The DRAM, Vol. 21(11) – Effectiveness of a digital text-based intervention for at-risk drinkers

At-risk drinking involves drinking above recommended guidelines, but below the level of severe alcohol use disorder. It is a prevalent public health concern. While brief digital interventions for risky drinking exist, many are not readily available and have not been used in real-world settings. This week, as part of our Special Series on Addiction and Technology, The DRAM reviews a study by Jon Morgenstern and colleagues that examined the effectiveness of a text messaging and telehealth therapy digital intervention for at-risk drinkers.

What were the research questions?
(1) What are peoples’ preferences regarding digital text-based interventions? (2) How effective is a text-based intervention in reducing levels of alcohol consumption among at-risk drinkers?

What did the researchers do?
A cohort of 163 participants who were over 21 years old, owned a mobile phone, and were willing to receive text messages participated in an eight-week pilot study, which was advertised as appropriate for people drinking at mild to moderate levels. First, they completed a baseline assessment that measured drinking behavior, cognitions, and goals. Next, they chose between two options for the intervention: text support (daily tailored text messages based on responses to the baseline assessment) or coaching (tailored text messages plus six sessions of treatment from a personal therapist). After the eight-week period, participants completed another survey measuring their drinking behaviors. The researchers then assessed differences in drinking behaviors between the text support and coaching groups, and before and after the intervention.

What did they find?
Most participants selected the text support option (72.4%) rather than coaching (27.6%). At baseline, coaching participants reported consuming significantly more weekly standard drinks, having higher rates of prior engagement with substance use treatment, and having higher levels of perceived harm from drinking, compared to text support participants (see Figure). Those in coaching were also more likely to select abstinence as their drinking goal, while those in text support were more likely to select drinking in moderation as their goal. After the intervention period, participants in coaching had greater reductions in their average number of drinks per drinking day than those in text support.

Figure. Differences in drinking behaviors, cognitions, and goals between participants in the text support intervention and participants in the coaching intervention. Click image to enlarge.

Why do these findings matter?
Most participants chose the text support intervention, which may reflect a preference for self-guided, convenient, and less intensive forms of support. However, those with more severe alcohol-related concerns may prefer higher-intensity interventions. Thus, giving users the option to tailor their experiences with digital interventions based on their drinking status, goals, and preferences for treatment may be beneficial. Overall, alcohol consumption decreased among participants in both the text support and coaching interventions, which supports the feasibility and effectiveness of digital interventions for at-risk drinking.

Every study has limitations. What are the limitations in this study?
There was attrition, with less than half of participants completing the survey after the intervention period. There also might’ve been selection bias, as more motivated individuals who were determined to meet their drinking goal may have chosen the coaching option to begin with.

For more information:
The National Institute on Alcohol Abuse and Alcoholism has tips and resources for people struggling with problem drinking. For additional drinking self-help tools, please visit our Addiction Resources page.

— Annette Siu

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