Effectiveness of a digital intervention versus alcohol information for online help-seekers in Sweden

1. Among a group of risky drinkers seeking online help in Sweden, a digital alcohol intervention was more effective at reducing total weekly alcohol consumption, frequency of heavy episodic drinking, and odds of risky drinking when compared with control groups

Evidence Rating Level: 1 (Excellent)

Study Rundown: Drinking is highly prevalent in many societies. However, excessive alcohol consumption has significant risks, including increased risk of stroke, heart failure, and cancer. Additionally, heavy drinking may cause harms to others, including family members and unborn babies, and to society at large, including traffic accidents, violence, and associated burdens on the health, criminal justice, and welfare systems. As internet availability and accessibility increases, digital alcohol interventions have been found to be effective in helping individuals reduce their alcohol consumption. Nevertheless, there are many uncertainties about how to create and implement digital alcohol programming effectively. This study aimed to investigate if a digital alcohol intervention was helpful in reducing alcohol consumption among people seeking assistance online in Sweden. Risky drinkers aged 18 or older with access to a mobile phone were randomly assigned to the digital intervention, which included weekly monitoring of alcohol consumption followed by tools and feedback for behaviour change, or one of two control groups. Outcome measures included total weekly alcohol consumption and frequency of heavy episodic drinking, measured at 2- and 4-months post-randomization. A total of 2129 participants were randomized (treatment: 1063; controls: 1066). At 2- and 4-months, both total weekly alcohol consumption and frequency of heavy episodic drinking were significantly lower in the treatment group than in the control groups. In conclusion, a digital alcohol intervention was found to be effective at reducing alcohol consumption among online help seekers in the general Swedish population.

Click here to read the study in BMC Medicine

Relevant Reading: Personalized digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations

In-Depth [Randomized Controlled Trial]: This 2-arm parallel group randomized controlled trial targeted Swedish adults seeking help online to reduce their alcohol consumption. Participants were required to be at least 18 years of age, have access to a mobile device, and be considered risky drinkers, as per Swedish guidelines. Before randomization, those who consented were asked to complete a baseline questionnaire, which included questions on demographics, current alcohol consumption, perceived importance of reducing drinking, confidence in one’s ability to reduce drinking, and knowledge of how to reduce drinking. After questionnaire completion, eligible participants were randomized to one of two groups. Those in the treatment group received weekly text messages that included a prompt to self-monitor one’s current alcohol consumption and a hyperlink to a web-based tool. Those who clicked the provided link were given access to a personalized support tool. The control group was further randomized into two groups. Participants in both control groups received a single text message with basic information about effects and complications of alcohol consumption. The control subgroups differed in terms of specific content. One subgroup received a message emphasizing possible complexities associated with short- and long-term effects of alcohol (Info-1), whereas the other received one with a clear and straightforward public health message (Info-2). The primary outcomes measures were total weekly alcohol consumption and frequency of heavy episodic drinking. The secondary outcome measure was classification as a risky drinker according to Swedish guidelines. All outcome measures were assessed at 2 and 4 months post-randomization. Between April 2019 and November 2020, a total of 2129 participants were randomized, with 1063 allocated to the treatment group, 539 to the Info-1 control subgroup, and 527 to the Info-2 control subgroup. In the treatment group, 144 participants asked to stop receiving text messages before the 4-month treatment period had passed, resulting in 919 (86.5%) participants who used the support tool for the entire study period. At the 4-month mark, the mean score on the System Usability Scale for treatment group participants was 82/100, indicating high usability of the digital application. Among those in the control subgroups, the rate at which participants clicked on the supplied link was 49% in Info-1 and 51% in Info-2. Total weekly alcohol consumption was significantly lower in the intervention group than in the control groups at both the 2- and 4-month follow-up intervals (P-value = 0.033 at 2 months and <0.0001 at 4 months). The frequency of heavy episodic drinking was also significantly less in the treatment group than in the control groups at the 2- and 4-month marks (P-value = 0.0009 at 2 months and <0.0001 at 4 months). Finally, the odds of risky drinking in the intervention group were estimated to be 0.85 times that in the control group at 2 months and 0.58 times that in the control group at 4 months. The authors concluded that digital alcohol programming may be helpful for producing behaviour change among online help-seekers in the Swedish population.

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