Table 1 Summary of included studies: salient characteristics and outcomes
From: Building the first step: a review of low-intensity interventions for stepped care
Intervention modality | Investigators | Study design | Sample | Elements of intervention | Magnitude of alcohol consumption change & dependence measure | Attract individuals* | Positive outcomes** | Inspire help-seeking† |
|---|---|---|---|---|---|---|---|---|
Bibliotherapy | Apodaca & Miller (2003) | Meta-analytic review of 22 bibliotherapy studies | Included studies broadly targeting “problem drinkers” | Included studies invited participants to read and implement self-help materials | Bibliotherapy versus control (self-referred drinkers), d = 0.31 | X | XX | X |
Dependence measure: varied across studies (e.g., abstinence rates, alcohol consumption frequency, liver enzyme levels) | ||||||||
Bibliotherapy | Sobell et al (2002) | Randomized trial | Individuals who consumed >12 drinks per week or ≥5 drinks on ≥5 days in the year prior to assessment | Participants received 1 of 2 written interventions by mail: 1) Motivational enhancement-based feedback and advice (personalized based on participants’ drinking history and patterns); 2) General information on the effects of alcohol, guidelines for safe use, and information on self -monitoring | No significant differences between groups in alcohol consumption change | X | XX | X |
Motivational enhancement/personalized feedback (n = 414); | ||||||||
Bibliotherapy/drinking guidelines (n = 411) | ||||||||
Bibliotherapy | Cunningham et al (2002) | Randomized trial | Individuals who expressed interest in self-help and scored ≥8 on the AUDIT | Drink Wise, which uses CBT principles, served as the self-help text. Personalized assessment/feedback was based on the “Drinker’s Check-up” and included personalized assessment, normative feedback, and information regarding the potential negative consequences of alcohol use | Self-help book & personalized assessment/feedback versus single treatment or control, d = 0.21 | X | ||
Self-help book (n = 22); personalized assessment/feedback (n = 21); self-help book & personalized assessment/feedback (n = 17); no materials (n = 26) | ||||||||
Dependence measure: Mean days per week of ≥5 drinks per occasion during a typical week in the 6-month follow-up period | ||||||||
Bibliotherapy | Bamford et al (2005) | Randomized trial | Individuals presenting for clinic-based alcohol treatment | Participants received a 6-page leaflet based on FRAMES | Leaflet versus no leaflet, d = 0.20 | X | X | |
Leaflet condition (n = 180); no leaflet condition (n = 181) | ||||||||
Dependence measure: Self-rated categorical (yes/no) reduction in alcohol use at follow-up | ||||||||
Bibliotherapy | Wild et al (2007) | Randomized trial | Current drinkers (used alcohol in the 12 months prior to assessment) with no previous participation in alcohol treatment who had an interest in self-help materials | The self-help pamphlet gave normative feedback regarding drinking habits and included information on the hazards of alcohol use at various consumption levels, guidelines for reducing alcohol use, and referral to a local treatment hotline | Unable to calculate | X | ||
Pamphlet (n = 877); no pamphlet (n = 850) | ||||||||
Bibliotherapy | Kavanagh & Connolly (2009) | Randomized trial | Individuals who met DSM-IV criteria for an AUD | Participants were enrolled in primary care and received information regarding the effects of alcohol, self-monitoring forms, and a self-help booklet. The mailed correspondence treatment further included personalized progress letters and 8 CBT-based newsletters | Dependence measure: Mean drinks per week = 0.39 | XX | ||
Immediate mailed intervention (n = 103); delayed mailed intervention (n = 101) | ||||||||
Telephone-delivered intervention | Brown et al (2007) | Randomized trial | Individuals who met DSM-IV criteria for alcohol abuse or dependence who were drawn from primary care | The telephone-based intervention consisted of 6 sessions based on MI principles and the stages of change model. Behavioral techniques were used to monitor sobriety goals. Participants were also sent individualized letters summarizing progress after sessions | Telephone-based intervention versus control (male participants) = 0.16 | XX | ||
Telephone-based intervention (n = 445); control (n = 452) | ||||||||
The intervention was not superior to control for women | ||||||||
Dependence measure: Total standard drinks consumed in the month prior to 3-month follow-up interview | ||||||||
Telephone-delivered intervention | Mello et al (2008) | Randomized trial | Noncritically injured emergency department patients who used alcohol at risky levels per NIAAA quantity/frequency guidelines | Targeted individuals with a recent alcohol-related injury. Counselors initiated 2 brief calls (30 minutes & 15 minutes) based on MI principles | No significant differences between groups in alcohol consumption change | X | ||
Telephone-based intervention (n = 140); control (n = 145) | ||||||||
Computer-based intervention | Hester et al (2005) | Randomized trial | Individuals who scored ≥8 on the AUDIT | Participants were given access to computer-based MI. Components include assessment and normative feedback, decisional balance, and negotiating sobriety goals | Pre versus post for computer-based intervention, = 1.05 | X | X | |
Computer-based intervention (n = 35); control (n = 26) | ||||||||
Dependence measure: Mean of 3 dependent variables (average drinks per day, drinks per drinking day, and average peak BAC level) during 12-month follow-up period | ||||||||
