CLINICAL EFFECTIVITY OF DIGITAL THERAPEUTICS BASED COGNITIVE BEHAVIORAL TREATMENT FOR THE IMPROVEMENT OF ALCOHOL USE DISORDER IN KOREANS : FOCUSED ON EXPLORATORY CLINICAL STUDY
Authors: Jo *Yeong Seon , Chun Ji-Won , Pyeon Arom , Hu Min Kyung , Kim Dai Jin 
Published: February 2025

Abstract

Background
Recently, the growth of the digital healthcare service market is accelerating. The need to utilize digital software programs in the field of behavioral modification and chronic diseases is especially being emphasized (Digital Therapeutics Alliance, 2018). In South Korea, drinking is the number one disease burden factor. Also, the prevalence of alcohol use disorder (AUD) and the rate of drunk driving accidents are the highest among the OECD countries (Korea Health Promotion Institute, 2022). In particular, due to the influence of COVID-19, alcohol-related deaths exceeded 10 per 100,000 people for the first time in 2020 which highlights that alcohol use (AU) is a serious social problem (Korea Health Promotion Institute, 2022). Cognitive behavioral therapy (CBT) is an effective evidence-based treatment for AUD, one of the representative chronic diseases (Magill et al., 2019). To improve the AU problem, a CBT-based 12-week digital program, combination of mobile application and virtual reality, was developed.

Objectives
The safety and effectiveness of CBT-based DTx, targeted toward patients with AUD, were verified in this exploratory clinical study.

Method
In this study, the CBT-based DTx was designed to improve awareness of cravings and behavioral processes by identifying the situations and emotions that trigger AU. Furthermore, there was included training content to correct dysfunctional and irrational thinking patterns for AU and to cope with trigger factors. In addition, Motivational Enhancement Therapy (MET) was used to enhance the therapeutic effect by promoting changes in AU behavior with consideration of user’ s motivation. From January to September 2022, an exploratory clinical study was conducted to provide 12 weeks of treatment to improve addiction in 30 patients diagnosed with AUD. The subjects who were qualified to the screening assessment were randomly assigned to either the ‘digital therapy group (DTG)’ or the ‘basic therapy group (BTG)’. DTG had digital therapy that provides digital content education through mobile application and virtual reality. Meanwhile, BTG got basic treatment which provides both written and video educational materials. At the time of 12th week, abstinence from alcohol drinking cessation and average daily alcohol consumption were evaluated.

Results
In the 12th week, the effect of abstinence from alcohol drinking cessation was higher in the DTG, utilizing the digital therapeutics, compared to the BTG. The DTG showed a 40% abstinence rate in the 12th week, and the BTG showed a 20% abstinence rate. In addition, the average alcohol consumption per day was 2.7 drinks in the DTG and 4.3 drinks in the BTG which shows a low level of AU in the DTG.

Conclusion
Since the COVID-19 pandemic, in-patient treatment for AUD has been continuously decreasing, and psychosocial services for alcoholics are insufficient compared to other diseases. DTX is an alternative treatment that can overcome the practical limitations of existing addiction treatments. The results of this study suggest the potential of improving clinical effectiveness by supplementing drug and outpatient treatment. The CBT-based DTx will increase accessibility to alcoholism treatment and can contribute to the growth of patient-centered participatory medicine. Also, healthcare workers could monitor the patient's daily condition and reflect DTx in the treatment plan.

References
1.Korea Health Promotion Institute, 2022. 2022 Alcohol Harm Prevention Day: Forum for a Society Without Alcohol Harm. Korea Health Promotion Institute Korea Health Promotion Institute (KHPI).
2.Magill, M., Ray, L., Kiluk, B., Hoadley, A., Bernstein, M., Tonigan, J.S. and Carroll, K., 2019. A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: Treatment efficacy by contrast condition. Journal of consulting and clinical psychology, 87(12), p.1093.
3.Digital Therapeutics Alliance, 2018. Digital Therapeutics: Combining technology and evidence-based medicine to transform personalized patient care. Digital Therapeutics Alliance. (Retrieved from http://www.dtxalliance.org)