Guided and unguided Internet-based treatment for problematic alcohol use

Background: The Internet has increasingly been studied as mode of delivery for interventions targeting problematic alcohol use. Most interventions have been fully automated, but some research suggests that adding counselor guidance may improve alcohol consumption outcomes. Methods: An eight-module Internet-based self-help program based on cognitive behavioral therapy (CBT) was tested among Internet help-seekers. Eighty participants with problematic alcohol use according to the Alcohol Use Disorders Identification Test (AUDIT; scores of ≥ 6 for women and ≥ 8 for men) were recruited online from an open access website and randomized into three different groups. All groups were offered the same self-help program, but participants in two of the three groups received Internet-based counselor guidance in addition to the self-help program. One of the guidance groups was given a choice between guidance via asynchronous text messages or synchronous text-based chat, while the other guidance group received counselor guidance via asynchronous text messages only. Results: In the choice group, 65% (13 of 20 participants) chose guidance via asynchronous text messages. At the 10-week post-treatment follow-up, an intention-to-treat (ITT) analysis showed that participants in the two guidance groups (choice and messages) reported significantly lower past week alcohol consumption compared to the group without guidance; 10.8 (SD=12.1) versus 22.6 (SD=18.4); p=0.001; Cohen’s d=0.77. Participants in both guidance groups reported significantly lower scores on the AUDIT at follow-up compared to the group without guidance, with a mean score of 14.4 (SD=5.2) versus 18.2 (SD=5.9); p=0.003; Cohen’s d=0.68. A higher proportion of participants in the guidance groups said that they would recommend the program compared to the group without guidance (81% for choice; 93% for messages versus 47% for self-help). Conclusion: Self-help programs for problematic alcohol use can be more effective in reducing alcohol consumption over a 10-week period when counselor guidance is added.

研究背景：针对酒精使用障碍的干预手段，其依托互联网开展的模式正受到越来越多的关注。现有多数干预方案已实现全自动化，但部分研究表明，增加咨询师指导环节或可改善酒精消费相关结局。
研究方法：本研究针对互联网求助人群，测试了一款基于认知行为疗法（Cognitive Behavioral Therapy，CBT）的8模块互联网自助方案。研究从公开访问网站在线招募了80名符合酒精使用障碍识别测试（Alcohol Use Disorders Identification Test，AUDIT）标准的酒精使用障碍受试者：女性得分≥6分，男性得分≥8分，并将其随机分为3组。三组受试者均获得相同的自助方案，但其中两组受试者除自助方案外，还可获得互联网咨询师指导。其中一组指导组可选择异步短信指导或同步文本聊天指导，另一组指导组仅可获得异步短信形式的咨询师指导。
研究结果：在选择组中，65%的受试者（20名受试者中的13名）选择了异步短信指导。在治疗后10周的随访中，意向性治疗（Intention-to-Treat，ITT）分析显示，两组指导组（选择组与短信指导组）受试者报告的过去一周酒精摄入量显著低于无指导组：分别为10.8（标准差（Standard Deviation，SD）=12.1）与22.6（标准差SD=18.4）；p=0.001，Cohen’s d=0.77。随访时，两组指导组受试者的AUDIT得分均显著低于无指导组：平均得分分别为14.4（标准差SD=5.2）与18.2（标准差SD=5.9）；p=0.003，Cohen’s d=0.68。与无指导组相比，指导组中表示愿意推荐该方案的受试者比例更高：选择组为81%，短信指导组为93%，而自助组仅为47%。
研究结论：针对酒精使用障碍的自助方案，若增加咨询师指导环节，在10周周期内可更有效地降低受试者的酒精摄入量。