Comparison of Two Internet-Based Interventions for Problem Drinkers

Original Paper

Comparison of Two Internet-Based Interventions for Problem Drinkers: Randomized Controlled Trial

John Alastair Cunningham, PhD

Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, ON, Canada

Corresponding Author:
John Alastair Cunningham, PhD

Social and Epidemiological Research
Centre for Addiction and Mental Health
33 Russell St
Toronto, ON, M5S 2S1
Canada
Phone: 1 416 535 8501 ext 4682
Fax: 1 416 595 6899
Email:

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ABSTRACT

Background: Alcohol problems are a serious public health concern, and few problem drinkers ever seek treatment. The Internet is one means of promoting access to care, but more research is needed to test the best types of interventions to employ. Evaluation of Internet-based interventions that contain a variety of research-validated cognitive-behavioral tools, which have been shown to be helpful to those with more severe alcohol concerns, should be a priority.
Objective: To evaluate whether providing access to an extended Internet intervention for alcohol problems offers additional benefits in promoting reductions in alcohol consumption compared with a brief Internet intervention. The hypothesis for the current trial was that respondents who were provided with access to an extended Internet intervention (the Alcohol Help Center [AHC]) would display significantly improved drinking outcomes at 6-month follow-up, compared with respondents who were provided with access to a brief Internet intervention (the Check Your Drinking [CYD] screener).
Methods: A single-blinded randomized controlled trial with a 6-month follow-up. A general population sample of problem drinkers was recruited through newspaper advertisements in a large metropolitan city. Baseline and follow-up data were collected by postal mail.
Results: A volunteer sample of problem drinkers of legal drinking age with home access to the Internet were recruited for the trial. Of 239 potential respondents recruited in 2010, 170 met inclusion criteria (average age 45 years; 101/170, 59.4% male; average Alcohol Use Disorders Identification Test [AUDIT] score of 22). Follow-up rates were 90.0% (153/170) with no adverse effects of the interventions reported. A repeated-measures multivariate analysis of variance of the outcome measures using an intent-to-treat approach found a significantly greater reduction in amount of drinking among participants provided access to the AHC than among participants provided access to the CYD (P = .046).
Conclusions: The provision of the AHC gave additional benefit in the short term to problem drinkers over that seen from the research-validated CYD, indicating the benefits of promoting access to these interventions as one means of helping people with problem drinking concerns.
Trial Registration: ClinicalTrials.gov NCT01114919; http://clinicaltrials.gov/ct2/show/NCT01114919 (Archived by WebCite at http://www.webcitation.org/68t1dCkRZ)

(J Med Internet Res 2012;14(4):e107)
doi:10.2196/jmir.2090

KEYWORDS

Randomized controlled trial; problem drinking; alcohol abuse; Internet-based intervention; eHealth; brief intervention

Alcohol is the third-leading cause of preventable death [1]. Unfortunately, the majority of people with drinking problems will never seek specialized addictions treatment [2]. Brief interventions in primary care settings have been identified as one means of addressing this important health problem [3]. However, given the prevalence of drinking problems and the resource restrictions in primary care settings, there is a need to also find alternative means of helping those with drinking problems.

Internet-based interventions have been identified as one promising option. Several reviews have concluded that there is a fast-developing evidence base for the efficacy of these interventions [4-8], particularly among college students, where the majority of these trials have been conducted. The evaluation of the efficacy of Internet-based interventions in general population samples is important if these brief interventions are to be promoted as helpful to anyone other than problem drinking, young adult college students. In addition, the majority of these Internet-based interventions have consisted of brief, personalized feedback interventions, which are thought to be useful to those with less severe alcohol problems. Evaluation of extended interventions that contain a variety of research-validated cognitive-behavioral tools, which have been shown to be helpful to those with more severe alcohol concerns, should also be a priority.

