Can stand-alone computer-based interventions reduce alcohol consumption? A systematic review
Zarnie Khadjesari,
Elizabeth Murray,
Catherine Hewitt,
Suzanne Hartley,
Christine Godfrey,
Corresponding Author
Zarnie Khadjesari
E-health Unit, Research Department of Primary Care and Population Health, University College London, Royal Free Hospital, London
Zarnie Khadjesari, E-health Unit, Research Department of Primary Care and Population Health, University College London, Upper Floor 3, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK. E-mail: [email protected]Search for more papers by this authorElizabeth Murray
E-health Unit, Research Department of Primary Care and Population Health, University College London, Royal Free Hospital, London
Search for more papers by this authorCatherine Hewitt
Department of Health Sciences and HYMS, Seebohm Rowntree Building, University of York, Heslington, York
Search for more papers by this authorSuzanne Hartley
Clinical Trials Research Unit, University of Leeds, Leeds, UK
Search for more papers by this authorChristine Godfrey
Department of Health Sciences and HYMS, Seebohm Rowntree Building, University of York, Heslington, York
Search for more papers by this authorZarnie Khadjesari,
Elizabeth Murray,
Catherine Hewitt,
Suzanne Hartley,
Christine Godfrey,
Corresponding Author
Zarnie Khadjesari
E-health Unit, Research Department of Primary Care and Population Health, University College London, Royal Free Hospital, London
Zarnie Khadjesari, E-health Unit, Research Department of Primary Care and Population Health, University College London, Upper Floor 3, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK. E-mail: [email protected]Search for more papers by this authorElizabeth Murray
E-health Unit, Research Department of Primary Care and Population Health, University College London, Royal Free Hospital, London
Search for more papers by this authorCatherine Hewitt
Department of Health Sciences and HYMS, Seebohm Rowntree Building, University of York, Heslington, York
Search for more papers by this authorSuzanne Hartley
Clinical Trials Research Unit, University of Leeds, Leeds, UK
Search for more papers by this authorChristine Godfrey
Department of Health Sciences and HYMS, Seebohm Rowntree Building, University of York, Heslington, York
Search for more papers by this authorConflict of Interest: None.
ABSTRACT
Aim To determine the effects of computer-based interventions aimed at reducing alcohol consumption in adult populations.
Methods The review was undertaken following standard Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance for systematic reviews. The literature was searched until December 2008, with no restrictions on language. Randomized trials with parallel comparator groups were identified in the form of published and unpublished data. Two authors independently screened abstracts and papers for inclusion. Data extraction and bias assessment was undertaken by one author and checked by a second author. Studies that measured total alcohol consumption and frequency of binge drinking episodes were eligible for inclusion in meta-analyses. A random-effects model was used to pool mean differences.
Results Twenty-four studies were included in the review (19 combined in meta-analyses). The meta-analyses suggested that computer-based interventions were more effective than minimally active comparator groups (e.g. assessment-only) at reducing alcohol consumed per week in student and non-student populations. However, most studies used the mean to summarize skewed data, which could be misleading in small samples. A sensitivity analysis of those studies that used suitable measures of central tendency found that there was no difference between intervention and minimally active comparator groups in alcohol consumed per week by students. Few studies investigated non-student populations or compared interventions with active comparator groups.
Conclusion Computer-based interventions may reduce alcohol consumption compared with assessment-only; the conclusion remains tentative because of methodological weaknesses in the studies. Future research should consider that the distribution of alcohol consumption data is likely to be skewed and that appropriate measures of central tendency are reported.
References
- 1 Bien T. H., Miller W. R., Tonigan J. S. Brief interventions for alcohol problems: a review. Addiction 1993; 88: 315–35.
- 2 Kaner E. F., Beyer F., Dickinson H. O., Pienaar E., Campbell F., Schlesinger C. et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2007; issue 2: CD004148.
- 3 Moyer A., Finney J. W., Swearingen C. E., Vergun P. Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction 2002; 97: 279–92.
- 4 World Health Organization. Screening and Brief Intervention for Alcohol Problems in Primary Health Care. 2010. Available at: http://www.who.int/substance_abuse/activities/sbi/en/index.html (accessed 26 October 2010; archived by WebCite at http://www.webcitation.org/5tlXHduaA).
- 5 Babor T. F., Higgins-Biddle J. C. Brief Intervention for Hazardous and Harmful Drinking: A Manual for use in Primary Care. Geneva: World Health Organization, Department of Mental Health and Substance Dependence; 2001.
- 6 Seppa K., Aalto M., Raevaara L., Perakyla A. A brief intervention for risky drinking—analysis of videotaped consultations in primary health care. Drug Alcohol Rev 2004; 23: 167–70.
