During the lockdown there is undoubted escalation in drinking. This may bring the use of online digital treatments to the fore. At present, online interventions for drinking problems are more common than those for illegal drugs. In the last decade there has been a dramatic increase in the number of online and digital addiction services available. These tend to be of three different types:
· Unguided standalone apps that provide treatment directly to the individuals
· Augmenting apps that add support to human-human interventions that intensify treatment
· Therapy online delivers real time interventions such as counselling or group through social contact programmes such as Teams or Zoom.
Meta-analysis (a study of studies) has found encouraging outcomes for nicotine, alcohol, cannabis, opioids, cocaine, and amphetamines (Riper et al 2014; [1] Tait et al 2013[2];Carpenter et al 2016[3]; Boumparis et al 2017[4]). They demonstrate small but significant effects in decreasing substance use among various target populations at the end of treatment and at follow-up assessments.
A systematic review of ‘digital’ brief interventions from the Cochrane collaboration (which helps to facilitate evidence-based choices about health interventions) found that personalised advice using computers or mobile devices overall helps reduce heavy drinking and can even may match the effectiveness of face-to-face conversations in some cases. More than three-quarters of the studies examined showed a short-term decrease in use that was maintained six months later, but only two studies included a 12-month follow-up. The participants in the studies were mostly adults between 30 and 46 years olds. Less than a quarter reported having previously consulted a professional for drug or alcohol-related problems, the majority presented with high risk or problem drinking and/or drug use. Outside the context of a trial, this profile was broadly replicated in a study of people accessing help for problem drinking via the internet, suggesting the results of trials may be applicable to people seeking help in the normal way.
Research demonstrates that digital interventions are more likely to attract people with lower order substance problems and with more of the ‘recovery capital’ needed to lift themselves out of trouble without therapist intervention, such as problem drinkers who retain pro-social contacts (relationships, jobs, families, and a reputation to lose). Access to computer-based support might assist those users who are unlikely to seek face-to-face help, an inexpensive and short intervention would seem in line with the (non-) severity of their problems.
A German study (Baumannab et al, 2017)[6] tested whether people with different day-to-day drinking patterns benefitted differently from two computerised brief alcohol interventions. It randomly allocated 1,243 ‘at risk’ job-seekers drinkers to:
(1) an intervention tailored to their motivational stage
(2) a non-stage tailored intervention
(3) to a control group receiving assessment only
Four distinct patterns were observed. Those whose consumption was at the lower end were found to benefit more from stage-tailored brief alcohol interventions than non-stage tailored brief alcohol interventions and assessment only. As the authors identified, this is one core target population for brief interventions that is typically not reached. A key difference between the stage-tailored and non-stage tailored interventions was that the former reserved feedback about self-regulating drinking for those in later motivational stages of change, while the latter encouraged all participants to apply self-regulatory strategies. In line with the stages of change model (and broader transtheoretical model of behavioural change), the findings indicated that people in earlier motivational stages improved most when not encouraged to use self-regulatory strategies. Likewise in a Canadian (Cunningham et al, 2010)[7] study it was only the top 50 per cent of risky drinkers among a general adult sample who reduced their consumption and alcohol-related risk levels after being given access to a web-based brief intervention.
An excellent and comprehensive free digital therapy for drinking is Down Your Drink, developed by Camden & Islington NHS and UCL. This may be helpful to cleints during the lock down period and after. To access the site click here. It offers a offer set programmes from a one-hour brief intervention to several weeks, but also gives the user greater control over the use they made of the site. The approach remained based on principles and techniques derived from motivational interviewing and cognitive-behavioural therapies. Data from the first 10,000 people who registered revealed that most were in their 30s and 40s, half were women, nearly two-thirds were married or living with a partner, just 4% were unemployed, and most reported occupations from higher socioeconomic strata. About 17% completed the six weeks and of these, 57% returned an outcome questionnaire. On average they were now at substantially lower risk, and functioning better and living much improved lives. The sample had been recruited over about 27 months, a registration rate of about 4500 a year. Results from surveys sent to pilot programme completers indicated that three quarters had never previously sought help for their drinking.
References
[1] Riper H, Blankers M, Hadiwijaya H, Cunningham J, Clarke S, Wiers R, et al. (2014) Effectiveness of Guided and Unguided Low-Intensity Internet Interventions for Adult Alcohol Misuse: A Meta-Analysis. PLoS ONE 9(6): e99912. [2] Robert J.Tait, RenskeSpijkermancHeleenRiperdef (2013) Internet and computer based interventions for cannabis use: A meta-analysis. Drug and Alcohol Dependence, Volume 133, Issue 2, 1 December 2013, pp 295-304 [3] Graham A, Carpenter K, Cha S, Cole S, Jacobs M, Raskob M, Cole-Lewis H (2016) Systematic review and meta-analysis of Internet interventions for smoking cessation among adults Substance Abuse and Rehabilitation,18;7:55-69. [4] Nikolaos Boumparis, Eirini Karyotaki, Michael P. Schaub, Pim Cuijpers and Heleen Riper 2017 Internet interventions for adult illicit substance users: a meta‐analysis. Addiction. 112(9): 1521–1532. [6]SophieBaumannabBeateGaertnercKatjaHaberechtabGallusBischofdUlrichJohnabJennisFreyer-Adamabe 2017 Who benefits from computer-based brief alcohol intervention? Day-to-day drinking patterns as a moderator of intervention efficacy Drug and Alcohol Dependence, Volume 175, 1 June, Pages 119-126 [7] Cunningham J.A., Wild C., Cordingley J. et al. Twelve-month follow-up results from a randomized controlled trial of a brief personalized feedback intervention for problem drinkers. Alcohol & Alcoholism: 2010, 45(3), p. 258–262.