Effect of a 1-year short message service in detoxified alcohol-dependent patients: a multi-center, open-label randomized controlled trial.

Abstract

Existing evidence suggests that text message interventions can help people to reduce their alcohol consumption. However, studies with alcohol-dependent patients are lacking. In this study a 1-year automatic mobile phone-based short messaging service (SMS) intervention on alcohol consumption in patients after alcohol detoxification in hospital was compared with treatment as usual. Multi-center, randomized, controlled, two parallel-group, observer-blinded trial. Primary and secondary care: four hospitals and community (1million residents, 7600km2 area in Germany). A total of 462 patients with alcohol dependence (ICD-10) were included during inpatient detoxification treatment. Patients were randomly assigned (1:1) to an SMS intervention and treatment as usual (SMS+TAU; n=230; mean age: 45.4years; 22.6% women) or TAU alone (n=232 mean age: 44.5years; 22.8% women). Planned, automated messages were sent to patients over 1year to record assistance needs. A 'yes' or missing response triggered a telephone call from a hospital therapist. Outcome was assessed by an independent survey center. The primary end-point was a three-category alcohol consumption measure covering months 10-12 after discharge: abstinence, non-heavy drinking, heavy drinking [men >60g/day; women >40g/day equal to World Health Organization (WHO) criteria: high risk and very high risk, mean consumption]. Secondary end-points were number of abstinent days over 12months and frequency of abstinence. The arms differed primarily in the heavy drinking category (intervention group 22.2%, TAU-only group 32.3%) in months 9-12. This is reflected by an odds ratio (OR)=1.68, 95% confidence interval (CI)=1.11-2.54, P=0.015 for heavy drinking versus non-heavy drinking/abstinence. No difference between treatments was found with respect to any drinking versus abstinence (OR=1.13). These results were confirmed by models adjusting for randomization strata. In Germany, a 12-month mobile phone short messaging service-based intervention enhanced the reduction in heavy drinking for 1year in routine care among adults with alcohol dependence discharged from inpatient alcohol detoxification.