E-therapy for Problem Drinking: Results of a Randomized Controlled Trial
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Abstract
Background: Online, self-help interventions for problem drinkers show promising results, but the effectiveness of online therapy with Internet exclusive therapeutic involvement, has not been examined yet.
Objective: To evaluated an e-therapy program with active therapeutic involvement for problem drinkers (www.alcoholdebaas.nl).
Methods: Dutch-speaking problem drinkers in the general population were randomly assigned to the 3-month e-therapy program (n=78) or the waiting list control group (n=78). The e-therapy program consisted of a structured two-part online treatment program in which the participant and the therapist communicated asynchronously, via the Internet only. Participants in the waiting list control group received ‘no-reply’ email messages once every two weeks during the waiting period of 3 months to keep them involved in the study.
Results: The e-therapy group showed a significantly greater improvement in alcohol consumption and health status compared to the control group. The e-therapy group significantly decreased their mean weekly alcohol consumption by 28.8 units compared to 3.1 units in the control group, a difference in means of 25.6 units on a weekly basis (95% CI 15.69-35.80; p<.001). The between-group effect size (pooled SD) was large (d=1.21). At 3 months, 68% of the e-therapy group no longer fulfilled the criteria for problem drinking, versus 15% of the control group (OR=12.0; NNT=1.9; p<.001). The secondary outcome data showed that participants in the e-therapy group also scored significantly better on the MAP-HSS (95% CI 2.37 to 6.17; p<.001), GHQ-28 (95% CI 3.82 to 13.09; p<.005), and the DASS-21 (95% CI 7.96 to 20.29; p<.001). We expect to have the long term follow-up results available in November 2010.
Besides the outcome measures, this study also gained insight in the reasons for dropout; the main reasons for dropping out of the e-therapy program were personal reasons unrelated to the program, the form and content of the e-therapy program, and satisfaction with the positive results that had been achieved.
Conclusions: Participants who received the therapist supported e-therapy program reported substantially greater gains than those who received ‘no-reply’ email messages. At the end of treatment, seven out of ten participants in the e-therapy group achieved drinking behaviour within the guidelines for low-risk drinking. The e-therapy group also showed greater improvement on general health and depression symptoms, compared to the control group.
It appears that because many problem drinkers do not receive any kind of treatment, these initial results point to a meaningful way to deliver easily accessible and effective alcohol treatment to a larger population, members of which do not otherwise seek or receive help for their drinking problem. Additional research is needed to directly compare the effectiveness and costs of the e-therapy program with a face-to-face treatment program.
Based on the results with the Dutch e-therapy programme www.alcoholdebaas.nl; the English programme www.lookatyourdrinking.com was launched in February 2010.
Objective: To evaluated an e-therapy program with active therapeutic involvement for problem drinkers (www.alcoholdebaas.nl).
Methods: Dutch-speaking problem drinkers in the general population were randomly assigned to the 3-month e-therapy program (n=78) or the waiting list control group (n=78). The e-therapy program consisted of a structured two-part online treatment program in which the participant and the therapist communicated asynchronously, via the Internet only. Participants in the waiting list control group received ‘no-reply’ email messages once every two weeks during the waiting period of 3 months to keep them involved in the study.
Results: The e-therapy group showed a significantly greater improvement in alcohol consumption and health status compared to the control group. The e-therapy group significantly decreased their mean weekly alcohol consumption by 28.8 units compared to 3.1 units in the control group, a difference in means of 25.6 units on a weekly basis (95% CI 15.69-35.80; p<.001). The between-group effect size (pooled SD) was large (d=1.21). At 3 months, 68% of the e-therapy group no longer fulfilled the criteria for problem drinking, versus 15% of the control group (OR=12.0; NNT=1.9; p<.001). The secondary outcome data showed that participants in the e-therapy group also scored significantly better on the MAP-HSS (95% CI 2.37 to 6.17; p<.001), GHQ-28 (95% CI 3.82 to 13.09; p<.005), and the DASS-21 (95% CI 7.96 to 20.29; p<.001). We expect to have the long term follow-up results available in November 2010.
Besides the outcome measures, this study also gained insight in the reasons for dropout; the main reasons for dropping out of the e-therapy program were personal reasons unrelated to the program, the form and content of the e-therapy program, and satisfaction with the positive results that had been achieved.
Conclusions: Participants who received the therapist supported e-therapy program reported substantially greater gains than those who received ‘no-reply’ email messages. At the end of treatment, seven out of ten participants in the e-therapy group achieved drinking behaviour within the guidelines for low-risk drinking. The e-therapy group also showed greater improvement on general health and depression symptoms, compared to the control group.
It appears that because many problem drinkers do not receive any kind of treatment, these initial results point to a meaningful way to deliver easily accessible and effective alcohol treatment to a larger population, members of which do not otherwise seek or receive help for their drinking problem. Additional research is needed to directly compare the effectiveness and costs of the e-therapy program with a face-to-face treatment program.
Based on the results with the Dutch e-therapy programme www.alcoholdebaas.nl; the English programme www.lookatyourdrinking.com was launched in February 2010.
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