Dutch trial of web-based treatment programme for problem drinking

This was featured on Findings in December and looked at the use of a web-based treatment programme for problem drinking as part of a randomised trial within the Netherlands.

Web-based-addiction-treatment-services-2The trial had included 156 adult problem drinkers who on the project’s web site (now also available in an English-language version) had identified themselves as drinking at least 150g alcohol a week for women and 220g for men (about 19 and 28 UK units respectively), but no more than 670g for women and 990g for men. They were among over 500 who had responded to adverts and other invitations to join the study who said they had not recently been in alcohol treatment and were not suffering a psychiatric disorder. Just over half were women, 82% were employed, and they averaged 45 years of age. About 8 in 10 self-assessed as dependent on alcohol, though 86% had never received professional help. The women averaged 352g alcohol (44 UK units) a week and the men 419g (about 52 UK units).

Half were allocated at random to immediately gain access to a 12-session web-based treatment programme. The other half formed a control group who had to wait three months for access, during which they were kept in touch with through fortnightly email messages from the research project.

The web-based programme involved patients being allocated their own personal therapist with whom they communicated in writing via the project’s web site. Rather than online ‘chatting’ in real time, communication was analogous to email messages, responses following some time after the initial contact. The programme was based on cognitive-behavioural therapy and motivational interviewing. The first part involved assessment, assessment feedback, a drinking diary, and identifying situations which for that individual risked heavy drinking. This part culminated in advice from the therapist on how the patient might change their drinking habits. Part two was the change phase, involving setting a drinking goal and formulating a plan for maintaining the new drinking behaviour.

The authors’ conclusions

Post-therapy improvements in drinking and health and in quality of life were sustained over the next six months. The decrease in alcohol consumption was substantial and clinically meaningful. These results suggest web-based alcohol interventions with intensive personal support from a therapist can help reduce problem drinking. However, support of the kind offered in this trial requires more resources than less intensive web-based interventions such as brief interventions or self-help programmes. Professional therapists available at least twice a week are needed to maintain communication with participants, and technology and security requirements are greater because personal information is sent between clients and therapists. Despite these costs, web-based alcohol interventions of this kind are legitimate additions to the range of treatment modalities as they attract new groups of problem drinkers and extend the accessibility of interventions.

Web-based treatment particularly attracts women and better educated and employed drinkers, groups under-represented in face-to-face therapy. Anonymity means participants no longer need stay away from treatment because of shame, fear of stigmatisation, or other barriers to professional help. Participants are helped in their own environments at times of their choosing, making therapy more accessible and convenient. These are also why email type communications have an advantage over ‘chat’ sessions which require client and therapist to be available at the same, set times. An advantage over self-help is the added value of personal contact with a professional therapist. The main challenge seems to be keeping participants involved until the end of the programme.

As part of my online course 1:1 support is available via email – and as this study shows it can be very successful 🙂

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