Abstract
Purpose
The aim of this study was to compare the effectiveness of a brief and an intensive self-help alcohol intervention and to assess the feasibility of recruiting to such interventions in a workplace setting.
Method
Employees who screened positive for hazardous drinking (n = 85) received online personalized normative feedback and were randomly assigned to one out of two conditions: either they received an e-booklet about the effects of alcohol or they received a self-help intervention comprising 62 web-based, fully automated, and interactive sessions, plus reminder e-mails, and mobile phone text messages (Short Message Service).
Results
Two months after baseline, the responders in the intensive condition drank an average of five to six drinks less per week compared to the responders in the brief condition (B = 5.68, 95% CI = 0.48–10.87, P = .03). There was no significant difference between conditions, using baseline observation carried forward imputation (B = 2.96, 95% CI = −0.50–6.42, P = .09). Six months after baseline, no significant difference was found, neither based on complete cases nor intent-to-treat (B = 1.07, 95% CI = −1.29–3.44, P = .37). Challenges with recruitment are thoroughly reported.
Conclusion
The study supports the feasibility and the safety of use for both brief and intensive Internet-based self-help in an occupational setting. The study may inform future trials, but due to recruitment problems and low statistical power, the findings are inconclusive in terms of the intensive program being more effective than brief intervention alone.
Trial Registration
ClinicalTrials.gov Identifier: NCT01931618
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.References
Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra JJ. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet. 2009;373(9682):2223–33.
World Health Organization (WHO). Global status report on alcohol and health 2014. Geneva: WHO Press; 2014.
Anderson P. Alcohol as a key area. BMJ. 1991;303(6805):766–9.
Mangione TW, Howland J, Amick B, Cote J, Lee M, Bell N, et al. Employee drinking practices and work performance. J Stud Alcohol. 1999;60(2):261–70.
Gjelsvik R. Utredning av de samfunnsmessige kostnadene relatert til alkohol [Report of the societal costs related to alcohol]. Notatserie i helseøkonomi [Notes on health economy], Rokkansenteret, Bergen, Norway, 2004, no. 07.
Collins DJ, Lapsley HM. The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05. National Drug Strategy Monograph Series no. 66. Canberra: Australian Government Department of Health and Ageing; 2008.
McFarlin SK, Fals-Stewart W. Workplace absenteeism and alcohol use: a sequential analysis. Psychol Addict Behav. 2002;16(1):17–21.
Roche AM, Pidd K, Berry JG, Harrison JE. Workers’ drinking patterns: the impact on absenteeism in the Australian work-place. Addiction. 2008;103(5):738–48.
Roman PM, Blum TC. The workplace and alcohol problem prevention. Alcohol Res Health. 2002;26(1):49–57.
Webb G, Shakeshaft A, Sanson-Fisher R, Havard A. A systematic review of work-place interventions for alcohol-related problems. Addiction. 2009;104(3):365–77.
Roman PM. Missing work. In: Miller WR, Weisner CM, editors. Changing substance abuse through health and social systems. 1st ed. New York: Kluwer Academic; 2002. p. 197–210.
Hester RK, Miller JH. Computer-based tools for diagnosis and treatment of alcohol problems. Alcohol Res Health. 2006;29(1):36–40.
Griffiths F, Lindenmeyer A, Powell J, Lowe P, Thorogood M. Why are health care interventions delivered over the Internet? A systematic review of the published literature. J Med Internet Res. 2006;8(2):e10.
White A, Kavanagh D, Stallman H, Klein B, Kay-Lambkin F, Proudfoot J, et al. Online alcohol interventions: a systematic review. J Med Internet Res. 2010;12:e62.
Murray E. Web-based interventions for behavior change and self-management: potential, pitfalls, and progress. Med 2 0. 2012;1(2):e3.
Duckert F, Drozd F, Kraft P. Alkoholproblemer på arbeidsplassen—en arena for tidlig intervensjon via nye medier [Alcohol problems at the workplace—an arena for early interventions through the Internet]. J Nor Psychol Assoc. 2011;48(8):767–73.
Keyes KM, Hatzenbuehler ML, McLaughlin KA, Link B, Olfson M, Grant BF, et al. Stigma and treatment for alcohol disorders in the United States. Am J Epidemiol. 2010;172(12):1364–72.
Room R. Stigma, social inequality and alcohol and drug use. Drug Alcohol Rev. 2005;24(2):143–55.
Khadjesari Z, Stevenson F, Godfrey C, Murray E. Negotiating the ‘grey area between normal social drinking and being a smelly tramp’: a qualitative study of people searching for help online to reduce their drinking. Health Expect. 2015;18(6):2011–20.
Riper H, Spek V, Boon B, Conijn B, Kramer J, Martin-Abello K, et al. Effectiveness of E-self-help interventions for curbing adult problem drinking: a meta-analysis. J Med Internet Res. 2011;13(2):e42.
