Web-based treatment of harmful alcohol use and alcohol dependence: A randomized controlled trial (Preprint)

BACKGROUND Problematic alcohol use is a major contributor to health loss. Many people with harmful use or alcohol dependence are not reached by treatment, due to limited availability or stigma. They might use internet interventions as an alternative way of getting support. Internet interventions have previously been shown to be effective in reducing alcohol consumption in studies that included hazardous use, but few studies with specific focus on harmful use or alcohol dependence have been conducted. The importance of internet cognitive behavioral therapy (ICBT) programs and therapist guidance in internet interventions are still unclear. OBJECTIVE To investigate the effects of a web-based alcohol-program with or without therapist guidance. METHODS We conducted a three-armed randomized controlled trial comparing therapist-guided ICBT and self-help ICBT with an information only control condition. Help-seeking adult internet-users (n=1169) with alcohol dependence (>=3 ICD criteria) or harmful alcohol use (AUDIT>15) were included in the study during the recruitment period, from March 2015 to March 2017. Participants in the therapist-guided ICBT and self-help ICBT groups had 12-week access to a program consisting of five main and three extra modules as well as a drinking-calendar with automatic feedback. The 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 with the total AUDIT-score, diagnostic criteria for alcohol dependence (ICD-10 criteria) and Alcohol Use Disorder (DSM-5), depression (MADRS-S), anxiety (GAD-7), health (EQ-5D-5L), readiness to change (Readiness Ruler) and access to other treatment or support. Follow-up was conducted 3 (post-treatment) and 6 months after recruitment. RESULTS Participants had a mean age of 45 (SD=13) years and 56% were women. At 3-months follow-up the therapist-guided ICBT and control group differed significantly in weekly alcohol consumption (-3.84, 95 CI=-6.53 to -1.16, t=2.81, p=.005, 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 self-help ICBT and the control group at 3 months or between any of the groups at 6 months. CONCLUSIONS In this study we did not find a therapist-guided ICBT program to be more effective than the same program as self-help ICBT in reducing alcohol consumption or other alcohol-related outcomes. In the short run therapist-guided ICBT seems be more effective than information. Only some internet help-seekers might need a multi-session program and therapist guidance in order to change their drinking when they use internet interventions. CLINICALTRIAL Trial registration: ClinicalTrials.gov, identifier: NCT02377726, https://clinicaltrials.gov/ct2/show/NCT02377726 This trial was approved by the Stockholm Regional Ethical Review Board (No. 2014/1758-31/2).