Overcoming Addictions, a Web-Based Application, and SMART Recovery, an Online and In-Person Mutual Help Group for Problem Drinkers, Part 2: Six-Month Outcomes of a Randomized Controlled Trial and Qualitative Feedback From Participants

William Campbell, Reid K Hester, Kathryn L Lenberg, Harold D Delaney, William Campbell, Reid K Hester, Kathryn L Lenberg, Harold D Delaney

Abstract

Background: Despite empirical evidence supporting the use of Web-based interventions for problem drinking, much remains unknown about factors that influence their effectiveness.

Objective: We evaluated the performance of 2 resources for people who want to achieve and maintain abstinence: SMART Recovery (SR) and Overcoming Addictions (OA). OA is a Web application based on SR. We also examined participant and intervention-related factors hypothesized to impact clinical outcomes of Web-based interventions.

Methods: We recruited 189 heavy drinkers through SR's website and in-person meetings throughout the United States. We began by randomly assigning participants to (1) SR meetings alone, (2) OA alone, and (3) OA and SR (OA+SR). Recruitment challenges compelled us to assign participants only to SR (n=86) or OA+SR (n=102). The experimental hypotheses were as follows: (1) Both groups will reduce their drinking and alcohol-related consequences at follow-up compared with their baseline levels, and (2) The OA+SR condition will reduce their drinking and alcohol or drug-related consequences more than the SR only condition. Additionally, we derived 3 groups empirically (SR, OA, and OA+SR) based on the participants' actual use of each intervention and conducted analyses by comparing them. Primary outcome measures included percent days abstinent (PDA), mean drinks per drinking day (DDD), and alcohol or drug-related consequences. Postbaseline assessments were conducted by phone at 3 and 6 months. Secondary analyses explored whether clinical issues (eg, severity of alcohol problems, level of distress, readiness to change) or intervention-related factors (eg, Internet fluency, satisfaction with site) affected outcomes.

Results: Both intent-to-treat analyses and the actual-use analyses showed highly significant improvement from baseline to follow-ups for all 3 groups. Mean within-subject effect sizes were large (d>0.8) overall. There was no significant difference between groups in the amount of improvement from baseline to the average of the follow-ups. We found that participants who stopped drinking before joining the clinical trial had significantly better outcomes than participants who were still drinking when they joined the study. Neither Internet fluency nor participants' reported ease of navigating the site had an impact on outcomes.

Conclusions: These results support our first experimental hypothesis but not the second. On average, participants improved on all dependent measures. Both SR and OA helped participants recover from their problem drinking. Web-based interventions can help even those individuals with lengthy histories of heavy drinking to make clinically significant reductions in their consumption and related problems. These interventions work well for individuals in the action stage of change.

Trial registration: Clinicaltrials.gov NCT01389297; https://ichgcp.net/clinical-trials-registry/NCT01389297 (Archived by WebCite at http://www.webcitation.org/6kLNUNDcc).

Keywords: alcohol addiction; digital interventions; engagement; intervention study; online program; psychological techniques; self-help.

Conflict of interest statement

The second author holds the copyright to the Overcoming Addictions Web application. It went “live” to the general public in September, 2013 on a subscription basis with a portion of the proceeds going to SMART Recovery. He is also a member of SMART Recovery’s International Board of Advisors, a volunteer position.

Figures

Figure 1
Figure 1
Consort study participant flow chart. OA: Overcoming Addictions; SR: SMART Recovery.
Figure 2
Figure 2
Actual use analysis: percent days abstinent. OA: Overcoming Addictions; SR: SMART Recovery.
Figure 3
Figure 3
Actual use analysis: drinks per drinking day. OA: Overcoming Addictions; SR: SMART Recovery.
Figure 4
Figure 4
Actual use analysis: alcohol-related problems. OA: Overcoming Addictions; SR: SMART Recovery.
Figure 5
Figure 5
Stage of change analysis: percent days abstinent.
Figure 6
Figure 6
Stage of change analysis: drinks per drinking day.
Figure 7
Figure 7
Stage of change analysis: alcohol-related problems.

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