM produced specific and clinically meaningful aftercare benefits at one-year follow-up.