Effects of Internet-Based Cognitive Behavioral Therapy for Harmful Alcohol Use and Alcohol Dependence as Self-help or With Therapist Guidance: Three-Armed Randomized Trial

• Published in: Journal of medical Internet research Vol. 23; no. 11; p. e29666
• Main Authors: Johansson, Magnus, Berman, Anne H, Sinadinovic, Kristina, Lindner, Philip, Hermansson, Ulric, Andréasson, Sven
• Format: Journal Article
• Language: English
• Published: Canada Gunther Eysenbach MD MPH, Associate Professor 24-11-2021; JMIR Publications
• Subjects: Access; Adult; alcohol dependence; Alcohol related disorders; Alcohol use; alcohol use disorders; Alcoholism; Alcoholism - therapy; Anxiety; Anxiety Disorders; Behavior modification; CBT; Classification; Clinical trials; Cognitive Behavioral Therapy; Cognitive-behavioral factors; Drinks; eHealth; Ethanol; Female; help-seeking behavior; Humans; Hypotheses; ICBT; Internet; internet-based cognitive behavioral therapy; Internet-Based Intervention; internet-based interventions; Intervention; Medical personnel; Medicin och hälsovetenskap; Middle Aged; mobile phone; Mortality; Motivational interviewing; Original Paper; outcomes; Questionnaires; Recruitment; Self help; Stages of change; Stigma; substance abuse; Therapists; Treatment Outcome; Websites; Women; cognitive behavioral therapy; help-seeking behavior; alcohol use; internet-based cognitive behavioral therapy; ICBT; alcohol use disorders; eHealth; CBT; alcohol dependence; outcomes; mobile phone; internet-based interventions; substance abuse
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/29666

Alcohol use is a major contributor to health loss. Many persons with harmful use or alcohol dependence do not obtain treatment because of limited availability or stigma. They may use internet-based interventions as an alternative way of obtaining support. Internet-based interventions have previously been shown to be effective in reducing alcohol consumption in studies that included hazardous use; however, few studies have been conducted with a specific focus on harmful use or alcohol dependence. The importance of therapist guidance in internet-based cognitive behavioral therapy (ICBT) programs is still unclear.
This trial aims to investigate the effects of a web-based alcohol program with or without therapist guidance among anonymous adult help-seekers.
A three-armed randomized controlled trial was conducted to compare therapist-guided ICBT and self-help ICBT with an information-only control condition. Swedish-speaking adult internet users with alcohol dependence (3 or more International Classification of Diseases, Tenth Revision criteria) or harmful alcohol use (alcohol use disorder identification test>15) were included in the study. Participants in the therapist-guided ICBT and self-help ICBT groups had 12-week access to a program consisting of 5 main modules, as well as a drinking calendar with automatic feedback. Guidance was given by experienced therapists trained in motivational interviewing. The primary outcome measure was weekly alcohol consumption in standard drinks (12 g of ethanol). Secondary outcomes were alcohol-related problems measured using the total alcohol use disorder identification test-score, diagnostic criteria for alcohol dependence and alcohol use disorder, depression, anxiety, health, readiness to change, and access to other treatments or support. Follow-up was conducted 3 (posttreatment) and 6 months after recruitment.
During the recruitment period, from March 2015 to March 2017, 1169 participants were included. Participants had a mean age of 45 (SD 13) years, and 56.72% (663/1169) were women. At the 3-month follow-up, the therapist-guided ICBT and control groups differed significantly in weekly alcohol consumption (-3.84, 95% Cl -6.53 to -1.16; t
=2.81; P=.005; Cohen d=0.27). No significant differences were found in weekly alcohol consumption between the self-help ICBT group and the therapist-guided ICBT at 3 months, between the self-help ICBT and the control group at 3 months, or between any of the groups at the 6-month follow-up. A limitation of the study was the large number of participants who were completely lost to follow-up (477/1169, 40.8%).
In this study, a therapist-guided ICBT program was not found to be more effective than the same program in a self-help ICBT version for reducing alcohol consumption or other alcohol-related outcomes. In the short run, therapist-guided ICBT was more effective than information. Only some internet help-seekers may need a multisession program and therapist guidance to change their drinking when they use internet-based interventions.
ClinicalTrials.gov NCT02377726; https://clinicaltrials.gov/ct2/show/NCT02377726.