In this paper we report results of a randomized controlled trial testing the added benefit of providing access to such an extended Internet-based intervention, which contained an extensive array of cognitive-behavioral tools for problem drinkers (the Alcohol Help Center [AHC]), over the provision of a brief, personalized feedback Internet-based intervention (the Check Your Drinking [CYD] screener). Both of these Internet-based interventions are available free of charge on the Internet, making evaluations of their use of immediate benefit to problem drinkers. In addition, the CYD has already been subjected to four randomized controlled trials, in which the provision of this brief intervention yielded reductions in alcohol consumption among participants in a variety of different settings [9-12]. In the one study that employed a general population sample of problem drinkers [9], being provided access to the CYD resulted in an average reduction of 6 drinks at 3- and 6-month follow-up as compared with a no-intervention control group. Thus, the CYD brief intervention is an excellent comparator to evaluate whether providing access to an extended intervention (the AHC) would have additional benefit in promoting reductions in alcohol consumption. Finally, as there are few freely accessible, extended Internet-based interventions available [13,14] and as the evaluation of the efficacy of these extended Internet-based interventions has yielded mixed results [15], it is important to conduct further research in this area. The hypothesis for the current trial was that respondents in the extended Internet intervention condition (the AHC) would display significantly improved drinking outcomes at 6-month follow-up, compared with respondents in the brief Internet intervention condition (the CYD).

Participants were recruited through newspaper advertisements in metropolitan Toronto, Canada (May to September 2010) asking for current drinkers interested in helping ?in the process of developing and evaluating Internet-based interventions for alcohol users.? Interested potential participants called the telephone number provided and left their name and address to be sent a consent form and a baseline questionnaire by postal mail. The questionnaire contained a graphic describing a standard drink (note that a standard drink in Canada contains 13.6 g of alcohol).

Those returning the signed consent form and the completed baseline questionnaire were randomly assigned into one of two conditions: to be provided access to the brief Internet-based CYD brief personalized feedback intervention or to be provided access to the extended Internet-based AHC. Access was provided by sending each participant a unique password to be entered into a study-specific online portal (password sent in a letter by postal mail). Random numbers where generated in blocks of two using an online random numbers generator (Research Randomizer, Social Psychology Network; http://www.randomizer.org/) by the author. The random numbers list was used sequentially by a research assistant, who sent out the relevant intervention letter to participants in the order that their consent forms were returned. Participants were blind to the different experimental conditions in the study. Participants were followed up at 6 months and were compensated Can $20 for completing the follow-up questionnaire (questionnaire and check sent by postal mail). Follow-ups were conducted from November 2010 to June 2011. If participants did not return their original follow-up questionnaire within 1 month, they were sent a second questionnaire by postal mail. The research assistant in charge of follow-up was not blind to experimental condition, as the follow-up questionnaires were slightly different (outcome variables were identical and were asked about first, but some questions about impressions of the websites were different at the end of the questionnaire). The trial was approved by the standing research ethics committee for the Centre for Addiction and Mental Health.

As per protocol, the primary outcome measures were number of drinks consumed in a typical week, highest number of drinks on one occasion in the last 6 months, frequency of drinking, typical quantity of drinking on one occasion, and frequency of drinking 5 or more drinks on one occasion (the questions were the same for male and female participants). These last 3 items were combined to form the Alcohol Use Disorders Identification Test-Consumption subscale (AUDIT-C) [16]. For participants who did not return the follow-up questionnaire, missing data on the outcome measures were replaced with their respective baseline values. In addition, variables were examined for distributional properties and were Winsorized to deal with outliers. Exclusion criteria were being less than 19 years old (the legal drinking age in Ontario, Canada), having an AUDIT-C score of less than 8 (a score of 8 or more indicates current problem drinking) [17,18], and not having home access to the Internet. Lack of home Internet access was included in an attempt to include only regular Internet users in the trial. See Figure 1 for a CONSORT diagram of the trial.

Source: http://www.jmir.org/2012/4/e107/

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