Chess-based cognitive remediation training and alcohol cue reactivity in alcohol use disorder: exploratory evidence for supplementary motor area activation changes

Background Cue-induced craving is a key driver of relapse in alcohol use disorder (AUD), yet standard inpatient treatments do not directly target the neurocognitive control deficits underlying it. Chess-based cognitive remediation training (CB-CRT) is a manualised group intervention engaging working memory, attention, and inhibitory control. This exploratory study examined whether CB-CRT modulates neural cue reactivity in AUD. Methods In this study ( ClinicalTrials.gov : NCT04057534), 41 abstinent inpatients with AUD were quasi-randomised to treatment as usual (TAU; n = 16) or TAU plus CB-CRT ( n = 25) over 6 weeks at a rehabilitation center. Neural responses to alcohol-related cues were assessed with a validated cue reactivity paradigm before and after the intervention period (T1, T2); the primary endpoint was the change in BOLD activation (Alcohol > Rest). Craving (Obsessive Compulsive Drinking Scale, OCDS; Alcohol Urge Questionnaire, AUQ) and depressive symptoms (Beck Depression Inventory II, BDI) were assessed and correlated with neural changes. Results Whole-brain analysis revealed a significant Time × Group interaction in the supplementary motor area (SMA; peak MNI −2, 4, 80; k = 544; cluster-level p FWE = 0.025), with increased SMA activation in CB-CRT + TAU and a decrease in TAU. Within CB-CRT + TAU, change in SMA activation correlated positively with change in obsessive-compulsive craving (OCDS total: r = 0.439, p = 0.032; cognitive subscale: r = 0.453, p = 0.026). The CB-CRT + TAU showed significant within-group reductions in BDI and OCDS; the between-group comparison of change scores before baseline adjustment reached significance for BDI only ( d = −0.80), which was no longer significant after adjustment. Conclusion These exploratory findings indicate differential longitudinal SMA activation between groups during alcohol-cue viewing relative to rest. CB-CRT might have additional effect against depressive symptoms, though this finding was affected by baseline severity and requires further validation. Clinical trial registration ClinicalTrials.gov , identifier NCT04057534.