BACKGROUND Adolescents at risk for substance misuse are rarely identified early due to existing barriers to screening that include lack of time and privacy in clinic settings. Games, which can be delivered without need for trained personnel, can be used for screening, and thus can mitigate these barriers. Performance in a game is influenced by cognitive processes such as working memory and inhibitory control which are implicated in the development of and are impacted by substance misuse. Performance in a game is captured by in-game metrics such as reaction time or time to complete a task. As such, in-game performance metrics may represent digital biomarkers of cognitive processes that can offer an objective method for assessing underlying risk for substance misuse. OBJECTIVE This is a protocol for a proof-of concept study to investigate the utility of in-game performance metrics as digital biomarkers of cognitive processes (working memory and inhibitory control) implicated in the development of substance misuse. METHODS This study has two Aims. In Aim 1, using previously collected data from 166 adolescents aged 11-14 years, we extracted in-game performance metrics from an existing videogame and are employing machine learning methods to determine whether these metrics are predictive of substance misuse. In Aim 2, using data from a new sample of 30 adolescents who play the same videogame, we will test if metrics identified in Aim 1 are correlated with cognitive processes (working memory and inhibitory control). Our hypothesis is that the in-game performance metrics that are predictive of substance misuse in Aim 1 will correlate with poor cognitive function in our second sample. RESULTS This study is funded by National Institute on Drug Abuse Grant number P30DA029926. To date, we have extracted 285 in-game performance metrics. We have also obtained IRB approval and data collection for Aim 2 is projected to start in April 2023. Results will be reported in a following publication. CONCLUSIONS Results from this study will inform the utility of game-based digital biomarkers for identifying adolescents at high risk for substance misuse.

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