Evaluating the Efficacy of the Drinks:Ration Mobile App to Reduce Alcohol Consumption in a Help-Seeking Military Veteran Population: Randomized Controlled Trial

Daniel Leightley, Charlotte Williamson, Roberto J Rona, Ewan Carr, James Shearer, Jordan P Davis, Amos Simms, Nicola T Fear, Laura Goodwin, Dominic Murphy, Daniel Leightley, Charlotte Williamson, Roberto J Rona, Ewan Carr, James Shearer, Jordan P Davis, Amos Simms, Nicola T Fear, Laura Goodwin, Dominic Murphy

Abstract

Background: Alcohol misuse is higher in the UK armed forces (AF) than in the general population. Research demonstrates that alcohol misuse persists after an individual leaves service, and this is notably the case for those who are seeking help for a mental health difficulty. Despite this, there is no work on testing a mobile alcohol reduction intervention that is personalized to support the UK AF.

Objective: To address this gap, we investigated the efficacy of a 28-day brief alcohol intervention delivered via a mobile app in reducing weekly self-reported alcohol consumption among UK veterans seeking help for mental health difficulties.

Methods: We performed a 2-arm participant-blinded randomized controlled trial (RCT). We compared a mobile app that included interactive features designed to enhance participants' motivation and personalized messaging (intervention arm) with a version that provided government guidance on alcohol consumption only (control arm). Adults were eligible if they had served in the UK AF, were currently receiving or had received clinical support for mental health symptoms, and consumed 14 units (approximately 112 g of ethanol) or more of alcohol per week. Participants received the intervention or the control mobile app (1:1 ratio). The primary outcome was a change in self-reported weekly alcohol consumption between baseline and day 84 assessed using the validated Timeline Follow Back for Alcohol Consumption (TLFB) (prior 7 days), with a secondary outcome exploring self-reported change in the Alcohol Use Disorder Identification Test (AUDIT) score.

Results: Between October 2020 and April 2021, 2708 individuals were invited to take part, of which 2531 (93.5%) did not respond, 54 (2%) were ineligible, and 123 (4.5%) responded and were randomly allocated (62, 50.4%, intervention; 61, 49.6%, control). At day 84, 41 (66.1%) participants in the intervention arm and 37 (60.7%) in the control arm completed the primary outcome assessment. Between baseline and day 84, weekly alcohol consumption reduced by -10.5 (95% CI -19.5 to -1.5) units in the control arm and -28.2 (95% CI -36.9 to -19.5) units in the intervention arm (P=.003, Cohen d=0.35). We also found a significant reduction in the AUDIT score of -3.9 (95% CI -6.2 to -1.6) in the intervention arm (Cohen d=0.48). Our primary and secondary effects did not persist over the longer term (day 168). Two adverse events were detected during the trial.

Conclusions: This study examined the efficacy of a fully automated 28-day brief alcohol intervention delivered via a mobile app in a help-seeking sample of UK veterans with hazardous alcohol consumption. We found that participants receiving Drinks:Ration reduced their alcohol consumption more than participants receiving guidance only (at day 84). In the short term, we found Drinks:Ration is efficacious in reducing alcohol consumption in help-seeking veterans.

Trial registration: ClinicalTrials.gov NCT04494594; https://tinyurl.com/34em6n9f.

International registered report identifier (irrid): RR2-10.2196/19720.

Keywords: alcohol consumption; alcohol intervention; alcohol misuse; digital health; digital intervention; health intervention; mHealth; mental health; military; mobile health; smartphone; smartphone application; veteran.

Conflict of interest statement

Conflicts of Interest: NTF is partly funded by a grant from the UK Ministry of Defence. NTF sits on the Independent Group Advising on the Release of Patient Data at NHS Digital. NTF is also a trustee of a military-related charity. AS is a full-time member of the UK armed forces (AF) seconded to King’s College London. DL is a reservist in the UK AF. DM is employed by Combat Stress, a national charity in the United Kingdom that provides clinical mental health services to veterans and is a trustee of the Forces in Mind Trust (the funder for the project). DL and EC are partly funded by the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at South London and the Maudsley NHS Foundation Trust and King’s College London and represents independent research.

©Daniel Leightley, Charlotte Williamson, Roberto J Rona, Ewan Carr, James Shearer, Jordan P Davis, Amos Simms, Nicola T Fear, Laura Goodwin, Dominic Murphy. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 20.06.2022.

Figures

Figure 1
Figure 1
Example screenshots extracted from the Drinks:Ration app.
Figure 2
Figure 2
CONSORT diagram for recruitment into the RCT. CONSORT: Consolidated Standards of Reporting Trials; RCT: randomized controlled trial.
Figure 3
Figure 3
Trajectory for self-reported alcohol unit consumption per week as estimated from the mixed model.

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