Background: Alcohol use disorder (AUD) involves an impaired ability to stop or control alcohol use despite adverse consequences and represents a major public health problem. While AUD is most prevalent among college students, integrated evidence-based treatments for this population are lacking. Objective: The objectives of our study were to test the #feasibility and acceptability of a newly developed behavioral intervention, problem-solving therapy and Apple Watch (PST-APPLE), and to preliminarily investigate the effectiveness of PST-APPLE among college students with symptoms of AUD. Methods: Participants were recruited through online advertising and on campus at universities in the Chicago area between May and September 2024. They were randomized in a 1:1 ratio using block randomization to the intervention group (PST-APPLE: n=12 individuals) or the control group (education-only: n=14 individuals), with the data analyst blinded to treatment assignment. Participants in the intervention group completed 12 weeks of the PST-APPLE intervention, delivered remotely via Zoom videoconferencing and interactions with the Apple Watch. Participants in the control group were asked to watch a 20-minute abstinence-motivation video and then participate in a 30-minute group discussion via Zoom. All participants completed follow-up assessments at 3 months. Outcomes included alcohol-related problems (Alcohol Use Disorders Identification Test [AUDIT] and Rutgers Alcohol Problem Index [RAPI]) and drinking motivation (Drinking Motives Questionnaire Revised [DMQR]). Results: We enrolled 26 participants aged 18‐25 years. The mean age was 22.5 (SD 2.20) years. We found reduced scores between preintervention and postintervention measures in the intervention group using 2-tailed paired tests and baseline-adjusted analysis of covariance, including reduced alcohol misuse and problems (AUDIT and RAPI scores) and reduced DMQR social and coping motivation scores. Baseline-adjusted mean differences comparing the intervention with the control group showed reductions in alcohol use (AUDIT; mean difference −4.70, 95% CI −8.69 to −0.70) and in DMQR social motivation (mean difference −0.85, 95% CI −1.51 to −0.18) and enhancement motivation scores (mean difference −0.75, 95% CI −1.47 to −0.04). Conclusions: Our study findings indicate that the PST-APPLE intervention is feasible, acceptable, and hypothesis generating among college students with AUD. While findings are promising, this pilot study was not powered for definitive efficacy testing. A fully powered randomized controlled trial is needed to confirm these effects. Future studies could adapt PST-APPLE to other wrist-worn electronic devices/watches that capture physiological data (eg, Fitbit, Samsung Galaxy Watch) to increase reach and scalability, particularly among younger adults and digitally literate populations. Trial Registration: ClinicalTrials.gov NCT06333288; https://clinicaltrials.gov/study/NCT06333288