Ames GM, Bennett JB. Prevention interventions of alcohol problems in the workplace. Alcohol Res Health. 2011;34(2):175–87.
Pemberton MR, Williams J, Herman-Stahl M, Calvin SL, Bradshaw MR, Bray RM, et al. Evaluation of two web-based alcohol interventions in the U.S. military. J Stud Alcohol Drugs. 2011;72(3):480–9.
Matano RA, Koopman C, Wanat SF, Winzelberg AJ, Whitsell SD, Westrup D, et al. A pilot study of an interactive web site in the workplace for reducing alcohol consumption. J Subst Abus Treat. 2007;32(1):71–80.
Billings DW, Cook RF, Hendrickson A, Dove DC. A web-based approach to managing stress and mood disorders in the workforce. J Occup Environ Med. 2008;50(8):960–8.
Doumas DM, Hannah E. Preventing high-risk drinking in youth in the workplace: a web-based normative feedback program. J Subst Abus Treat. 2008;34(3):263–71.
Khadjesari Z, Freemantle N, Linke S, Hunter R, Murray E. Health on the web: randomised controlled trial of online screening and brief alcohol intervention delivered in a workplace setting. PLoS One. 2014;9(11):e112553.
Riper H, van Straten A, Keuken M, Smit F, Schippers G, Cuijpers P. Curbing problem drinking with personalized-feedback interventions: a meta-analysis. Am J Prev Med. 2009;36(3):247–55.
Donoghue K, Patton R, Phillips T, Deluca P, Drummond C. The effectiveness of electronic screening and brief intervention for reducing levels of alcohol consumption: a systematic review and meta-analysis. J Med Internet Res. 2014;16(6):e142.
Smit F, Lokkerbol J, Riper H, Majo MC, Boon B, Blankers M. Modeling the cost-effectiveness of health care systems for alcohol use disorders: how implementation of eHealth interventions improves cost-effectiveness. J Med Internet Res. 2011;13(3):e56.
Brendryen H, Johansen A, Nesvåg S, Kok G, Duckert F. Constructing a theory- and evidence-based treatment rationale for complex eHealth interventions: development of an online alcohol intervention using an intervention mapping approach. JMIR Res Protoc. 2013;2(1):e6.
Breslin FC, Sobell MB, Sobell LC, Buchan G, Cunningham JA. Toward a stepped care approach to treating problem drinkers: the predictive utility of within-treatment variables and therapist prognostic ratings. Addiction. 1997;92(11):1479–89.
Murray E, Khadjesari Z, Linke S, Hunter R, Freemantle N. Health on the web: randomised trial of work-based online screening and brief intervention for hazardous and harmful drinking. BMC Public Health. 2013;13:505.
Brendryen H, Lund IO, Johansen AB, Riksheim M, Nesvåg S, Duckert F. Balance: a pragmatic randomized controlled trial of an online intensive self-help alcohol intervention. Addiction. 2014;109(2):218–26.
Hodgson R, Alwyn T, John B, Thom B, Smith A. The FAST alcohol screening test. Alcohol Alcohol. 2002;37(1):61–6.
Danaher BG, Boles SM, Akers L, Gordon JS, Severson HH. Defining participant exposure measures in web-based health behavior change programs. J Med Internet Res. 2006;8(3):e15.
Danaher BG, Seeley JR. Methodological issues in research on web-based behavioral interventions. Ann Behav Med. 2009;38(1):28–39.
Baumeister RF, Vohs KD. Handbook of self-regulation: research, theory, and applications. New York: The Guilford Press; 2004. ISBN: 1606239481
Marlatt GA, Gordon JR. Relapse prevention. New York: Guilford; 1985. ISBN: 1593856415
Gross JJ. Handbook of emotion regulation. New York: Guilford; 2007. ISBN: 1606233548
Curven B, Palmer S, Ruddell P. Brief cognitive behaviour therapy. London: Sage Publications; 2006. ISBN: 9780761958017
Seligman ME, Steen TA, Park N, Peterson C. Positive psychology progress: empirical validation of interventions. Am Psychol. 2005;60(5):410–21.
Lyubomirsky S, Sheldon KM, Schkade D. Pursuing happiness: the architecture of sustainable change. Rev Gen Psychol. 2005;9(2):111–31. doi:10.1037/1089-2680.9.2.111.
Danaher BG, McKay HG, Seeley JR. The information architecture of behavior change websites. J Med Internet Res. 2005;7(2):e12.
Brendryen H, Kraft P, Schaalma H. Looking inside the black box: using intervention mapping to describe the development of the automated smoking cessation intervention ‘happy ending’. J Smok Cessat. 2010;5(1):29–56. doi:10.1375/jsc.5.1.29.
