Traditional treatment facilities for alcohol problems tend to concentrate on the heavy dependent drinker. They do not suit everyone. There are many people who drink hazardously, but do not present themselves for treatment. They find that the prospect of discussing their private drink problems with anyone at all is often deeply unappealing and not taken up. The social and health costs associated with such drinking are very high and it is important to find new ways to provide hazardous drinkers with help to control their consumption. One way to reach some of this group may be via the World Wide Web. In the first quarter of 2002 approximately 10.7 million households in the UK had internet access and this figure is rising all the time. “Down Your Drink” is an interactive, structured web based intervention aimed at helping people drink safely.
Previous research has shown that brief interventions and self-help manuals may be attractive to many and present a good chance of success. The rapid development, spread and availability of information technologies offers new opportunities to provide help to those whom it may be otherwise hard to reach. In fact, early experience
with online treatments suggests that many people are extremely open and motivated when talking to a computer about personal topics. “Down Your Drink” was developed by Stuart Linke (Clinical Psychologist), Paul Wallace (GP and Professor of Primary Care) and Andrew Brown (Research Assistant).
“Down Your Drink” is based upon an earlier printed treatment manual developed by Charles Elstone (a volunteer alcohol counsellor) and Toni Brisby (a specialist in health promotion). It contains many elements widely utilised in self-help treatment manuals and can be completed in less than one hour a week over a period of six weeks. The computerised web based version, of course, contains many unique elements. These include on-line quizzes, “mouse overs” revealing useful factual information, motivational questions, an interactive drinking diary, emailed “drinking tips” and a blood alcohol concentration calculator. There is also an associated email discussion group.
A range of screening instruments were considered for the site and the FAST instrument was selected (Fast Alcohol Screening Test). This is the latest screening instrument for risky drinking developed by Professor Ray Hodgson and colleagues.
It is quicker and easier to administer than its predecessor the AUDIT (Alcohol Use Disorders Identification Test).
The early user trials of” Down Your Drink” were very encouraging, indicating that many problem drinkers prefer to remain anonymous and click through the web pages, than talk to their doctor or an alcohol counsellor. Participants particularly liked the self-assessment questionnaires, the “drinking genie” which calculates alcohol consumption and expenditure on drink automatically, as well as the light-hearted “Cyber Saloon” where members can take a break from the program.
This program, is available for anyone who is concerned about their drinking. The web-site is confidential, free of charge and accessible 24 hours a day from any PC connected to the Internet.
The site is easy to use, engaging and informative. Program members are placed firmly in control of the program, they set their own drinking targets, decide when and where to complete the program and receive individual feedback. Importantly, information is provided in a neutral way without “preaching” and to ensure confidentiality members can choose their own alias user name just for the program and are not required to surrender their private personal details. Throughout the program users are encouraged to discuss any medical problems they may have with their doctor. As a follow up to the programme users are invited to join an online email discussion group.
“Down Your Drink” has proved to be a very popular site. It receives around 40 visits a day and over 1000 visits each month. Visitors are from across the globe. Most people find the site via Internet Search Engines suggesting that there are many people who are using the Internet to find help for their problem drinking.
Around sixty percent of those who visited the site registered with the programme. We anticipated that drop out would be high, but during the first six months 79 people completed the course (see Figure 1).
Comparisons were made between week and week 6 of the programme. Those who completed the programme demonstrated statistically Significant reductions in their alcohol consumption of, on average, 10 units each week. They also halved the number of number of drinking binges and significantly reduced their levels of alcohol dependence. Improvements were not confined to alcohol related measures alone. Responses on a questionnaire assessing mental health symptoms showed that at the beginning of the programme participants scores were, on average, above the clinical threshold. By the end of the programme these scores had reduced to below the clinical threshold,
The profile of users was very encouraging, Equal numbers of men and women used the programme and half of the users were married and half had children. The average age was thirty-nine. They used the site at work and at home, but the most popular time was between midnight and 1.00am suggesting that they were logging on when the house was quiet, possibly after the kids had gone to bed. We sent users questionnaires and many of them told us that they were not currently receiving alcohol counselling, had never previously sought help and would have been unlikely to have done so if they hadn’t come across the site. So “Down Your Drink” appears to have found an important “niche”, and thus may prove a very useful adjunct to existing services. It appears that the site reflects a cross section of Internet users as a whole and that it has successfully targeted a group of hazardous drinkers (assessed by the FAST) who would be unlikely to seek help elsewhere and are otherwise difficult to reach and who may go on to develop significant long term harmful drinking.
There are still improvements that could still be made to the site so that, for example, the drinking diary is easier to use and the online chat room facility is made more user friendly. Nevertheless, “Down Your Drink” is a very low cost intervention with the potential to reach millions of hazardous drinkers, providing them with a valuable form of help.
Future plans include the transfer of responsibility for developing and managing the site to Alcohol Concern and further research to more thoroughly evaluate i.
Stuart Linke (Clinical Psychologist), Paul Wallace (GP and Professor of Primary Care) and Andrew Brown (Research Assistant).
The Final Report (external link to the Down Your Drink website)