Translating effective web-based self-help for problem drinking into the real world.
BACKGROUND
Drinking Less (DL) is a 24/7 free-access anonymous interactive web-based self-help intervention without therapeutic guidance for adult problem drinkers in the community. In a randomized controlled trial (referred to here as DL-RCT), DL has been shown effective in reducing risky alcohol consumption.


OBJECTIVE
To assess whether the findings of DL-RCT are generalizable to a naturalistic setting (DL-RW) in terms of ability to reach the target group and alcohol treatment response.


METHODS
Pretest-posttest study with 6-month follow-up. An online survey was conducted of 378 of the 1,625 people who used DL-RW from May to November 2007. Primary outcome measures were (1) problem drinking, defined as alcohol consumption in the previous 4 weeks averaging >21 or >14 standard units (male/female) per week or >or=6 or >or=4 units (m/f) on 1 or more days per week; and (2) mean weekly alcohol consumption. DL-RW and DL-RCT data were compared and pooled. Intention-to-treat (ITT) analysis was performed to analyze and compare changes in drinking from baseline to follow-up.


RESULTS
In the DL-RW group, 18.8% (n = 71) were drinking successfully within the limits of the Dutch guideline for low-risk drinking (p < 0.001) 6 months after baseline (ITT). The DL-RW group also decreased its mean weekly alcohol intake by 7.4 units, t(377) = 6.67, p < 0.001, d = 0.29. Drinking reduction in DL-RW was of a similar magnitude to that in the DL-RCT condition in terms of drinking within the guideline [chi(2)(1) = 1.83, CI: 0.82-3.00, p = 0.18, RD = 0.05, OR = 1.55] and mean weekly consumption (a negligible difference of d = 0.03 in favor of DL-RW group).


CONCLUSIONS
The results from DL-RCT and DL-RW were similar, and they demonstrate that web-based self-help without therapeutic guidance is feasible, well accepted, and effective for curbing adult problem drinking in the community.
Innovation Centre of Mental Health and Technology, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands. hriper@trimbos.nl
Heleen
H
Riper
Jeannet
J
Kramer
Barbara
B
Conijn
Filip
F
Smit
Gerard
G
Schippers
Pim
P
Cuijpers
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000628:therapy*; D000437:Alcoholism / Q000453:epidemiology / Q000628:therapy*; D015331:Cohort Studies; D003625:Data Collection / Q000379:methods / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D020407:Internet / Q000639:trends; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012648:Self Care / Q000379:methods* / Q000639:trends; D012657:Self-Help Groups / Q000639:trends