Translating Effective Web-Based Self-Help for Problem Drinking Into the Real World

Authors

  • Heleen Riper,

    1. From the Innovation Centre of Mental Health and Technology (HR, JK, BC, FS), Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands; Department of Clinical Psychology and EMGO Institute (HR, FS, PC), VU University Medical Centre, Amsterdam, The Netherlands; and Amsterdam Institute for Addiction Research (GS), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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  • Jeannet Kramer,

    1. From the Innovation Centre of Mental Health and Technology (HR, JK, BC, FS), Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands; Department of Clinical Psychology and EMGO Institute (HR, FS, PC), VU University Medical Centre, Amsterdam, The Netherlands; and Amsterdam Institute for Addiction Research (GS), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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  • Barbara Conijn,

    1. From the Innovation Centre of Mental Health and Technology (HR, JK, BC, FS), Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands; Department of Clinical Psychology and EMGO Institute (HR, FS, PC), VU University Medical Centre, Amsterdam, The Netherlands; and Amsterdam Institute for Addiction Research (GS), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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  • Filip Smit,

    1. From the Innovation Centre of Mental Health and Technology (HR, JK, BC, FS), Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands; Department of Clinical Psychology and EMGO Institute (HR, FS, PC), VU University Medical Centre, Amsterdam, The Netherlands; and Amsterdam Institute for Addiction Research (GS), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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  • Gerard Schippers,

    1. From the Innovation Centre of Mental Health and Technology (HR, JK, BC, FS), Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands; Department of Clinical Psychology and EMGO Institute (HR, FS, PC), VU University Medical Centre, Amsterdam, The Netherlands; and Amsterdam Institute for Addiction Research (GS), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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  • Pim Cuijpers

    1. From the Innovation Centre of Mental Health and Technology (HR, JK, BC, FS), Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands; Department of Clinical Psychology and EMGO Institute (HR, FS, PC), VU University Medical Centre, Amsterdam, The Netherlands; and Amsterdam Institute for Addiction Research (GS), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Reprint requests: Heleen Riper, Innovation Centre of Mental Health and Technology, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), PO Box 725, 2500 AS Utrecht, The Netherlands; Fax: +31-30-297-1111; E-mail: hriper@trimbos.nl

Abstract

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 ≥6 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% (= 71) were drinking successfully within the limits of the Dutch guideline for low-risk drinking (< 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, < 0.001, = 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 [χ2(1) = 1.83, CI: 0.82–3.00, = 0.18, RD = 0.05, OR = 1.55] and mean weekly consumption (a negligible difference of = 0.03 in favor of DL-RW group).

Conclusion:  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.

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