Digital psychological self-care for problematic alcohol use: feasibility of a new clinical concept

Abstract

Background Digital interventions based on cognitive–behavioural therapy and relapse prevention can increase treatment access for people with problematic alcohol use, but for these interventions to be cost-effective, clinician workload needs to remain low while ensuring patient adherence and effects. Digital psychological self-care is the provision of a self-guided digital intervention within a structured care process. Aims To investigate the feasibility and preliminary effects of digital psychological self-care for reducing alcohol consumption. Method Thirty-six adults with problematic alcohol use received digital psychological self-care during 8 weeks, including telephone assessments as well as filling out self-rated questionnaires, before, directly after and 3 months after the intervention. Intervention adherence, usefulness, credibility and use of clinician time were assessed, along with preliminary effects on alcohol consumption. The study was prospectively registered as a clinical trial (NCT05037630). Results Most participants used the intervention daily or several times a week. The digital intervention was regarded as credible and useful, and there were no reported adverse effects. Around 1 h of clinician time per participant was spent on telephone assessments. At the 3-month follow-up, preliminary within-group effects on alcohol consumption were moderate (standardised drinks per week, Hedge's g = 0.70, 95% CI = 0.19–1.21; heavy drinking days, Hedge's g = 0.60, 95% CI = 0.09–1.11), reflecting a decrease from 23 to 13 drinks per week on average. Conclusions Digital psychological self-care for reducing alcohol consumption appears both feasible and preliminarily effective and should be further optimised and studied in larger trials.

Investigating the added effects of guidance in digital psychological self-care for alcohol problems (ALVA)—protocol for a randomized factorial optimization trial

“…The feedback is intended to act as a motivation to continue to work with the exercises after the intervention’s 8 weeks. For a more detailed description of the basic version of the intervention, see the previous study [ 13 ]. The experimental additions to the basic version of ALVA are detailed below.…”

“…As mentioned above under the “ Study setting {9} ” section, participants will be recruited nationally in Sweden via advertisements on the patient community and support website Alkoholhjalpen.se as well as on digital search services or social media. Advertisements achieved a satisfying rate of participant enrollment in the previous smaller study of the intervention [ 13 ].…”

“…Digital psychological self-care (DPSC) is a new proposed delivery format wherein an essentially self-guided digital intervention is provided within the framework of a structured care process that includes an initial clinical assessment interview with a clinician and one or several follow-up interviews [ 13 ]. The efficacy of well-designed self-guided digital interventions in depression and anxiety has in some studies been shown to be comparable to digital interventions with therapist guidance [ 14 , 15 ].…”

“…We recently conducted a small feasibility study ( n = 36) on a basic version of DPSC for problematic alcohol use named ALVA [ 13 ]. We found not only that the intervention was safe and credible but also that it rendered a high degree of use.…”

“…In terms of effects, participants reduced their alcohol consumption from 22.6 standard drinks preceding week before the digital intervention to 10.6 standard drinks after the intervention (Hedge’s g intra-group = 0.85) and 12.7 standard drinks at a 3-month follow-up (Hedge’s g intra group = 0.70). The clinicians in the study spent less than 1 h on average per participant, time which was mainly spent on the initial clinical assessment interview and the post-intervention interview [ 13 ]. There was also a follow-up interview in the feasibility study, but this was not an essential part of the DPSC concept.…”