Web-based self-help intervention reduces alcohol consumption in both heavy-drinking and dependent alcohol users: A pilot study.

As part of a multicenter project supported by the World Health Organization, we developed a web-based intervention to reduce alcohol use and related problems. We evaluated the predictors of adherence to, and the outcomes of the intervention. Success was defined as a reduction in consumption to low risk levels or to <50% of the baseline levels of number of drinks. From the 32,401 people who accessed the site, 3389 registered and 929 completed the full Alcohol Use Disorders Identification Test (AUDIT), a necessary condition to be considered eligible to take part in the intervention. Based on their AUDIT scores, these participants were classified into: low risk users (LRU; n=319) harmful/hazardous users (HHU; n=298) or suggestive of dependence users (SDU; n=312). 29.1% of the registered users (LRU=42; HHU=90; SDU=82) completed the evaluation form at the end of the six-week period, and 63.5% reported low-risk drinking levels. We observed a significant reduction in alcohol consumption in the HHU (62.5%) and SDU (64.5%) groups in relation to baseline. One month after the intervention, in the follow-up, 94 users filled out the evaluation form, and their rate of success was similar to the one observed in the previous evaluation. Logistic regression analyses indicated that HHU participants presented higher adherence than LRU. Despite a relatively low adherence to the program, its good outcomes and low cost, as well as the high number of people that can be reached by a web-based intervention, suggest it has good cost-effectiveness.

[1]  Renske Spijkerman,et al.  Effectiveness of a Web-Based Brief Alcohol Intervention and Added Value of Normative Feedback in Reducing Underage Drinking: A Randomized Controlled Trial , 2010, Journal of medical Internet research.

[2]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[3]  M. Barkham,et al.  The Effectiveness of a Web-Based Personalized Feedback and Social Norms Alcohol Intervention on United Kingdom University Students: Randomized Controlled Trial , 2013, Journal of medical Internet research.

[4]  Mark B Reed,et al.  Reasons for nonresponse in a web-based survey of alcohol involvement among first-year college students. , 2008, Addictive behaviors.

[5]  L. Forsberg,et al.  Psychometric properties and factor structure of the readiness to change questionnaire. , 2003, Alcohol and alcoholism.

[6]  E. F. Furtado,et al.  Stigmatization of alcohol and other drug users by primary care providers in Southeast Brazil. , 2009, Social science & medicine.

[7]  G. Gmel,et al.  A Pre-Post Study on the Appropriateness and Effectiveness of a Web- and Text Messaging-Based Intervention to Reduce Problem Drinking in Emerging Adults , 2013, Journal of medical Internet research.

[8]  S. Michie,et al.  Using the Internet to Promote Health Behavior Change: A Systematic Review and Meta-analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy , 2010, Journal of medical Internet research.

[9]  M. Schaub,et al.  Snow Control - An RCT protocol for a web-based self-help therapy to reduce cocaine consumption in problematic cocaine users , 2011, BMC psychiatry.

[10]  Elizabeth L. Ogburn,et al.  Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. , 2007, Archives of general psychiatry.

[11]  K. Witkiewitz,et al.  Alcohol use trajectories among non-treatment-seeking heavy drinkers. , 2014, Journal of studies on alcohol and drugs.

[12]  J O Prochaska,et al.  Self change processes, self efficacy and decisional balance across five stages of smoking cessation. , 1984, Progress in clinical and biological research.

[13]  G. Eysenbach The Law of Attrition , 2005, Journal of medical Internet research.

[14]  K. Richter,et al.  Screening and brief intervention for alcohol and other drug use in primary care: associations between organizational climate and practice , 2013, Addiction Science & Clinical Practice.

[15]  Kypros Kypri,et al.  Web-based alcohol screening and brief intervention for university students: a randomized trial. , 2014, JAMA.

[16]  M. Vallejo,et al.  Usage and Effectiveness of a Fully Automated, Open-Access, Spanish Web-Based Smoking Cessation Program: Randomized Controlled Trial , 2014, Journal of medical Internet research.

[17]  P. Bendtsen,et al.  A Text Messaging-Based Smoking Cessation Program for Adult Smokers: Randomized Controlled Trial , 2012, Journal of medical Internet research.

