Effects of a minimal‐guided on‐line intervention for alcohol misuse in Estonia: a randomized controlled trial

Abstract

Background and Aims Estonia has one of the highest alcohol‐attributable mortality rates within the European Union. The aim of this study was to estimate the efficacy of an on‐line self‐help intervention to reduce problem drinking at the population level. Design On‐line open randomized controlled trial with an 8‐week intervention and an active control group (intervention n = 303, control n = 286). Assessments took place at baseline and at 6 months follow‐up. Setting On‐ and offline channels were used for population‐based recruitment within a nation‐wide prevention campaign in Estonia. Participants Inclusion criteria were age ≥ 18 years, heavy drinking [Alcohol Use Disorders Identification (AUDIT) test score ≥ 8], literacy in Estonian and at least weekly access to the internet; n = 589 participants were randomized (50% male, 1% other; mean age 37.86 years; 45% with higher level of education). Intervention and comparator The intervention consisted of 10 modules based on principles of cognitive–behavioral therapy and motivational interviewing. The active control group received access to a website with a self‐test including personalized normative feedback and information for standard alcohol treatment. Measurements The primary outcome was AUDIT scores at 6 months follow‐up adjusted for baseline scores. Findings Intention‐to‐treat analyses were applied. Missing data were addressed by using baseline observation carried forward (BOCF) and multiple imputation by chained equations (MI); 175 completed follow‐up in the intervention group and 209 in the control group. AUDIT score at follow‐up was significantly smaller in the intervention [BOCF mean = 13.91, standard deviation (SD) = 7.61, MI mean = 11.03, SD = 6.55] than control group (BOCF mean = 15.30, SD = 7.31; MI mean = 14.30, SD = 7.21), with a group difference of −1.38 [95% confidence interval (CI) = –2.58, –0.18], P = 0.02 for BOCF and −3.26 (95% CI = –2.01, –4.51), P < 0.001 for MI. Conclusions A randomized controlled trial has found that an on‐line self‐help intervention with minimal guidance was effective at reducing problem drinking in Estonia.

Optimizing internet-delivered cognitive behaviour therapy for alcohol misuse—a randomized factorial trial examining effects of a pre-treatment assessment interview and guidance

“…The Alcohol Change Course (ACC) is an ICBT program originally developed in Switzerland [ 25 – 27 ] and translated to English [ 28 ] to target alcohol misuse and depression in young adults. For the purpose of this study, the program was adapted for use by adults, with relevant information about alcohol use in Canada (prevalence, guidelines etc.…”

Comparative effectiveness of psychosocial interventions in adults with harmful use of alcohol: a systematic review and network meta‐analysis

“…The average age of participants was 35.68 years (average age ranged from 18.99 to 62.83 years), and 67% ( n = 4790) of participants were male. Of the 19 RCTs included in this systematic review, 17 studies used AUDIT as an outcome (and were included in the primary analysis) [37–41, 43–52, 54, 55], while two used the AUDIT‐C (and were added to the secondary analysis) [42, 53]. Three studies (Hansson et al ., Safsten et al ., Xiaolu et al .)…”

“…Sixteen trials were included in the primary analysis of the NMA [37–41, 44–52, 54, 55]. One study (Cunningham et al .…”

“…A summary of the risk of bias assessment is provided in Supporting information, Appendix S12. Of the 19 studies included in the systematic review, 11 were found to be low risk [40–44, 46, 47, 49, 50, 52, 53], four high risk [37, 39, 45, 51] and four wunclear risk of bias [38, 48, 54, 55]. Of the four overall high‐risk studies, two had incomplete data [39, 51] and two did not adequately protect against contamination [37, 45].…”

Seeking care where they can: A systematic review of global trends in online alcohol treatment utilization among non-veteran and veteran women

“…Importantly, while the field is indebted to Riper et al. (2018) for the person-level meta-analysis that allowed us to see that overall women do not appear to be benefiting as much as men from online alcohol interventions, overall only 11% of the available studies and only one study published nearly contemporaneously ( Tait et al., 2019 ) have evaluated whether gender interacts with treatment condition to influence outcomes while none of the eight studies published since 2020 have done so ( Augsburger et al., 2022 ; Baumgartner et al., 2021 ; Mujcic et al., 2020 ; Sanatkar et al., 2021 ; Schaub et al., 2021 ; Stapinski et al., 2021 ; Sundström et al., 2020a , 2020b ). Thus, it would be very helpful if future investigations of online alcohol interventions tested gender x time x condition interactions and reported gender-specific baseline and follow-up outcome information as would such secondary analyses of extant trials.…”