Effects of Internet-Based Cognitive Behavioral Therapy for Harmful Alcohol Use and Alcohol Dependence as Self-help or With Therapist Guidance: Three-Armed Randomized Trial

Magnus Johansson, Anne H Berman, Kristina Sinadinovic, Philip Lindner, Ulric Hermansson, Sven Andréasson, Magnus Johansson, Anne H Berman, Kristina Sinadinovic, Philip Lindner, Ulric Hermansson, Sven Andréasson

Abstract

Background: Alcohol use is a major contributor to health loss. Many persons with harmful use or alcohol dependence do not obtain treatment because of limited availability or stigma. They may use internet-based interventions as an alternative way of obtaining support. Internet-based interventions have previously been shown to be effective in reducing alcohol consumption in studies that included hazardous use; however, few studies have been conducted with a specific focus on harmful use or alcohol dependence. The importance of therapist guidance in internet-based cognitive behavioral therapy (ICBT) programs is still unclear.

Objective: This trial aims to investigate the effects of a web-based alcohol program with or without therapist guidance among anonymous adult help-seekers.

Methods: A three-armed randomized controlled trial was conducted to compare therapist-guided ICBT and self-help ICBT with an information-only control condition. Swedish-speaking adult internet users with alcohol dependence (3 or more International Classification of Diseases, Tenth Revision criteria) or harmful alcohol use (alcohol use disorder identification test>15) were included in the study. Participants in the therapist-guided ICBT and self-help ICBT groups had 12-week access to a program consisting of 5 main modules, as well as a drinking calendar with automatic feedback. Guidance was given by experienced therapists trained in motivational interviewing. The primary outcome measure was weekly alcohol consumption in standard drinks (12 g of ethanol). Secondary outcomes were alcohol-related problems measured using the total alcohol use disorder identification test-score, diagnostic criteria for alcohol dependence and alcohol use disorder, depression, anxiety, health, readiness to change, and access to other treatments or support. Follow-up was conducted 3 (posttreatment) and 6 months after recruitment.

Results: During the recruitment period, from March 2015 to March 2017, 1169 participants were included. Participants had a mean age of 45 (SD 13) years, and 56.72% (663/1169) were women. At the 3-month follow-up, the therapist-guided ICBT and control groups differed significantly in weekly alcohol consumption (-3.84, 95% Cl -6.53 to -1.16; t417=2.81; P=.005; Cohen d=0.27). No significant differences were found in weekly alcohol consumption between the self-help ICBT group and the therapist-guided ICBT at 3 months, between the self-help ICBT and the control group at 3 months, or between any of the groups at the 6-month follow-up. A limitation of the study was the large number of participants who were completely lost to follow-up (477/1169, 40.8%).

Conclusions: In this study, a therapist-guided ICBT program was not found to be more effective than the same program in a self-help ICBT version for reducing alcohol consumption or other alcohol-related outcomes. In the short run, therapist-guided ICBT was more effective than information. Only some internet help-seekers may need a multisession program and therapist guidance to change their drinking when they use internet-based interventions.

Trial registration: ClinicalTrials.gov NCT02377726; https://ichgcp.net/clinical-trials-registry/NCT02377726.

Keywords: CBT; ICBT; alcohol dependence; alcohol use; alcohol use disorders; cognitive behavioral therapy; eHealth; help-seeking behavior; internet-based cognitive behavioral therapy; internet-based interventions; mobile phone; outcomes; substance abuse.

Conflict of interest statement

Conflicts of Interest: None declared.

©Magnus Johansson, Anne H Berman, Kristina Sinadinovic, Philip Lindner, Ulric Hermansson, Sven Andréasson. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 24.11.2021.

Figures

Figure 1
Figure 1
Program module on a computer and the drinking calendar on a smartphone.
Figure 2
Figure 2
CONSORT (Consolidated Standards of Reporting Trials) flow diagram. *All included participants were asked to complete a survey on why they had chosen to use web-based services and their preferences regarding such services. **Overall, 390 users were randomized to the therapist group, but 4 of them (due to a temporary technical error) never completed the baseline assessment and were never allocated to the intervention. ***Users who did not log in a second time after allocation to intervention. ICBT: internet-based cognitive behavioral therapy; ITT: intention-to-treat.
Figure 3
Figure 3
Tipping point analysis of significant contrast in primary outcome at 3 months.

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Source: PubMed

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