Further Considerations on the MyWayUp Digital Intervention for Alcohol Use Disorder in Alcohol‐Related Liver Disease

We read with great interest the randomised controlled trial by Oliveras et al. evaluating MyWayUp, a serious game-based digital intervention, to improve treatment retention for alcohol use disorder (AUD) in patients with alcohol-related liver disease (ArLD) [1]. The study presents a promising integrated care strategy for this underserved population. However, several aspects warrant further discussion to optimise future research and clinical translation. First, the sample representativeness and generalizability require careful consideration. The trial was conducted in two Spanish tertiary hospitals, with a mean patient age of 55.5 years and nearly half having a basic or lower education level. This limits the extrapolation of results to younger, more digitally native, or higher-educated populations. The utility of digital interventions can be significantly modulated by digital literacy [2]. Future studies should validate efficacy across diverse age groups, educational backgrounds and healthcare settings. Second, gender-specific analysis needs deepening. The study notes women's greater susceptibility to alcohol-induced liver injury, and women comprised 36.7% of the sample, yet subgroup analysis showed no significant gender differences. However, women face unique barriers to AUD treatment engagement, including higher stigma and caregiving responsibilities [3]. Whether future digital interventions require gender-sensitive modules (e.g., addressing parenting stress, comorbid anxiety/depression) to optimise outcomes for women merits dedicated investigation. Third, the mechanism of action and ‘active ingredients’ require elucidation. MyWayUp integrates motivational interviewing, cognitive-behavioural therapy and gamification. Which component (e.g., immediate feedback, goal setting, narrative metaphor) is most critical for boosting engagement? Employing mixed methods, collecting user interaction data with the app and conducting qualitative interviews could help deconstruct its mechanism and inform iterative optimization. Finally, the pathway for integration into existing healthcare systems. Although the intervention showed superiority, its implementation as an ‘add-on’ still relies on monthly follow-up with specialist addiction psychiatrists. How to simplify and integrate it into standard workflows in resource-limited primary care or hepatology clinics requires implementation science research [4]. Exploring tiered care models led by nurses or community health workers, coupled with a lighter version of the digital tool, may be key to scaling access. In conclusion, the MyWayUp study opens a valuable digital avenue for AUD treatment in ArLD. A deeper understanding of the points raised above will help translate this intervention from research evidence into widespread, equitable and effective clinical practice. The authors have nothing to report. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. This article is linked to C. Oliveras et al. paper. To view this article, visit https://doi.org/10.1111/liv.70506. A data statement is not applicable to this article, as no new data were generated in this study.