- 7 Denny C. H., Serdula M. K., Holtzman D., Nelson D. E. Physician advice about smoking and drinking: are U.S. adults being informed? Am J Prev Med 2003; 24: 71–4.
- 8 McAvoy B. R., Donovan R. J., Jalleh G., Saunders J. B., Wutzke S. E., Lee N. et al. General practitioners, prevention and alcohol—a powerful cocktail? Facilitators and inhibitors of practising preventive medicine in general and early intervention for alcohol in particular: a 12-nation key informant and general practitioner study. Drugs Educ Prev Policy 2001; 8: 103–17.
- 9 Wutzke S. E., Gomel M. K., Donovan R. J. Enhancing the delivery of brief interventions for hazardous alcohol use in the general practice setting: a role for both general practitioners and medical receptionists. Health Promot J Austr 1998; 8: 105–8.
- 10 Office of National Statistics. Internet Access: Households and Individuals. Statistical Bulletin; 2009. Available at http://www.statistics.gov.uk/pdfdir/iahi0809.pdf (accessed 26 October 2010; archived by WebCite at http://www.webcitation.org/5tlbWhDP8)
- 11 Internet World Stats. Internet World Stats: Usage and Population Statistics. 2009. Available at: http://www.internetworldstats.com/stats.htm (accessed 15 February 2010).
- 12 Copeland J., Martin G. Web-based interventions for substance use disorders: a qualitative review. J Subst Abuse Treat 2004; 26: 109–16.
- 13 Linke S., Murray E., Butler C., Wallace P. Internet-based interactive health intervention for the promotion of sensible drinking: patterns of use and potential impact on members of the general public. J Med Int Res 2007; 9: e10.
- 14 Murray E. The role of internet-delivered interventions in self-care. In: A. Edwards, G. Elwyn, editors. Shared Decision-Making in Health Care. Achieving Evidence-Based Patient Choice, 2nd edn. Oxford: Oxford University Press; 2009, p. 223–30.
- 15 Gerbert B., Bronstone A., Pantilat S., McPhee S., Allerton M., Moe J. When asked, patients tell: disclosure of sensitive health-risk behaviors. Med Care 1999; 37: 104–11.
- 16 Turner C. F., Ku L., Rogers S. M., Lindberg L. D., Pleck J. H., Sonenstein F. L. Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology. Science 1998; 280: 867–73.
- 17
Cloud R. N.,
Peacock P. L.
Internet screening and interventions for problem drinking: results from the http://www.carebetter.com pilot study.
Alcohol Treat Q
2001; 19: 23–44.
10.1300/J020v19n02_02 Google Scholar
- 18 Cunningham J. A., Humphreys K., Koski-Jannes A. Providing personalized assessment feedback for problem drinking on the internet: a pilot project. J Stud Alcohol 2000; 61: 794–8.
- 19 Lieberman D. Z. Determinants of satisfaction with an automated alcohol evaluation program. Cyberpsychol Behav 2003; 6: 677–82.
- 20 Linke S., Brown A., Wallace P. Down your drink: a web-based intervention for people with excessive alcohol consumption. Alcohol Alcohol 2004; 39: 29–32.
- 21 Saitz R., Helmuth E. D., Aromaa S. E., Guard A., Belanger M., Rosenbloom D. L. Web-based screening and brief intervention for the spectrum of alcohol problems. Prev Med 2004; 39: 969–75.
- 22 Elliott J. C., Carey K. B., Bolles J. R. Computer-based interventions for college drinking: a qualitative review. Addict Behav 2008; 33: 994–1005.
- 23 Bewick B. M., Trusler K., Barkham M., Hill A. J., Cahill J., Mulhern B. The effectiveness of web-based interventions designed to decrease alcohol consumption—a systematic review. Prev Med 2008; 47: 17–26.
- 24 Carey K. B., Scott-Sheldon L. A., Elliott J. C., Bolles J. R., Carey M. P. Computer-delivered interventions to reduce college student drinking: a meta-analysis. Addiction 2009; 104: 1807–19.
- 25 Rooke S., Thorsteinsson E., Karpin A., Copeland J., Allsop D. Computer-delivered interventions for alcohol and tobacco use: a meta-analysis. Addiction 2010; 105: 1381–90.
- 26 Deeks J. J., Higgins J. P. T., Altman D. G. Analysing data and undertaking meta-analyses. 9.4.5.3 Meta-analysis of skewed data. In: J. P. T. Higgins, S. Green, editors. Cochrane Handbook for Systematic Reviews of Interventions, version 5.0.2 [updated September 2009]. The Cochrane Collaboration; 2009.
- 27 Horton N. J., Kim E., Saitz R. A cautionary note regarding count models of alcohol consumption in randomized controlled trials. BMC Med Res Methodol 2007; 7: 9.
