by Michael D. Anestis, M.S.
I'm a big fan of innovations in health care aimed towards reaching broad groups of individuals in need and helping them meet their health goals. The bottom line is that a large proportion of individuals in need of mental health care do not have access to effective treatments for a variety of reasons (e.g., unable to travel to treatment center, no treatment centers in area offering evidence-based care) and others have access but choose not to use it. Interventions capable of reaching these individuals and engaging them in treatment offer immense potential value. Recently, I wrote a PBB post about telehealth treatment for PTSD and today I want to discuss another technology-based treatment: moderatedrinking.com.
In an article published in the current issue of the Journal of Consulting and Clinical Psychology by PBB guest author Reid Hester, Harold Delaney, and PBB guest author William Campbell, the authors described an effectiveness trial comparing their new program in combination with moderation management (MM) - another online treatment tool - to MM on its own in the treatment of problem drinking. The study included follow-ups at 3, 6, and 12 months post-baseline, allowing for an analysis of sustained benefits.
The authors had two central hypotheses:
- Both groups would demonstrate reductions in alcohol-related problems and drinking at follow-ups
- The individuals using moderatedrinking.com as well as MM would exhibit greater reduction in alcohol-related problems and drinking relative to individuals only using MM.
Importantly, the goals of this trial were very specific. The authors were not claiming that individuals with severe mental illnesses would benefit from treatment or that individuals with alcohol dependence would be treated effectively through the protocol. Rather, they were aiming to help individuals with moderate drinking problems looking to decrease the problems in their lives associated with that particular behavior. The authors had detailed inclusion (must have in order to participate) and exclusion (must not have in order to participate) criteria:
- A score on the Alcohol Use Disorder Identification Test (AUDIT; Saunders, Aasland, Babor, de la Fuente, & Grant, 1993) greater than 7
- Self-report that the individual is drinking at least 10 standard drinks per week during the past 30 days
- Individual is not currently abstaining from alcohol
- Individual expresses an interest in moderate drinking
- Individual is at least 21 years old
- Individual has a computer with internet access at home
- History of treatment for substance abuse
- Already member of MM
- History of hospitalization for alcohol or drug dependence or detoxification
- Past or current diagnosis of drug abuse or dependence
- Evidence of past or present physical dependence
- Current indication of psychosis or bipolar spectrum disorder
- Evidence of significant cognitive impairment from brain dysfunction
- Evidence of health-oriented contraindications to any further drinking
- English reading below 8th grade level
- Unwilling/unable to attend follow-ups
- Unwilling/unable to provide significant other to corroborate self-report of drinking
Now, you might look at these criteria and think "hey, they're exclusing a lot of people who need treatment for alcohol use disorders!" You're right...and the authors are up front about that. Again, the point here is not that this treatment is going to be the best thing for everyone, but rather that, for individuals with only moderate problems with drinking, an online intervention might enable them to attain moderation in their behavior and improvement in a range of important variables. Given that many of these individuals are not going to seek or be referred to more intensive treatment programs, either because they do not meet diagnostic criteria for dependence or because abstinance, which is the sole focus in most treatments, is not their goal, this provides a potential opportunity to use technology to reach an underserved population in need of help.
In total, 40 individuals were randomly assigned to the moderatedrinking.com + MM group and 44 were randomly assigned to the MM only group. 30 participants from the moderatedrinking.com + MM group were assessed at all four time points and 29 from the MM only group were assessed at all four time points. Here's what they found:
Looking at both groups together, they found significant improvement from baseline through 12-months post-baseline, with evidence for increased improvement from 6 to 12 months post-baseline (meaning that the effects not only held over time, but actually continued to improve). At baseline, participants, on average, were at the 54th percentile for women and 65th for men. At 12 months, they were at the 29th for women and 38th for men. Reduction in overall alcohol consumption was significant, as were increases in percentage of days abstinant and decreases in number of drinks per drinking day and blood alcohol content (BAC) on drinking days. More specifically, average drinks per drinking day dropped from 5.35 at baseline to 3.28 at 12 months and BAC on drinking days dropped from 102 mg% to 58 mg%.
Looking at the groups separately, improvement from baseline to average at follow-ups was twice as large in the moderatedrinking.com + MM group than in the MM group. That being said, while the improvement was significantly greater in the combined group than in the MM only group at 3 months, that difference was non-significant at the other follow-ups (meaning the two groups did not differ on level of improvement at those times). Additionally, individuals in the combined group demonstrated a greater improvment in the number of days abstinent from alcohol than did folks in the MM only group. Finally, lighter drinkers in the combined group had better outcomes in terms of BAC on drinking days than did folks in the MM only group, but heavier drinkers in the combined group did not have significantly better results. This last result further supports the notion that this treatment option is not aimed at individuals with severe alcohol use problems, but rather individuals who are developing problems and would like to adjust their behavior and its associated outcomes.
Okay...I threw a lot of results at you there (and there are some I left out). The overall point here from this study is that there is some compelling preliminary evidence that a new online intervention can, in combination with another online resource, prove incrementally useful for non-severe problem drinkers. Again, I love that this study uses technology to reach individuals outside of the clinic. As much as I love the idea of people in need of mental health care travelling to local clinics to receive evidence-based care, that simply is not realistic in a lot of cases, so programs like this offer another potential method of providing evidence-based care to large groups of people in need.
As I write this, I am aware that the goal of this program - and, in fact, the name itself - may seem odd to some readers. After all, isn't abstinance the only goal in alcohol use treatment? The short answer is that the evidence says differently - that for those who seek moderation as an outcome, this is, in fact, an attainable goal. Keep in mind, however, that neither PBB nor moderatedrinking.com is proclaiming abstinance from drinking to be a bad goal or that all individuals with alcohol use disorders can attain a healthy level of moderate drinking. This is simply one means towards attaining one goal that could fit for certain individuals.
If you would like to learn more about this or other topics discussed on PBB, we recommend that you consult our online store for scientifically-based psychological resources.