Ultra-brief intervention for problem drinkers: results from a randomized controlled trial

John A Cunningham, Clayton Neighbors, Cameron Wild, Keith Humphreys, John A Cunningham, Clayton Neighbors, Cameron Wild, Keith Humphreys

Abstract

Background: There are a number of evidence-based, in-person clinical inteventions for problem drinkers, but most problem drinkers will never seek such treatments. Reaching the population of non-treatment seeking problem drinkers will require a different approach. Accordingly, this randomized clinical trial evaluated an intervention that has been validated in clinical settings and then modified into an ultra-brief format suitable for use as an indicated public health intervention (i.e., targeting the population of non-treatment seeking problem drinkers).

Methodology/principal findings: Problem drinkers (N = 1767) completed a baseline population telephone survey and then were randomized to one of three conditions - a personalized feedback pamphlet condition, a control pamphlet condition, or a no intervention control condition. In the week after the baseline survey, households in the two pamphlet conditions were sent their respective interventions by postal mail addressed to 'Check Your Drinking.' Changes in drinking were assessed post intervention at three-month and six-month follow-ups. The follow-up rate was 86% at three-months and 76% at six-months. There was a small effect (p = .04) in one of three outcome variables (reduction in AUDIT-C, a composite measure of quantity and frequency of drinking) observed for the personalized feedback pamphlet compared to the no intervention control. No significant differences (p>.05) between groups were observed for the other two outcome variables - number of drinks consumed in the past seven days and highest number of drinks on one occasion.

Conclusions/significance: Based on the results of this study, we tentatively conclude that a brief intervention, modified to an ultra-brief, public health format can have a meaningful impact.

Trial registration: ClinicalTrials.gov NCT00688584.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. CONSORT diagram of participant recruitment.
Figure 1. CONSORT diagram of participant recruitment.
Figure 2. Mean AUDIT-C scores for participants…
Figure 2. Mean AUDIT-C scores for participants in the three conditions across baseline, three-month, and six-month follow-ups.

References

    1. World Health Organization (2009) Global health risks: Mortality and burden of disease attributable to selected major risks. Geneva, Switzerland: World Health Organization.
    1. Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, et al. (2009) Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet 373: 2223–2233.
    1. Rehm J, Patra J, Popova S (2006) Alcohol-attributable mortality and potential years of life lost in Canada 2001: Implications for prevention and policy. Addiction 101: 373–384.
    1. Rehm J, Gnam W, Popova S, Baliunas D, Brochu S, et al. (2007) The costs of alcohol, illegal drugs, and tobacco in Canada, 2002. Journal of studies on alcohol and drugs 68: 886–895.
    1. Babor TF, Caetano R, Casswell S, Edwards G, Giesbrecht N, et al... (2010) Alcohol: No Ordinary Commodity - Research and Public Policy. Oxford and London: Oxford University Press.
    1. Miller WR (2000) Rediscovering fire: Small interventions, large effects. Psychology of Addictive Behaviors 14: 6–18.
    1. Room R, Babor T, Rehm J (2005) Alcohol and public health. Lancet 365: 519–530.
    1. National Institute on Alcohol Abuse and Alcoholism (2005) Helping patients who drink too much: A clinician’s guide. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism.
    1. Cunningham JA, Breslin FC (2004) Only one in three people with alcohol abuse or dependence ever seek treatment. Addictive Behaviors 29: 221–223.
    1. Anderson P, Kaner E, Wutzke S, Funk M, Heather N, et al. (2004) Attitudes and managing alcohol problems in general practice: an interaction analysis based on findings from a WHO collaborative study. Alcohol and Alcoholism 39: 351–356.
    1. Koski-Jännes A, Cunningham JA (2001) Interest in different forms of self-help in a general population sample of drinkers. Addictive Behaviors 26: 91–99.
    1. Cunningham JA, Kypri K, McCambridge J (2011) The use of emerging technologies in alcohol treatment. Alcohol Research & Health 33: 320–326.
    1. Cunningham JA, Wild TC, Cordingley J, van Mierlo T, Humphreys K (2009) A randomized controlled trial of an internet-based intervention for alcohol abusers. Addiction 104: 2023–2032.
    1. Riper H, Spek V, Boon B, Conijn B, Kramer J, et al. (2011) Effectiveness of E-self-help interventions for curbing adult problem drinking: a meta-analysis. Journal of medical Internet research 13: e42.
    1. Cunningham JA, Selby PL, Kypri K, Humphreys KN (2006) Access to the Internet among drinkers, smokers and illicit drug users: Is it a barrier to the provision of interventions on the World Wide Web? Medical Informatics and the Internet in Medicine 31: 53–58.
    1. Horrigan J, Raine L (2006) When facing a tough decision, 60 million Americans now seek the Internet’s help - the Internet’s growing role in life’s major moments.: Pew Internet & American Life Project.
    1. Cunningham JA, Wild TC, Bondy SJ, Lin E (2001) Impact of normative feedback on problem drinkers: A small-area population study. Journal of Studies on Alcohol 62: 228–233.
    1. Wild TC, Cunningham JA, Roberts AB (2007) Controlled study of brief personalized assessment-feedback for drinkers interested in self-help. Addiction 102: 241–250.
    1. Karlsson T, Raitasalo K, Holmila M, Koski-Jännes A, Ollikainen H, et al. (2005) The impact of a self-help pamphlet on reducing risk drinking among 30- to 49-year-old men in Helsinki, Finland. Substance Use and Misuse 40: 1831–1847.
    1. Cunningham J, Neighbors C, Wild C, Humphreys K (2008) Ultra-brief intervention for problem drinkers: research protocol. BMC Public Health 8: 298.
    1. Babor TF, De La Fuente MF, Saunders JB, Grant M (1989) AUDIT - The alcohol use disorders identification test: Guidelines for use in primary health care. Geneva, Switzerland: World Health Organization.
    1. Saunders JB, Conigrave KM (1990) Early identification of alcohol problems. Canadian Medical Association Journal 143: 1060–1069.
    1. Dawson DA, Grant BF, Stinson FS, Zhou Y (2005) Effectiveness of the derived Alcohol Use Disorders Identification Test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the US general population. Alcoholism: Clinical and Experimental Research 29: 844–854.
    1. McCambridge J, Day M (2008) Randomized controlled trial of the effects of completing the Alcohol Use Disorders Identification Test questionnaire on self-reported hazardous drinking. Addiction 103: 241–248.
    1. Kypri K, Langley JD, Saunders JB, Cashell-Smith ML (2007) Assessment may conceal therapeutic benefit: findings from a randomized controlled trial for hazardous drinking. Addiction 102: 62–70.

Source: PubMed

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