Crutzen R, Cyr D, de Vries NK. The role of user control in adherence to and knowledge gained from a website: randomized comparison between a tunneled version and a freedom-of-choice version. J Med Internet Res. 2012;14(2):e45.
Fogg BJ. Persuasive technology: using computers to change what we think and do. San Francisco: Elsevier; 2003. ISBN: 1558606432
Kraft P, Schjelderup-Lund H, Brendryen H. Digital therapy: the coming together of psychology and technology can create a new generation of programs for more sustainable behavioral change. LNCS. 2007;4744:18–23.
Haga SM, Drozd F, Brendryen H, Slinning K. Mamma mia: a feasibility study of a web-based intervention to reduce the risk of postpartum depression and enhance subjective well-being. JMIR Res Protoc. 2013;2(2):e29. doi:10.2196/resprot.2659.
Danaher BG, Brendryen H, Seeley JR, Tyler MS, Woolley T. From black box to toolbox: outlining device functionality, engagement activities, and the pervasive information architecture of mHealth interventions. Internet Interv. 2015;2(1):91–101.
Lehto T, Oinas-Kukkonen H. Persuasive features in web-based alcohol and smoking interventions: a systematic review of the literature. J Med Internet Res. 2011;13(3):e46.
Drozd F, Haga SM, Brendryen H, Slinning K. An Internet-based intervention (Mamma Mia) for postpartum depression: mapping the development from theory to practice. JMIR research protocols. 2015;4(4):e120. doi:10.2196/resprot.4858.
Holter MTS, Johansen A, Brendryen H. How a fully automated eHealth program simulates three therapeutic processes: a case study. J Med Internet Res. 2016;18(6):e176. doi:10.2196/jmir.5415.
Cunningham JA. Comparison of two internet-based interventions for problem drinkers: randomized controlled trial. J Med Internet Res. 2012;14(4):e107.
Sinadinovic K, Wennberg P, Johansson M, Berman AH. Targeting individuals with problematic alcohol use via web-based cognitive-behavioral self-help modules, personalized screening feedback or assessment only: a randomized controlled trial. Eur Addict Res. 2014;20(6):305–18.
Postel MG, de Haan HA, ter Huurne ED, van der Palen J, Becker ES, de Jong CA. Attrition in web-based treatment for problem drinkers. J Med Internet Res. 2011;13(4):e117.
Riper H, Kramer J, Smit F, Conijn B, Schippers G, Cuijpers P. Web-based self-help for problem drinkers: a pragmatic randomized trial. Addiction. 2008;103(2):218–27.
Hester RK, Delaney HD, Campbell W. ModerateDrinking.Com and moderation management: outcomes of a randomized clinical trial with non-dependent problem drinkers. J Consult Clin Psychol. 2011;79(2):215–24.
Eysenbach G. The law of attrition. J Med Internet Res. 2005;7(1):e11.
Murray E, Khadjesari Z, White IR, Kalaitzaki E, Godfrey C, McCambridge J, et al. Methodological challenges in online trials. J Med Internet Res. 2009;11(2):e9.
Murray E, White IR, Varagunam M, Godfrey C, Khadjesari Z, McCambridge J. Attrition revisited: adherence and retention in a web-based alcohol trial. J Med Internet Res. 2013;15(8):e162.
Yardley L, Spring BJ, Riper H, Morrison LG, Crane DH, Curtis K, et al. Understanding and promoting effective engagement with digital behavior change interventions. Am J Prev Med. 2016;51(5):833–42.
Acknowledgements
This trial was funded by the Norwegian Research Council and the Norwegian Centre for Addiction Research. The intervention was funded by The Workplace Advisory Centre for Issues Relating to Alcohol, Drugs, and Addictive Gambling. Trial results are owned by the University of Oslo, and there are no contractual constraints regarding publication from any of the sponsors. Thanks are extended to Marianne T. S. Holter for her useful comments and language editing of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
In 2009, the first author, H.B., received payments from The Workplace Advisory Centre for Issues Relating to Alcohol, Drugs, and Addictive Gambling, a non-profit organization working with prevention and recovery of addictions. The advisory centre developed and funded the current intervention, and is currently implementing it across Norway. H.B. has no other competing interests. The co-authors, A.B.J., F.D., and S.N., declare that they have no competing interests.
Human and Animal Rights and Informed Consent
This trial was conducted in accordance with the Helsinki Declaration, and it was approved by the Regional Ethics Comity for Medical Research (REC south-east D). Informed consent was obtained from all individual participants included in this study.
Rights and permissions
About this article
Cite this article
Brendryen, H., Johansen, A., Duckert, F. et al. A Pilot Randomized Controlled Trial of an Internet-Based Alcohol Intervention in a Workplace Setting. Int.J. Behav. Med. 24, 768–777 (2017). https://doi.org/10.1007/s12529-017-9665-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12529-017-9665-0