Down Your Drink: A pragmatic cohort study of an on-line intervention aimed at hazardous drinkers.

Elizabeth Murray
Primary Care and Population Sciences, University College Lon

*Stuart Linke
Psychology Department, Camden and Islington Mentall Health and Social Care Trust.

*Paul Wallace
Primary Care and Population Sciences, University College London

Topic: Psychobehavioral interventions
Track: Research
Type: Oral presentation

     Full text: Not available
     Slides: available to participants
     Last modified: March 15, 2006
     Presentation date: 10/18/2006 11:00 AM in RYH Confederation 5
     (View Schedule)

Abstract
Background.
The adverse effects of excessive alcohol consumption include physical and mental health problems, antisocial behaviour, violence, accidents, suicide, injuries, road traffic accidents and unsafe sexual behaviour. In the UK nearly 10% of adults are estimated to be at harm from binge drinking (predominantly those aged under 25), and 15% from regular excessive alcohol intake,1 costing the National Health Service £1.7bn ($2.9bn) per annum. In the US the costs of alcohol abuse were estimated as $184.6 billion in 1998, of which $26.3 billion were direct costs to the health services2.

A series of systematic reviews have confirmed the effectiveness of brief interventions in reducing alcohol consumption and the risk of harm3. However, brief interventions are underutilised4. One potential solution may be to deliver a brief intervention aimed at reducing alcohol intake amongst hazardous drinkers over the Internet. Down Your Drink (www.downyourdrink.org.uk) is such an intervention. This paper reports data from the first 10,000 users of the site.

Methods
Pragmatic cohort study of the first 10,000 registrants of Down Your Drink.

Intervention. Down Your Drink, a free six week on-line brief intervention aimed at reducing alcohol consumption amongst hazardous drinkers. It contains motivational enhancement, cognitive behavioural therapy, and relapse prevention with additional interactive features such as an automated drinking diary and consumption calculator, online quizzes, interactive behavioural analysis of drinking situations (the "thinking drinking" log), blood alcohol concentration calculator and an intelligent email service.

Visitors to the site completed the Fast Alcohol Screening Test; those whose scores suggested risky drinking were directed to the free course. The primary outcome measure, completed at the end of weeks 1 and 6 was the Short Alcohol Dependency Questionnaire (SADD), secondary outcome measures were the Alcohol Problem Questionnaire (HARM) (which assesses harm associated with heavy drinking) and the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) (which assesses mental health).

Results
10,000 people scoring above the cut-off for risky drinking registered to use the site between September 2003 and January 2006 (51.9% female, mean age 37y, one-third single, 42% living with children). 16.5% of these (1,654 registrants) completed the six week programme. Mean scores improved on all outcome measures for those who completed the programme. Mean SADD scores for men: week 1 = 11.51, week 6 = 7.65, mean difference (95% confidence intervals) = -3.86 (-4.31 to – 3.40); for women week 1 = 11.58, week 6 = 7.64, men difference (95% CI) –3.93 (-4.32 to –3.54). Mean HARM scores for men: week 1 = 7.18, week 6 = 3.43, mean difference (95% CI) = -3.76 (-4.18 to – 3.33); for women week 1 = 6.61, week 6 = 3.05, mean difference (95% CI) = -3.56 (-3.89 to -3.23). CORE-OM scores showed similar improvements.

Conclusions
This preliminary study suggests that an on-line intervention to reduce hazardous drinking is acceptable to some people, and that those who completed the intervention reduced their risk of harm from alcohol, although this may not have been due to the intervention. This intervention shows promise, and we are proceeding to an on-line randomised controlled trial.


(1) Cabinet Office Strategy Unit. Alcohol Harm Reduction Strategy for England. London: Prime Minister's Strategy Unit; 2004.
(2 ) Department of Health and Human Services. 10th Special Report to the US Congress on Alcohol and Health. Washington: Department of Health and Human Services; 2000.
(3 ) Heather N. Effectiveness of brief interventions proved beyond reasonable doubt. Addiction 2002 Mar;97(3):293-4.
(4) Heather N. The public health and brief interventions for excessive alcohol consumption: the British experience. Addict Behav 1996 Nov;21(6):857-68.