Curbing Problem Drinking with Personalized-Feedback Interventions A Meta-Analysis

Innovation Centre of Mental Health and Technology, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.
American journal of preventive medicine (Impact Factor: 4.53). 04/2009; 36(3):247-55. DOI: 10.1016/j.amepre.2008.10.016
Source: PubMed


The effectiveness of personalized-feedback interventions to reduce problem drinking has been evaluated in several RCTs and systematic reviews. A meta-analysis was performed to examine the overall effectiveness of brief, single-session personalized-feedback interventions without therapeutic guidance.
The selection and analyses of studies were conducted in 2008. Fourteen RCTs of single-session personalized-feedback interventions without therapeutic guidance were identified, and their combined effectiveness on the reduction of problematic alcohol consumption was evaluated in a meta-analysis. Alcohol consumption was the primary outcome measure.
The pooled standardized-effect size (14 studies, 15 comparisons) for reduced alcohol consumption at post-intervention was d=0.22 (95% CI=0.16, 0.29; the number needed to treat=8.06; areas under the curve=0.562). No heterogeneity existed among the studies (Q=10.962; p=0.69; I(2)=0).
The use of single-session personalized-feedback interventions without therapeutic guidance appears to be a viable and probably cost-effective option for reducing problem drinking in student and general populations. The Internet offers ample opportunities to deliver personalized-feedback interventions on a broad scale, and problem drinkers are known to be amenable to Internet-based interventions. More research is needed on the long-term effectiveness of personalized-feedback interventions for problem drinking, on its potential as a first step in a stepped-care approach, and on its effectiveness with other groups (such as youth obliged to use judicial service programs because of violations of minimum-age drinking laws) and in other settings (such as primary care).

