Web‐based self‐help for problem drinkers: a pragmatic randomized trial

<jats:title>ABSTRACT</jats:title><jats:p><jats:bold>Aims </jats:bold> Self‐help interventions for adult problem drinkers in the general population have proved effective. The question is whether this also holds for self‐help interventions delivered over the internet.</jats:p><jats:p><jats:bold>Design </jats:bold> We conducted a pragmatic randomized trial with two parallel groups, using block randomization stratified for gender and with follow‐up at 6 months.</jats:p><jats:p><jats:bold>Setting </jats:bold> The intervention and trial were conducted online in the Netherlands in 2003–2004.</jats:p><jats:p><jats:bold>Participants </jats:bold> We selected 261 adult problem drinkers from the general population with a weekly alcohol consumption above 210 g of ethanol for men or 140 g for women, or consuming at least 60 g (men) or 40 g (women) at least 1 day a week over the past 3 months. Participants were randomized to either the experimental drinking less (DL) condition or to the control condition (PBA).</jats:p><jats:p><jats:bold>Intervention </jats:bold> DL is a web‐based, multi‐component, interactive self‐help intervention for problem drinkers without therapist guidance. The recommended treatment period is 6 weeks. The intervention is based on cognitive–behavioural and self‐control principles. The control group received access to an online psychoeducational brochure on alcohol use (PBA).</jats:p><jats:p><jats:bold>Outcome measures </jats:bold> We assessed the following outcome measures at 6‐month follow‐up: (i) the percentage of participants who had reduced their drinking levels to within the normative limits of the Dutch guideline for low‐risk drinking; and (ii) the reduction in mean weekly alcohol consumption.</jats:p><jats:p><jats:bold>Findings </jats:bold> At follow‐up, 17.2% of the intervention group participants had reduced their drinking successfully to within the guideline norms; in the control group this was 5.4% [odds ratio (OR) = 3.66; 95% confidence interval (CI) 1.3–10.8; <jats:italic>P</jats:italic> = 0.006; number needed to treat (NNT) = 8.5]. The intervention subjects decreased their mean weekly alcohol consumption significantly more than control subjects, with a difference of 12.0 standardized units (95% CI 5.9–18.1; <jats:italic>P</jats:italic> < 0.001; standardized mean difference 0.40).</jats:p><jats:p><jats:bold>Conclusions </jats:bold> To our knowledge this is one of the first randomized controlled trials on a web‐based self‐help intervention without therapist guidance for self‐referred problem drinkers among the adult general population. The intervention showed itself to be effective in reducing problem drinking in the community.</jats:p>