Computer-based intervention | Neumann et al (2006) | Randomized trial | Emergency department patients who scored ≥5 on the AUDIT | Patients in the active treatment condition were given access to computer-delivered personalized advice and normative feedback. Feedback was based on the MI principles and FRAMES guidelines. Other components included information about alcohol and provider referral information | Computer-based intervention versus control = 0.20 | X | ||
Computer-based intervention (n = 561); control (n = 575) | ||||||||
Dependence measure: Proportion of participants who met British Medical Association criteria for at-risk drinking at 6 months post-treatment | ||||||||
Computer-based intervention | Boon et al (2011) | Randomized trial | Drinkers with alcohol consumption levels exceeding the limits set by the Dutch guidelines for low-risk drinking | Participants in the treatment group received normative feedback and information regarding the negative consequences of alcohol use. Personalized advice was informed by participant drinking patterns, self-efficacy and attitude, and stage of change | Intervention versus control = 0.25 | X | ||
Computer-based advice (n = 230); control (n = 220) | ||||||||
Dependence measure: Meeting or failing to meet Dutch guidelines for low-risk drinking at 1-month follow-up | ||||||||
Internet-based intervention | Cunningham et al (2009) | Randomized trial | Drinkers who scored ≥4 on the 3 consumption items on the AUDIT-C & expressed an interest in self-help | Participants in the active condition were mailed a URL that allowed them to access the screening program, which provided a personalized assessment and normative feedback | Mailed intervention URL versus control, ηp2 = 0.08 | X | ||
Sent URL by mail to participate in intervention (n = 92); control (n = 93) | ||||||||
Dependence measure: Mean drinks consumed per week during follow-up period | ||||||||
Internet-based intervention | Pemberton et al (2011) | Quasi-randomized trial | Active duty military personnel | Participants assigned to active treatment received either AS or DCU. Controls received no intervention. Both interventions were adapted for a military population via expert consensus | AS versus control = no significant differences in alcohol consumption change | X | ||
Internet-based intervention based on social learning theory (AS) (n = 686);Internet-based intervention based on MI principles (DCU) (n = 1470); control (n = 914) | ||||||||
DCU versus control = 0.10 | ||||||||
Dependence measure: Average drinks per drinking occasion during 1-month follow-up | ||||||||
Internet-based intervention | Riper et al (2007) | Randomized trial | Drinkers whose consumption levels exceeded Dutch guidelines for low-risk drinking | Online self-help protocol was consistent with CBT and self-control principles. The intervention was accessed via the study website and included goal setting and analysis of alcohol behavior. Participants also had access to a peer-to-peer chat room | Online self-help versus control = 0.40 | X | X | |
Online self-help, (n = 130); control (n = 131) | ||||||||
Dependence measure: Mean weekly alcohol consumption during 6-month follow-up period | ||||||||
Internet-based intervention | Postel et al (2010) | Pre-post design | Individuals concerned about their drinking | Therapy was delivered online by a therapist who communicated with the patient asynchronously. Treatment was a blend of CBT and motivational enhancement, along with elements from the stages-of-change model. Therapy assignments were given in 2 stages; patients could choose (with therapist approval) to move to the second stage of treatment | Pre- versus post-intervention = 1.11 | X | XX | |
(N = 527) | ||||||||
Dependence measure: Mean weekly alcohol consumption immediately post-treatment | ||||||||
Internet-based intervention | Blankers et al (2011) | Randomized trial | Score >8 on the AUDIT and consumption of >14 standard drinks in a week | SAO: An automated, fully self-guided Internet intervention based on elements of MI and CBT. | TAO versus WL = 0.59 SAO versus WL = 0.36 | XX | ||
Internet-based self-help, (SAO) (n = 68); Internet-based therapy (TAO) (n = 68); control (WL) (n = 69) | ||||||||
Dependence measure: Number of drinks in the 7 days prior to 3-month follow-up | ||||||||
TAO: A therapist-led online intervention (elaborated version of SAO’s MI/CBT protocol plus 7 synchronous chat-based therapy sessions) | ||||||||
Control: waitlist (WL) condition | ||||||||
Internet-based intervention | Wallace et al (2011) | Randomized trial | Individuals who accessed the DYD website and scored ≥5 on the AUDIT-C | Participants in the active condition received access to the DYD interactive online alcohol intervention based on CBT, MI, and relapse prevention techniques | DYD versus control = no significant differences in alcohol consumption change | X | ||
“Down Your Drink” Internet-based intervention (DYD) n = 3972); control (n = 3963) | ||||||||
Internet-based intervention (television-supported) | Kramer et al (2009) | Randomized trial | Drinkers whose consumption levels exceeded Dutch guidelines for low-risk drinking | Participants in active treatment were asked to use a CBT-based, television-supported online self-help intervention. The 5-part series depicts a coach guiding 2 individuals with alcohol problems through an intervention. Participants also received written self-help materials and access to the website | Television-based intervention versus control = 0.90 | X | ||
Television-supported intervention (n = 90); control (n = 91) | ||||||||
Dependence measure: Mean weekly alcohol consumption at follow-up |