Abstract
BackgroundAlcohol use is prevalent in many societies and has major adverse impacts on health, but the availability of effective interventions limits treatment options for those who want assistance in changing their patterns of alcohol use.ObjectiveThis study evaluated the new Daybreak program, which is accessible via mobile app and desktop and was developed by Hello Sunday Morning to support high-risk drinking individuals looking to change their relationship with alcohol. In particular, we compared the effect of adding online coaching via real-time chat messages (intervention group) to an otherwise self-guided program (control group).MethodsWe designed the intervention as a randomized control trial, but as some people (n=48; 11.9%) in the control group were able to use the online coaching, the main analysis comprised all participants. We collected online surveys at one-month and three-months follow-up. The primary outcome was change in alcohol risk (measured with the alcohol use disorders identification test–consumption [AUDIT–C] score), but other outcomes included the number of standard drinks per week, alcohol-related days out of role, psychological distress (Kessler-10), and quality of life (EUROHIS-QOL). Markers of engagement with the program included posts to the site and comments on the posts of others. The primary analysis used Weighted Generalized Estimating Equations.ResultsWe recruited 398 people to the intervention group (50.2%) and 395 people to the control group (49.8%). Most were female (71%) and the mean age was 40.1 years. Most participants were classified as probably dependent (550, 69%) on the AUDIT–10, with 243 (31%) classified with hazardous or harmful consumption. We followed up with 334 (42.1%) participants at one month and 293 (36.9%) at three months. By three months there were significant improvements in AUDIT–C scores (down from mean 9.1 [SD 1.9] to 5.8 [SD 3.1]), alcohol consumed per week (down from mean 37.1 [SD 28.3] to mean 17.5 [SD 18.9]), days out of role (down from mean 1.6 [SD 3.6] to 0.5 [SD 1.6]), quality of life (up from 3.2 [SD 0.7] to 3.6 [SD 0.7]) and reduced distress (down from 24.8 [SD 7.0] to 19.0 [SD 6.6]). Accessing online coaching was not associated with improved outcomes, but engagement with the program (eg, posts and comments on the posts of others) were significantly associated with improvements (eg, in AUDIT–C, alcohol use and EUROHIS-QOL). Reduced alcohol use was found for both probably dependent (estimated marginal mean of 40.8 to 20.1 drinks) and hazardous or harmful alcohol users (estimated marginal mean of 22.9 to 11.9 drinks).ConclusionsClinically significant reductions in alcohol use were found, as well as reduced alcohol risk (AUDIT–C) and days out of role. Importantly, improved alcohol-related outcomes were found for both hazardous or harmful and probably dependent drinkers. Since October 2016, Daybreak has reached more than 50,000 participants. Therefore, there is the potential for the program to have an impact on alcohol-related problems at a population health level, importantly including an effect on probably dependent drinkers.Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12618000010291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373110International Registered Report Identifier (IRRID)RR2-10.2196/9982
Highlights
The use of alcohol is one of the leading causes of disease burden and deaths globally, and among those aged 15-49 years it is the leading risk factor for deaths for both males and females [1]
J Med Internet Res 2019 | vol 21 | iss. 9 | e14967 | p. 1 program to have an impact on alcohol-related problems at a population health level, importantly including an effect on probably dependent drinkers
The study was planned as a randomized control trial to compare the Daybreak program plus online coaching via real-time chat messages (Intervention group) and the Daybreak program without online coaching (Control group) at one, three and six months
Summary
The use of alcohol is one of the leading causes of disease burden and deaths globally, and among those aged 15-49 years it is the leading risk factor for deaths for both males and females [1]. While there are increasing doubts that alcohol use confers any health benefits [2], national guidelines tend to be framed in terms of reducing the risks to health from alcohol use [3,4] Despite these guidelines, many people still consume alcohol in a manner that increases their risk of adverse consequences: in Australia, about 38% of those aged 12 years or older exceeded either the single occasion consumption guideline or the regular use guideline in 2016 [5]. In the United States, about 24.5% of those aged 12 years or older are classified as having binged in the last 12 months, about 6.1% have engaged in heavy alcohol use and about 5.1% have an alcohol use disorder [7] Even among those with an alcohol use disorder, less than 10% are likely to have received treatment in the last year [8]. Alcohol use is prevalent in many societies and has major adverse impacts on health, but the availability of effective interventions limits treatment options for those who want assistance in changing their patterns of alcohol use
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