Effects of a minimal-guided on-line intervention for alcohol misuse in Estonia: a randomized controlled trial

Mareike Augsburger*, Esta Kaal, Triin Ülesoo, Andreas Wenger, Matthijs Blankers, Severin Haug, David D. Ebert, Heleen Riper, Matthew Keough, Helen Noormets, Michael P. Schaub, Karin Kilp

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Background and Aims: Estonia has one of the highest alcohol-attributable mortality rates within the European Union. The aim of this study was to estimate the efficacy of an on-line self-help intervention to reduce problem drinking at the population level. Design: On-line open randomized controlled trial with an 8-week intervention and an active control group (intervention n = 303, control n = 286). Assessments took place at baseline and at 6 months follow-up. Setting: On- and offline channels were used for population-based recruitment within a nation-wide prevention campaign in Estonia. Participants: Inclusion criteria were age ≥ 18 years, heavy drinking [Alcohol Use Disorders Identification (AUDIT) test score ≥ 8], literacy in Estonian and at least weekly access to the internet; n = 589 participants were randomized (50% male, 1% other; mean age 37.86 years; 45% with higher level of education). Intervention and comparator: The intervention consisted of 10 modules based on principles of cognitive–behavioral therapy and motivational interviewing. The active control group received access to a website with a self-test including personalized normative feedback and information for standard alcohol treatment. Measurements: The primary outcome was AUDIT scores at 6 months follow-up adjusted for baseline scores. Findings: Intention-to-treat analyses were applied. Missing data were addressed by using baseline observation carried forward (BOCF) and multiple imputation by chained equations (MI); 175 completed follow-up in the intervention group and 209 in the control group. AUDIT score at follow-up was significantly smaller in the intervention [BOCF mean = 13.91, standard deviation (SD) = 7.61, MI mean = 11.03, SD = 6.55] than control group (BOCF mean = 15.30, SD = 7.31; MI mean = 14.30, SD = 7.21), with a group difference of −1.38 [95% confidence interval (CI) = –2.58, –0.18], P = 0.02 for BOCF and −3.26 (95% CI = –2.01, –4.51), P < 0.001 for MI. Conclusions: A randomized controlled trial has found that an on-line self-help intervention with minimal guidance was effective at reducing problem drinking in Estonia.

Original languageEnglish
Pages (from-to)108-117
Number of pages10
JournalAddiction
Volume117
Issue number1
Early online date29 Jun 2021
DOIs
Publication statusPublished - Jan 2022

Bibliographical note

Funding Information:
The study was funded by the European Social Fund (program: A Soberer and Healthier Estonia, 2014‐2020.2.03.001.01.15‐0001) and the National Institute for Health Development, Estonian Government (NO.18‐2‐16/226). The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

Publisher Copyright:
© 2021 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Funding

The study was funded by the European Social Fund (program: A Soberer and Healthier Estonia, 2014‐2020.2.03.001.01.15‐0001) and the National Institute for Health Development, Estonian Government (NO.18‐2‐16/226). The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

Keywords

  • Alcohol
  • AUDIT
  • drinking
  • e-intervention
  • Estonia
  • minimal guidance
  • RCT
  • self-help

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