Chess Training Modulates Brain Cue Reactivity in Alcohol Use Disorder Study

An exploratory clinical trial evaluating chess-based cognitive remediation training in abstinent inpatients with alcohol use disorder found distinct longitudinal changes in neural reactivity within the supplementary motor area during alcohol cue exposure compared with rest. The research, published in Frontiers in Systems Neuroscience, investigated whether adding a structured neurocognitive intervention to standard care would alter the neurocognitive control deficits that underlie cue-induced craving and relapse vulnerability.

Cue-induced craving is recognized as a primary driver of relapse among individuals undergoing treatment for alcohol use disorder. Despite its clinical importance, standard inpatient regimens typically do not directly target the neurocognitive control deficits underlying this response. To test an approach addressing these mechanisms, researchers examined chess-based cognitive remediation training, which is structured as a manualized group intervention designed to actively engage working memory, attention, and inhibitory control.

The trial enrolled 41 abstinent inpatients undergoing rehabilitation at a specialized center and registered under ClinicalTrials.gov identifier NCT04057534. Participants were quasi-randomized into two parallel groups for a six-week intervention period. One group received standard treatment as usual, comprising 16 patients, while the second group received treatment as usual combined with chess-based cognitive remediation training, comprising 25 patients.

Neural responses were evaluated before and after the six-week intervention period using a validated alcohol cue reactivity paradigm administered during functional neuroimaging. The primary clinical trial endpoint was defined as the change in blood-oxygen-level-dependent activation when comparing alcohol-related cue viewing to rest conditions. Behavioral assessments administered alongside the imaging sessions included the Obsessive Compulsive Drinking Scale and the Alcohol Urge Questionnaire to measure craving, as well as the Beck Depression Inventory II to record depressive symptoms.

Whole-brain functional neuroimaging analysis revealed a statistically significant Time by Group interaction within the supplementary motor area, identified at peak MNI coordinates of minus 2, 4, 80, spanning a cluster size of 544 voxels with a family-wise error-corrected significance level of pFWE equal to 0.025. This interaction reflected an increase in supplementary motor area blood-oxygen-level-dependent activation over time in the group receiving chess training alongside standard treatment, contrasted with a decrease in activation among patients receiving standard treatment alone.

Within the group receiving the chess-based remediation training, the observed change in supplementary motor area activation correlated positively with changes in obsessive-compulsive craving. Specifically, increases in supplementary motor area response were positively associated with the total score on the Obsessive Compulsive Drinking Scale (r = 0.439, p = 0.032) as well as its cognitive subscale (r = 0.453, p = 0.026).

Both study arms exhibited significant within-group reductions over the course of the six-week period on both the Beck Depression Inventory II and the Obsessive Compulsive Drinking Scale. When evaluating between-group differences in change scores prior to adjusting for baseline differences, the comparison reached statistical significance solely for depressive symptoms, demonstrating an effect size of d = -0.80 favoring the combined intervention group. However, this between-group difference in depressive symptom changes was no longer statistically significant following adjustment for baseline symptom severity.

The authors concluded that these exploratory findings show differential longitudinal supplementary motor area activation between groups during alcohol cue viewing relative to rest. While the results suggest chess-based cognitive remediation training might provide an additional benefit against depressive symptoms, that secondary outcome was sensitive to baseline symptom severity, leading the investigative team to emphasize that these preliminary neurocognitive and clinical findings require further validation in future trials.

The exploratory investigation brought together an international collaboration of addiction medicine and psychological researchers led by corresponding author Sabine Vollstädt-Klein. Contributing investigators included Kathrin Matthiae, Alexander Kinzel, Alexandra Seeger, Roland Schmitt, Yury Shevchenko, Juan Antonio Montero, Tillmann Weber, Sarah Gerhardt, and Haoye Tan. Participating institutions encompassed the Department of Addictive Behaviour and Addiction Medicine at the Central Institute of Mental Health within the Medical Faculty Mannheim at Heidelberg University, the Department of Psychology at the University of Konstanz, and the Club de Ajedrez Magic de Extremadura in Mérida, Spain. Additional participating organizations included the Blomenburg Privatklinik für Psychiatrie, Psychotherapie und Psychosomatik in Selent, the partner site Mannheim-Heidelberg-Ulm of the German Center for Mental Health, and the Mannheim Center for Translational Neurosciences.

The published work reflects an extended peer-review timeline, with the manuscript initially received on June 29, 2026, and officially accepted for publication on October 29, 2026. The clinical trial, indexed under the primary keywords of alcohol use disorder, cognitive remediation, cue reactivity, and executive control, was issued under an open-access Creative Commons Attribution license. While the investigators utilized functional magnetic resonance imaging and administered craving measures such as the Alcohol Urge Questionnaire, the authors noted that the observed supplementary motor area activation patterns remain exploratory in nature. The authors underscored that the claims expressed in the study belong solely to the investigators and do not necessarily represent the official positions of their affiliated organizations or the journal publisher.

Subject of Research: Supplementary motor area reactivity changes following chess-based cognitive remediation in alcohol use disorder

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

Article References: Matthiae, K., Kinzel, A., Seeger, A., Schmitt, R., Shevchenko, Y., Montero, J. A., Weber, T., Gerhardt, S., Tan, H., & Vollstädt-Klein, S. (2026). Chess-based cognitive remediation training and alcohol cue reactivity in alcohol use disorder: exploratory evidence for supplementary motor area activation changes. Frontiers in Systems Neuroscience, 20, 1922841. https://doi.org/10.3389/fnsys.2026.1922841

Image Credits: AI Generated

DOI: 10.3389/fnsys.2026.1922841

Keywords: alcohol use disorder, cognitive remediation, cue reactivity, supplementary motor area, functional neuroimaging, fMRI, craving, inhibitory control, working memory, executive function, rehabilitation, clinical trial, Obsessive Compulsive Drinking Scale, Beck Depression Inventory, inpatient treatment, neurocognitive training