Treatment dismantling pilot study to identify the active ingredients in personalized feedback interventions for hazardous alcohol use: randomized controlled trial

Background There is a considerable body of evidence supporting the effectiveness of personalized feedback interventions for hazardous alcohol use—whether delivered face-to-face, by postal mail, or over the Internet (probably now the primary mode of delivery). The Check Your Drinking Screener (CYD; see www.CheckYourDrinking.net) is one such intervention. Objectives The current treatment dismantling study assessed which components of personalized feedback interventions were effective in motivating change in drinking. Specifically, the major objective of this project was to conduct a randomized controlled trial (RCT) comparing the impact of the normative feedback and other personalized feedback components of the CYD intervention in the general population. Methods Participants were recruited to take part in an RCT and received either the complete CYD final report, just the normative feedback sections of the CYD, just the personalized feedback components of the CYD, or were assigned to a no-intervention control group. Participants were followed-up at 3 months to assess changes in alcohol consumption. Results A total of 741 hazardous drinking participants were recruited for the trial, of which 73 percent provided follow-up data. Analyses using an intent-to-treat approach found some evidence for the impact of the personalized feedback components of the CYD in reducing alcohol consumption on the variables, number of drinks in a week and AUDIT-C (p = .028 and .047 respectively; no impact on highest number of drinks on one occasion; p = .594). However, there was no significant evidence of the impact of the normative feedback components (all p > .3). Conclusions Personalized feedback elements alone could provide an active intervention for hazardous drinkers, particularly in situations where normative feedback information was not available. Trials registration ClinicalTrials.gov NCT01608763. Electronic supplementary material The online version of this article (doi:10.1186/s13722-014-0022-1) contains supplementary material, which is available to authorized users.


Heavy Drinking Days
How often do males from Canada in your age range drink five or more drinks on one occasion? The highlighted slice shows where your drinking fits into the chart:

Sensible Drinking
Guidelines suggest that most people can drink up to two drinks a day without significant risk to their health, in the short or the long term.
Most people can and do drink safely and sensibly. This means no more than two drinks a day with a weekly maximum of 14 drinks for men and 9 drinks for women. It is also a good idea to make sure there are days when you don't drink at all. For some people, even 1 to 2 drinks per day would be too many. Pregnant women, for example, are advised to abstain from alcohol completely because even small amounts of alcohol could increase the risk to the unborn child. Heavy drinking days are especially dangerous to the unborn child. Certain health problems such as heart disease or cancer can make even moderate drinking unsafe.

Health Effects of Alcohol
We've included the following information in the event that you would like to learn more about how the use of alcohol can affect your health.

Your liver
Because the liver receives blood directly from the intestines, it takes the brunt of high alcohol concentrations. Heavy alcohol consumption can lead to two serious types of liver injury: hepatic inflammation (alcohol hepatitis) and progressive liver scarring (fibrosis or cirrhosis). (Chedid et al 1991;Dufour et al 1993) Women are more at risk to serious alcohol-related liver injury; they develop cirrhosis at a lower dose of alcohol than men do. (Marbet et al 1987) Heavy drinkers are 3 times more likely to develop liver cancer than non-drinkers. (English & Holman, 1995) Your throat, stomach, and intestines Alcohol is a cause of long-term throat inflammation that sometimes leads to cancer. Inflammation occurs in part because alcohol reduces contraction of the smooth muscle in the lower throat. (Keshavarzian et al 1994) People who drink more that 21 drinks per week have almost a ten-fold higher risk of throat cancer than those who consume fewer than 7 drinks per week. (Vaughan et al 1995) Mouth cancers are six times more common in heavy alcohol users than in non-alcohol users. (American Cancer Society, 2002) Back to the top

Your pancreas
The pancreas is a gland behind your stomach that releases chemicals important for digesting food. Heavy alcohol use can lead to long-term pancreatic inflammation, weakening, and scarring. (Haber et al 1995) Alcohol can also cause acute pancreatitis, a severe and very painful inflammation of the pancreas.

Your heart and circulatory system
The potential health benefits of moderate drinking (up to 2 drinks per occasion) do not apply to younger people, whose risk for heart disease is ordinarily very low.
Long-term drinking of more than four drinks per occasion has been linked to a variety of damaging effects on the heart and circulatory system. (Davidson, 1989) Back to the top Your brain Alcohol can cause direct or indirect damage to nervous tissues. Long-term heavy drinking is linked to brain damage and poor mental functioning. (Spreen and Strauss, 1991) Your endocrine system (hormone regulation) Alcohol interferes with the hormone regulation of a number of bodily activities. Men who have a history of heavy drinking often have lower levels of testosterone and increases in female sex steroids, such as estradiol and estrone.

Emergency Department
Patients treated in an emergency department for an unintentional injury are 13.5 times more likely to have drunk 5 or more alcohol-containing drinks within 6 hours of their injury. Alcohol-related unintentional injuries and deaths include motor vehicle crashes, drowning, falls, hypothermia, burns, suicides, and homicides. (Vinson, 2003) Road traffic crashes Road traffic crashes are the leading cause of death for people aged 1-34 years. They are also a leading cause of hospitalization for serious injury. Alcohol is involved in around 40% of crashes (LTSA, 2000;NHTSA, 2003).

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Compared with a person with no alcohol in their blood, a person with a blood alcohol concentration (BAC) of 0.10% is between 13 and 18 times more likely to have any crash and 50-90 times more likely to have a fatal crash. (Miller, 2001) Unlike what some people believe, vehicle occupants with high levels of alcohol in their system (high BAC) are more likely to be seriously injured or to die in the event of a crash. (Soderstrom, 1993)

Alcohol and Violence
In 1997, about 40% of all crimes (violent and non-violent) were committed by people who had alcohol in their system. (Bureau of Justice Statistics, 1998) In 1997, 40% of convicted rape and sexual assault offenders said that they were drinking at the time of their crime. (Greenfield, 2000) Approximately 72% of rapes reported on college campuses occur when victims are so intoxicated they are unable to consent or refuse. (Wecshler, 2004) Back to the top

Reducing Your Risk
There are many things that you can do to reduce the risk of hurting yourself or others. Here are some small steps you can take to start making a change: • Don't drink in any situation where there's a risk of accident or injury -for example, drinking and driving.
• Don't mix alcohol with other drugs -especially other depressants like tranquilizers, barbiturates, heroin or other opioids.
• Try to reduce by one or two days the number of days you drink each week.
• Decide how much you will drink ahead of time and keep yourself to this limit.
• Take a limited amount of money with you if you go out to have a drink.
• Keep track of the amount you drink.
• Alternate alcoholic with non-alcoholic beverages when you drink.
• Choose alcoholic beverages with lower alcohol content.
• If you are out drinking with friends, make sure at least one person stays sober. If that person is driving they should not drink any alcohol at all.
• Do not become intoxicated with people you do not know and trust; criminal victimization is a much greater risk when you are drunk.
• Remember the need to practice safer sex -always use condoms.