Problem drinking in Western societies contributes to disease and death as well as social and economic woes. Yet only a small number of people with alcohol problems – 10 to 20 percent – ever seek and participate in treatment. This study examined the real-world effectiveness of a 24/7 free-access, anonymous, interactive, and Web-based self-help intervention called Drinking Less (DL) at http://www.minderdrinken.nl. Findings show that DL can help problem drinkers in the privacy of their own homes.
"We were concerned that so few problem drinkers access the help they need," said Heleen Riper, a senior scientist at the Trimbos Institute and the Vrije Universiteit in the Netherlands, as well as corresponding author for the study.
"This may not come as a surprise, given that addiction services predominantly focus on severely dependent people."
"Web-based interventions can provide a cheap and easily accessible intervention for the large majority of problem drinkers who are not treated," noted Reinout W. Wiers, professor of developmental psychopathology at the University of Amsterdam.
Riper and her colleagues wanted to expand the use of DL – a self-help intervention for adults without therapeutic guidance – from a clinical trial to the community. "DL consists of motivational, cognitive-behavioral, and self-control information and exercises," she said. "It helps problem drinkers decide if they really want to change their problem drinking and, if so, helps them set realistic goals for achieving a change in their drinking behavior, providing tools and exercises to maintain these changes, or deal with relapse if it occurs."
The study authors recruited 378 (199 females, 179 males) of the 1,625 community-based people who used DL from May to November 2007 to complete an online survey six months later. All lived in the Netherlands; the vast majority, 91.5 percent, was of Dutch origin. Outcome measures included alcohol consumption during the preceding four weeks, and mean weekly alcohol consumption. The collected data were then compared with those from the previous trial of DL.
"The observed effectiveness of DL in a randomized, controlled trial setting was maintained when we offered the intervention to the general population in a real-world setting," said Riper. "After six months, participants decreased their mean weekly alcohol consumption, and 18.8 percent changed their drinking patterns to 'low risk drinking.' For 84 percent of the participants, this was their first professional contact for problem drinking. Furthermore, more than half was female, indicating that this form of help is highly acceptable for female problem drinkers."
Dutch guidelines for "low-risk drinking" are: for men, drinking less than 21 standard units per week, or six or more units at least one day per week; and for women, drinking less than 14 standard units per week, or four or more units at least one day a week. One standard unit contains 10 g of ethanol. In contrast, American standard drinks contain more alcohol, about 14 g. Thus, Dutch guidelines in terms of American drinks would mean: less than 15 drinks per week and no more than five in a row for men; and for women, no more than 10 drinks per week and no more than three in a row.
Both Riper and Wiers believe these findings from the Netherlands could easily be applied to a North American population. "This research is all about real world applications," said Wiers. "Similar websites could easily be translated and/or developed in other countries."
"While Web-based and digital interventions might not be effective for everyone," added Riper, "almost 20 percent of our participants were able to change their problem drinking to low-risk, while others became aware of their problems and were more willing to seek professional guidance. Our study also indicated that Web-based treatment like this is effective for people with different educational backgrounds."
Riper recommended that interventions such as DL become the "first step" to a collective approach to problem drinking in which online and offline services become integrated. "Web-based self-help … should be seen as an additional form of service next to existing services," she said. "It could be used as a stand-alone intervention, expanded with therapeutic guidance for those who are ready for it, or used to mitigate waiting times. It also provides accessibility for populations who live in low-density areas where professional services are scarce. Alone it cannot change the world, but it could help to make a difference once integrated."
Wiers agreed. "I think that this is an important first step in internet-delivered interventions for alcohol abuse and dependence," he said. "I foresee that in the future these cognitive motivational approaches could be augmented by other approaches that can be delivered over the internet, such as interventions that directly interfere with cognitive processes in alcohol problems. In addition, internet-based treatments can become part of the aftercare of regular treatment, helping to prevent relapse back home, one of the major challenges in treating alcohol-use disorders."
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