- 28 Kypri K. Methodological issues in alcohol screening and brief intervention research. Subst Abuse 2007; 28: 31–42.
- 29 Orford J. Addiction as excessive appetite. Addiction 2001; 96: 15–31.
- 30 Altman D. G. Practical Statistics for Medical Research. London: Chapman and Hall; 1991.
- 31 Ritterband L. M. Internet interventions: in review, in use, and into the future. Prof Psychol Res Pr 2003; 34: 527–34.
- 32 Hewitt C., Hahn S., Torgerson D. J., Watson J., Bland J. M. Adequacy and reporting of allocation concealment: review of recent trials published in four general medical journals. BMJ 2005; 330: 1057–8.
- 33 Schulz K. F., Chalmers I., Hayes R. J., Altman D. G. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995; 273: 408–12.
- 34 Kjaergard L. L., Villumsen J., Gluud C. Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 2001; 135: 982–9.
- 35 Higgins J. P. T., Altman D. G. Assessing risk of bias in included studies. In: J. P. T. Higgins, S. Green, editors. Cochrane Handbook for Systematic Reviews of Interventions, version 5.0.2 [updated September 2009]. The Cochrane Collaboration; 2009.
- 36 Miller W. R., Heather N., Hall W. Calculating standard drink units: international comparisons. Br J Addict 1991; 86: 43–7.
- 37 Hozo S. P., Djulbegovic B., Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005; 5: 13.
- 38 Altman D. G., Bland J. M. Detecting skewness from summary information. BMJ 1996; 313: 1200.
- 39 Barnett N. P., Murphy J. G., Colby S. M., Monti P. M. Efficacy of counselor versus computer-delivered intervention with mandated college students. Addict Behav 2007; 32: 2529–48.
- 40 Bewick B. M., Trusler K., Mulhern B., Barkham M., Hill A. J. The feasibility and effectiveness of a web-based personalised feedback and social norms alcohol intervention in UK university students: a randomised control trial. Addict Behav 2008; 33: 1192–8.
- 41 Chiauzzi E., Green T. C., Lord S., Thum C., Goldstein M. My student body: a high-risk drinking prevention web site for college students. J Am Coll Health 2005; 53: 263–74.
- 42 Donohue B., Allen D. N., Maurer A., Ozols J., DeStefano G. A controlled evaluation of two prevention programs in reducing alcohol use among college students at low and high risk for alcohol related problems. J Alcohol Drug Educ 2004; 48: 13–33.
- 43 Doumas D. M., Haustveit T. Reducing heavy drinking in intercollegiate athletes: evaluation of a web-based personalized feedback program. Sport Psychol 2008; 22: 212–28.
- 44 Hedman A. S. Effects of personalized feedback and tailored health communication on alcohol consumption, alcohol-related behaviors, and attitude among binge drinking college students. Diss Abstr Int A Humanit Soc Sci 2007; 68: 891.
- 45 Hunt W. M. Effects of participant engagement on alcohol expectancies and drinking outcomes for a computerized expectancy challenge intervention. Diss Abstr Int B Sci Eng 2004; 65: 6655.
- 46 Kypri K., Saunders J. B., Williams S. M., McGee R. O., Langley J. D., Cashell-Smith M. L. et al. Web-based screening and brief intervention for hazardous drinking: a double-blind randomized controlled trial. Addiction 2004; 99: 1410–7.
- 47 Kypri K., McAnally H. M. Randomized controlled trial of a web-based primary care intervention for multiple health risk behaviors. Prev Med 2005; 41: 761–6.
- 48 Kypri K., Langley J. D., Saunders J. B., Cashell-Smith M. L., Herbison P. Randomized controlled trial of web-based alcohol screening and brief intervention in primary care. Arch Int Med 2008; 168: 530–6.
- 49 Lau-Barraco C., Dunn M. E. Evaluation of a single-session expectancy challenge intervention to reduce alcohol use among college students. Psychol Addict Behav 2008; 22: 168–75.
- 50 Lewis M. A., Neighbors C., Oster-Aaland L., Kirkeby B. S., Larimer M. E. Indicated prevention for incoming freshmen: personalized normative feedback and high-risk drinking. Addict Behav 2007; 32: 2495–508.
- 51 Lewis M. A., Neighbors C. Optimizing personalized normative feedback: the use of gender-specific referents. J Stud Alcohol Drugs 2007; 68: 228–37.
- 52 Neighbors C., Larimer M. E., Lewis M. A. Targeting misperceptions of descriptive drinking norms: efficacy of a computer-delivered personalized normative feedback intervention. J Consult Clin Psychol 2004; 72: 434–47.
