J. Med. Internet Res. - Effectiveness of a web-based intervention for problem drinkers and reasons for dropout: randomized controlled trial.

Tópicos

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Resumo

CKGROUND: Online self-help interventions for problem drinkers show promising results, but the effectiveness of online therapy with active involvement of a therapist via the Internet only has not been examined.OBJECTIVE: The objective of our study was to evaluate an e-therapy program with active therapeutic involvement for problem drinkers, with the hypotheses that e-therapy would (1) reduce weekly alcohol consumption, and (2) improve health status. Reasons for dropout were also systematically investigated.METHOD: In an open randomized controlled trial, Dutch-speaking problem drinkers in the general population were randomly assigned (in blocks of 8, according to a computer-generated random list) to the 3-month e-therapy program (n = 78) or the waiting list control group (n = 78). The e-therapy program consisted of a structured 2-part online treatment program in which the participant and the therapist communicated asynchronously, via the Internet only. Participants in the waiting list control group received "no-reply" email messages once every 2 weeks. The primary outcome measures were (1) the difference in the score on weekly alcohol consumption, and (2) the proportion of participants drinking under the problem drinking limit. Intention-to-treat analyses were performed using multiple imputations to deal with loss to follow-up. A dropout questionnaire was sent to anyone who did not complete the 3-month assessment. Reasons for dropout were independently assessed by the first and third author.RESULTS: Of the 156 individuals who were randomly assigned, 102 (65%) completed assessment at 3 months. In the intention-to-treat analyses, the e-therapy group (n = 78) showed a significantly greater decrease in alcohol consumption than those in the control group (n = 78) at 3 months. The e-therapy group decreased their mean weekly alcohol consumption by 28.8 units compared with 3.1 units in the control group, a difference in means of 25.6 units on a weekly basis (95% confidence interval 15.69-35.80, P < .001). The between-group effect size (pooled SD) was large (d = 1.21). The results also showed that 68% (53/78) of the e-therapy group was drinking less than 15 (females) or 22 (males) units a week, compared with 15% (12/78) in the control group (OR 12.0, number needed to treat 1.9, P < .001). Dropout analysis showed that the main reasons for dropouts (n = 54) were personal reasons unrelated to the e-therapy program, discomfort with the treatment protocol, and satisfaction with the positive results achieved.CONCLUSIONS: E-therapy for problem drinking is an effective intervention that can be delivered to a large population who otherwise do not seek help for their drinking problem. Insight into reasons for dropout can help improve e-therapy programs to decrease the number of dropouts. Additional research is needed to directly compare the effectiveness of the e-therapy program with a face-to-face treatment program.

Resumo Limpo

ckground onlin selfhelp intervent problem drinker show promis result effect onlin therapi activ involv therapist via internet examinedobject object studi evalu etherapi program activ therapeut involv problem drinker hypothes etherapi reduc week alcohol consumpt improv health status reason dropout also systemat investigatedmethod open random control trial dutchspeak problem drinker general popul random assign block accord computergener random list month etherapi program n wait list control group n etherapi program consist structur part onlin treatment program particip therapist communic asynchron via internet particip wait list control group receiv norepli email messag everi week primari outcom measur differ score week alcohol consumpt proport particip drink problem drink limit intentiontotreat analys perform use multipl imput deal loss followup dropout questionnair sent anyon complet month assess reason dropout independ assess first third authorresult individu random assign complet assess month intentiontotreat analys etherapi group n show signific greater decreas alcohol consumpt control group n month etherapi group decreas mean week alcohol consumpt unit compar unit control group differ mean unit week basi confid interv p betweengroup effect size pool sd larg d result also show etherapi group drink less femal male unit week compar control group number need treat p dropout analysi show main reason dropout n person reason unrel etherapi program discomfort treatment protocol satisfact posit result achievedconclus etherapi problem drink effect intervent can deliv larg popul otherwis seek help drink problem insight reason dropout can help improv etherapi program decreas number dropout addit research need direct compar effect etherapi program facetofac treatment program

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