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Available from: Heleen Riper, Oct 01, 2015
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    • "No studies to date, however, have provided feedback based on student-generated decisional balance data. Considering the positive fi ndings for web-based personalized feedback interventions in the literature (Carey et al., 2007; Cronce and Larimer, 2011; Riper et al., 2009; Walters and Neighbors, 2005), decisional balance feedback (DBF) may be a novel variant of such interventions by providing students with a summary of their motivation to change (e.g., overall balance toward change, summary of perceived advantages/disadvantages, and the weight of their importance and likelihood). DBF is well positioned to support drinking reductions among college students. "
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    ABSTRACT: Objective: Web-based personalized feedback interventions, particularly personalized normative feedback (PNF), are efficacious in improving college drinking outcomes; however, no personalized feedback interventions to date have provided college drinkers with feedback about their own decisional balance. This study tested the relative efficacy of a novel decisional balance feedback (DBF) intervention, PNF, and an assessment-only control condition. Method: Participants (N = 724; 56% female) were undergraduate students at a 4-year university in the U.S. Pacific Northwest and were randomized to receive one-time exposure to web-based DBF, PNF, or assessment only. Web-based assessment occurred at baseline and at 1-, 6-, and 12-month follow-ups and included measures of motivation to change, drinking quantity norms, drinking frequency/quantity, and alcohol-related problems. Results: At the 1-month follow-up, DBF and PNF participants reported reductions in alcohol-related problems; however, only PNF participants reduced their drinking frequency and quantity. At the 6-month follow-up, only DBF participants showed significant reductions in drinking quantity and alcohol-related problems. Neither group maintained reductions in alcohol use or alcohol-related problems at the 12-month follow-up. Conclusions: This study provided preliminary evidence that web-based DBF and PNF are efficacious interventions for college drinkers, with DBF having somewhat longer lasting effects.
    Journal of studies on alcohol and drugs 11/2014; 75(6):982-92. DOI:10.15288/jsad.2014.75.982 · 2.76 Impact Factor
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    • "Learning to calculate the eBAC and relating it to its effects on the individual—both in terms of desirable and positive effects as well as harmful and negative effects—is an integral part of the Alcohol Skills Training Program (ASTP) [25] and Brief Alcohol Screening and Intervention for College Students Program (BASICS) [26], information and early intervention methods that have good documented support [3,4,27]. Calculating and displaying an individual’s eBAC is a form of personalized feedback, and personalized feedback via mail or computer has been found to be an effective brief intervention [28]. "
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    ABSTRACT: Brief interventions via the internet have been shown to reduce university students’ alcohol intake. This study tested two smartphone applications (apps) targeting drinking choices on party occasions, with the goal of reducing problematic alcohol intake among Swedish university students. Students were recruited via e-mails sent to student union members at two universities. Those who gave informed consent, had a smartphone, and showed risky alcohol consumption according to the Alcohol Use Disorders Identification Test (AUDIT) were randomized into three groups. Group 1 had access to the Swedish government alcohol monopoly’s app, Promillekoll, offering real-time estimated blood alcohol concentration (eBAC) calculation; Group 2 had access to a web-based app, PartyPlanner, developed by the research group, offering real-time eBAC calculation with planning and follow-up functions; and Group 3 participants were controls. Follow-up was conducted at 7 weeks. Among 28574 students offered participation, 4823 agreed to join; 415 were excluded due to incomplete data, and 1932 fulfilled eligibility criteria for randomization. Attrition was 22.7–39.3 percent, higher among heavier drinkers and highest in Group 2. Self-reported app use was higher in Group 1 (74%) compared to Group 2 (41%). Per-protocol analyses revealed only one significant time-by-group interaction, where Group 1 participants increased the frequency of their drinking occasions compared to controls (p = 0.001). Secondary analyses by gender showed a significant difference among men in Group 1 for frequency of drinking occasions per week (p = 0.001), but not among women. Among all participants, 29 percent showed high-risk drinking, over the recommended weekly drinking levels of 9 (women) and 14 (men) standard glasses. Smartphone apps can make brief interventions available to large numbers of university students. The apps studied using eBAC calculation did not, however, seem to affect alcohol consumption among university students and one app may have led to a negative effect among men. Future research should: 1) explore ways to increase user retention, 2) include apps facilitating technical manipulation for evaluation of added components, 3) explore the effects of adapting app content to possible gender differences, and 4) offer additional interventions to high-risk users. Trial registration NCT01958398.
    Addiction science & clinical practice 07/2014; 9(1):11. DOI:10.1186/1940-0640-9-11
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    • "We calculated both beforehand and afterwards how many studies would be needed to ensure sufficient statistical power to identify relevant effects as we expected a small to moderate effect size [26], [51]. The power calculations were carried out according to the procedures described by Borenstein and colleagues [46]. "
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    ABSTRACT: Background Alcohol misuse ranks within the top ten health conditions with the highest global burden of disease. Low-intensity, Internet interventions for curbing adult alcohol misuse have been shown effective. Few meta-analyses have been carried out, however, and they have involved small numbers of studies, lacked indicators of drinking within low risk guidelines, and examined the effectiveness of unguided self-help only. We therefore conducted a more thorough meta-analysis that included both guided and unguided interventions. Methods Systematic literature searches were performed up to September 2013. Primary outcome was the mean level of alcohol consumption and drinking within low risk guidelines for alcohol consumption at post-treatment. Findings We selected 16 randomised controlled trials (with 23 comparisons and 5,612 participants) for inclusion. Results, showed a small but significant overall effect size in favour of Internet interventions (g = 0.20, 95% CI: 0.13–0.27, p<.001). Participants in Internet interventions drunk on average 22 grams of ethanol less than controls and were significantly more likely to be adhering to low-risk drinking guidelines at post-treatment (RD 0.13, 95% CI: 0.09–0.17, p<.001). Subgroup analyses revealed no significant differences in potential moderators for the outcome of alcohol consumption, although there was a near-significant difference between comparisons with waitlist control and those with assessment-only or alcohol information control conditions (p = .056). Conclusions Internet interventions are effective in reducing adult alcohol consumption and inducing alcohol users to adhere to guidelines for low-risk drinking. This effect is small but from a public health point of view this may warrant large scale implementation at low cost of Internet interventions for adult alcohol misuse. Moderator analyses with sufficient power are, however, needed in order to assess the robustness of these overall results and to assess whether these interventions may impact on subgroups with different levels of success.
    PLoS ONE 06/2014; 9(6):e99912. DOI:10.1371/journal.pone.0099912 · 3.23 Impact Factor
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