Effectiveness of a web-based intervention for problem drinkers and reasons for dropout: Randomized controlled trial

Background: online self-help interventions for problem drinkers show promising results,but the effectiveness of online therapy with active involvement of a therapist via the internet only has not been examined. objective: the objective of our study was to evaluate an e-therapy program with active therapeutic involvement for problem drinkers,with the hypotheses that e-therapy would (1) reduce weekly alcohol consumption,and (2) improve health status. reasons for dropout were also systematically investigated. method: in an open randomized controlled trial,dutch-speaking problem drinkers in the general population were randomly assigned (in blocks of 8,according to a computer-generated random list) to the 3-month e-therapy program (n = 78) or the waiting list control group (n = 78). the e-therapy program consisted of a structured 2-part online treatment program in which the participant and the therapist communicated asynchronously,via the internet only. participants in the waiting list control group received no-reply email messages once every 2 weeks. the primary outcome measures were (1) the difference in the score on weekly alcohol consumption,and (2) the proportion of participants drinking under the problem drinking limit. intention-to-treat analyses were performed using multiple imputations to deal with loss to follow-up. a dropout questionnaire was sent to anyone who did not complete the 3-month assessment. reasons for dropout were independently assessed by the first and third author. results: of the 156 individuals who were randomly assigned,102 (65%) completed assessment at 3 months. in the intention-to-treat analyses,the e-therapy group (n = 78) showed a significantly greater decrease in alcohol consumption than those in the control group (n = 78) at 3 months. the e-therapy group decreased their mean weekly alcohol consumption by 28.8 units compared with 3.1 units in the control group,a difference in means of 25.6 units on a weekly basis (95% confidence interval 15.69-35.80,p <.001). the between-group effect size (pooled sd) was large (d = 1.21). the results also showed that 68% (53/78) of the e-therapy group was drinking less than 15 (females) or 22 (males) units a week,compared with 15% (12/78) in the control group (or 12.0,number needed to treat 1.9,p <.001). dropout analysis showed that the main reasons for dropouts (n = 54) were personal reasons unrelated to the e-therapy program,discomfort with the treatment protocol,and satisfaction with the positive results achieved. conclusions: e-therapy for problem drinking is an effective intervention that can be delivered to a large population who otherwise do not seek help for their drinking problem. insight into reasons for dropout can help improve e-therapy programs to decrease the number of dropouts. additional research is needed to directly compare the effectiveness of the e-therapy program with a face-to-face treatment program.