- 53 Neighbors C., Lewis M. A., Bergstrom R. L., Larimer M. E. Being controlled by normative influences: self-determination as a moderator of a normative feedback alcohol intervention. Health Psychol Off J Div Health Psychol Am Psychol Assoc 2006; 25: 571–9.
- 54 Paschall M. J., Bersamin M., Fearnow-Kenney M., Wyrick D., Currey D. Short-term evaluation of a web-based college alcohol misuse and harm prevention course (College Alc). J Alcohol Drug Educ 2006; 50: 49–65.
- 55 Walters S. T., Vader A. M., Harris T. R. A controlled trial of web-based feedback for heavy drinking college students. Prev Sci Off J Soc Pre Res 2007; 8: 83–8.
- 56 Weitzel J. A., Bernhardt J. M., Usdan S., Mays D., Glanz K. Using wireless handheld computers and tailored text messaging to reduce negative consequences of drinking alcohol. J Stud Alcohol Drugs 2007; 68: 534–7.
- 57 Hester R. K., Delaney H. D. Behavioral Self-Control Program for Windows: results of a controlled clinical trial. J Consult Clin Psychol 1997; 65: 686–93.
- 58 Hester R. K., Squires D. D., Delaney H. D. The Drinker's Check-up: 12-month outcomes of a controlled clinical trial of a stand-alone software program for problem drinkers. J Subst Abuse Treat 2005; 28: 159–69.
- 59 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: 218–27.
- 60 Doumas D. M., Hannah E. Preventing high-risk drinking in youth in the workplace: a web-based normative feedback program. J Subst Abuse Treat 2008; 34: 263–71.
- 61 Matano R. A., Koopman C., Wanat S. F., Winzelberg A. J., Whitsell S. D., Westrup D. et al. A pilot study of an interactive web site in the workplace for reducing alcohol consumption. J Subst Abuse Treat 2007; 32: 71–80.
- 62 Neumann T., Neuner B., Weiss-Gerlach E., Tonnesen H., Gentilello L. M., Wernecke K. D. et al. The effect of computerized tailored brief advice on at-risk drinking in subcritically injured trauma patients. J Trauma 2006; 61: 805–14.
- 63 Miller W. R., Rollnick S. Motivational Interviewing: Preparing People for Change, 2nd edn. New York: Guilford Press; 2002.
- 64 Miller W. R., Sanchez V. C. Motivating young adults for treatment and lifestyle change. In: G. Howard, P. E. Nathan, editors. Alcohol Use and Misuse by Young Adults. Notre Dame, IN: University of Notre Dame Press; 1994.
- 65 Dimeff L. A., Baer J. S., Kivlahan D. R., Marlatt G. A. Brief Alcohol Screening and Intervention for College Students: A Harm Reduction Approach. New York: Guilford Press; 1999.
- 66 Perkins H. W., Berkowitz A. D. Perceiving the community norms of alcohol use among students: some research implications for campus alcohol education programming. Int J Addict 1986; 21: 961–76.
- 67 Perkins H. W. Social norms and the prevention of alcohol misuse in collegiate contexts. J Stud Alcohol Suppl 2002; 14: 164–72.
- 68 Borsari B., Carey K. B. Peer influences on college drinking: a review of the research. J Subst Abuse 2001; 13: 391–424.
- 69 Hester R. K. Behavioral self-control training. In: R. K. Hester, W. R. Miller, editors. Handbook of Alcoholism Treatment Approaches: Effective Alternatives, 2nd edn. Needham Heights, MA: Allyn and Bacon; 1995, p. 148–59.
- 70 Miller W. R., Munoz R. F. How to Control Your Drinking. Albuquerque, NM: University of New Mexico Press; 1982.
- 71
Goldman M. S.
Expectancy operation: cognitive/neural models and architectures. In: I. E. Kirsch, editor. Expectancy, Experience, and Behavior. Washington, DC: APA Books; 1999, p.
41–63.
10.1037/10332-002 Google Scholar
- 72
Ajzen I.
Attitudes, Personality and Behavior. Milton Keynes, UK: Open University Press; 1988.
10.1148/radiology.166.3.3340772 Google Scholar
- 73 Jessor R., Jessor S. L. Problem Behavior and Psychosocial Development. New York: Academic Press; 1977.
- 74 Saunders J. B., Aasland O. G., Babor T. F., de l. F., Jr, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption—II. Addiction 1993; 88: 791–804.
- 75 Selzer M. L. The Michigan Alcoholism Screening Test: the quest for a new diagnostic instrument. Am J Psychiatry 1971; 127: 1653–8.
- 76 Mayfield D. G., McLeod G., Hall P. The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry 1974; 131: 1121–3.