[18]  M. Farrell,et al.  Concurrent and construct validity of the audit in an urban brazilian sample. , 2005, Alcohol and alcoholism.

[19]  P. Emmelkamp,et al.  Interapy: a controlled randomized trial of the standardized treatment of posttraumatic stress through the internet. , 2003, Journal of consulting and clinical psychology.

[20]  Brendan Mulhern,et al.  The feasibility and effectiveness of a web-based personalised feedback and social norms alcohol intervention in UK university students: a randomised control trial. , 2008, Addictive behaviors.

[21]  D. Doumas Web-based personalized feedback: is this an appropriate approach for reducing drinking among high school students? , 2015, Journal of substance abuse treatment.

[22]  M. Schaub,et al.  Web-Based Cognitive Behavioral Self-Help Intervention to Reduce Cocaine Consumption in Problematic Cocaine Users: Randomized Controlled Trial , 2012, Journal of medical Internet research.

[23]  Susanne Pedersen,et al.  Attrition and Adherence in a Web-Based Distress Management Program for Implantable Cardioverter Defibrillator Patients (WEBCARE): Randomized Controlled Trial , 2014, Journal of medical Internet research.

[24]  Brendan Mulhern,et al.  Providing Web-Based Feedback and Social Norms Information to Reduce Student Alcohol Intake: A Multisite Investigation , 2010, Journal of medical Internet research.

[25]  G. Schippers,et al.  Internet therapy versus internet self-help versus no treatment for problematic alcohol use: A randomized controlled trial. , 2011, Journal of consulting and clinical psychology.

[26]  Tibor P. Palfai,et al.  Personalized Feedback as a Universal Prevention Approach for College Drinking: A Randomized Trial of an e-Mail Linked Universal Web-Based Alcohol Intervention , 2014, The Journal of Primary Prevention.

[27]  D. Kivlahan,et al.  The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. , 1998, Archives of internal medicine.

[28]  P. Cuijpers,et al.  Curbing problem drinking with personalized-feedback interventions: a meta-analysis. , 2009, American journal of preventive medicine.

[29]  Marloes G. Postel,et al.  Attrition in Web-Based Treatment for Problem Drinkers , 2011, Journal of medical Internet research.

[30]  F. Smit,et al.  Curbing Alcohol Use in Male Adults Through Computer Generated Personalized Advice: Randomized Controlled Trial , 2011, Journal of medical Internet research.

[31]  Heleen Riper,et al.  Web-based self-help for problem drinkers: a pragmatic randomized trial. , 2008, Addiction.

[32]  A Koski-Jänne,et al.  Interest in different forms of self-help in a general population sample of drinkers. , 2001, Addictive behaviors.

[33]  J. Cunningham Comparison of Two Internet-Based Interventions for Problem Drinkers: Randomized Controlled Trial , 2012, Journal of medical Internet research.

[34]  E. Becker,et al.  Characteristics of Problem Drinkers in E-therapy versus Face-to-Face Treatment , 2011, The American journal of drug and alcohol abuse.

[35]  M. Laurant,et al.  Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysis. , 2015, Addiction.

[36]  R. Morriss,et al.  Computer-Delivered and Web-Based Interventions to Improve Depression, Anxiety, and Psychological Well-Being of University Students: A Systematic Review and Meta-Analysis , 2014, Journal of medical Internet research.

[37]  Judy Drennan,et al.  Online Alcohol Interventions: A Systematic Review , 2010, Journal of medical Internet research.

[38]  P. Cuijpers,et al.  Translating effective web-based self-help for problem drinking into the real world. , 2009, Alcoholism, clinical and experimental research.

[39]  J. Cunningham,et al.  Only one in three people with alcohol abuse or dependence ever seek treatment. , 2004, Addictive behaviors.

[40]  P. Cuijpers,et al.  Predicting Successful Treatment Outcome of Web-Based Self-help for Problem Drinkers: Secondary Analysis From a Randomized Controlled Trial , 2008, Journal of medical Internet research.

[41]  Helen Christensen,et al.  The Law of Attrition Revisited , 2006, Journal of medical Internet research.