Effectiveness of stand-alone telephone-delivered intervention for reducing problem alcohol use

1. In this randomized controlled trial, in participants with problem alcohol use, individuals in the active control group, receiving brief check-ins, and the intervention group, receiving telehealth cognitive and behavioural interventions, both experienced a significant decrease in alcohol use severity 3 months after randomization.  

2. The intervention group showed a significantly greater reduction in alcohol use than the active control group.

Evidence Rating Level: 1 (Excellent)

Alcohol use is a leading cause of preventable morbidity and mortality, but there is a sharp contrast between its prevalence and the use of alcohol treatments. This treatment gap is attributable to the multiple individual and structural barriers that exist, and especially since the pandemic, access to treatment has been further disrupted. Telehealth has the potential to overcome many of the barriers to accessing treatment and has been previously studied in smoking cessation with great success. There is a lack of high-quality evidence surrounding telehealth in the treatment of alcohol use disorders, and the purpose of this single-site, double-blind, parallel-group randomized controlled trial was to examine the effectiveness of a telephone-delivered treatment, Ready2Change, in reducing alcohol use in patients with alcohol use problems. Participants 18 years or older with problem alcohol use (as per the Alcohol Use Disorders Identification Test (AUDIT) score), were recruited from Australia using social media between May 2018 and October 2019. Participants were randomized in a 1:1 ratio to the intervention group or control group. The intervention group received 4-6 sessions of telephone-delivered intervention, while the active control group received 4 telephone check-ins from a researcher. The primary outcome was a change in alcohol problem severity at 3 months after baseline, using the AUDIT score. 344 participants were included in the study, with 173 patients (50.3%) assigned to the intervention group, and 171 participants (49.7%) assigned to the active control group. With respect to the primary outcome, there was a significant difference in the AUDIT score for the treatment group when compared to the active control group at 3 months (difference, -2.15; 95% CI, -3.64 to -0.65; P=.005). There were no significant treatment-by-time interactions observed between the two groups. In both groups, there was a significant decrease in total AUDIT score from baseline to 3 months (P<.001). A major limitation of this study was that the active control group experienced a significant reduction in alcohol use, which was greater than anticipated; future studies should consider this possibility and adjust their trial accordingly. Overall, the findings from this trial did not suggest the superior effectiveness of the intervention when compared to the active control, as both groups experienced a significant decrease in AUDIT score between baseline and three months. However, the intervention group showed a greater reduction in AUDIT score at 3 months relative to the active control group. The results of this trial support benefits of a telephone-delivered intervention, which may reduce the treatment gap for problem alcohol use in the general population.

Click to read the study in JAMA Psychiatry

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