The Effectiveness of the 'What Do You Drink' Web-Based Brief Alcohol Intervention in Reducing Heavy Drinking Among Students

A Two-arm Parallel Group Randomized Controlled Trial

Carmen V. Voogt; Evelien A.P. Poelen; Marloes Kleinjan; Lex A.C.J. Lemmers; Rutger C.M.E. Engels

Disclosures

Alcohol Alcohol. 2013;48(3):312-321. 

In This Article

Abstract and Introduction

Abstract

Aims: To evaluate the effectiveness of a web-based brief alcohol intervention 'What Do You Drink' (WDYD) among heavy drinking students at 1- and 6-month post-intervention. Additionally, it was investigated whether certain subgroups would benefit more than others from the WDYD intervention.

Methods: A two-arm parallel group randomized controlled trial was conducted online in the Netherlands in 2010–2011. Inclusion criteria were: (1) being between 18- and 24-year old, (2) reporting heavy drinking in the past 6 months, (3) being motivated to change alcohol consumption, (4) having access to the Internet and (5) giving informed consent. Participants (n = 913) were randomized to the experimental (WDYD intervention) or control condition (no intervention). Measures were heavy drinking, frequency of binge drinking and weekly alcohol consumption.

Results: Analyses according to the intention-to-treat principle revealed no significant main intervention effects in reducing the alcohol measures at the follow-up assessments. Secondary analyses revealed that gender, freshmen and fraternity or sorority membership did not moderate the effect of the WDYD intervention at both follow-ups. Readiness to change, problem drinking and carnival participation moderated intervention effects such that contemplators, those with severe symptoms of alcohol abuse or dependence, and those who participated in carnival benefited more than others from the WDYD intervention regarding weekly alcohol consumption at 1-month follow-up.

Conclusions: The WDYD intervention was not effective in reducing the alcohol measures among heavy drinking students at 1- and 6-month post-intervention. However, there is preliminary evidence that the WDYD intervention is effective in lowering drinking levels for subgroups of heavy drinking students in the short term.

Introduction

The high prevalence of heavy drinking among students, especially among those who are affiliated with fraternities or sororities, is cause for concern (Karam et al., 2007; Wicki et al., 2010; Maggs et al., 2011; Ragsdale et al., 2011). Heavy drinking among young adults significantly increases the risk of adverse consequences in terms of mortality and morbidity (Hingson et al., 2009). Adequate interventions are needed to curb the prevalence and associated consequences of heavy drinking among young adults. What is remarkable, however, is that few alcohol intervention programs that target young adults are available in the Netherlands (De Graaf et al., 2010; Van Laar et al., 2011; Geels et al., 2012).

Over the past decade, alcohol interventions are increasingly being delivered via the web with the growth of computer technology and the Internet (White et al., 2010). Prior studies suggested that web-based brief alcohol interventions providing personalized normative feedback are a promising way to reduce heavy drinking among young adults (Bewick et al., 2008), students (Doumas et al., 2009; Kypri et al., 2009), freshmen (Saitz et al., 2007; Hustad et al., 2010) and fraternity or sorority members (Larimer et al., 2001). The majority of web-based brief alcohol interventions are based on Motivational Interviewing principles (Miller and Rollnick, 2002) and social influence models (Bandura, 1986) and endeavor to detect harmful alcohol consumption and encourage non-treatment seeking heavy drinkers to alter their behavior (Spijkerman et al., 2010). Web-based brief alcohol interventions are beneficial over traditional face-to-face ones since they can target non-treatment seeking groups, are accessible 24 h a day, can safeguard the users' anonymity, and are cost-effective to implement (Riper et al., 2009).

Because of the high prevalence of heavy drinking among young adults and its consequences, the lack of Dutch alcohol prevention programs targeting young adults, the advantages of web-based delivered interventions, and the fact that the majority of young adults have access to the Internet and are actively using it (Escoffery et al., 2005), a web-based brief alcohol intervention targeting heavy drinking young adults was developed. This intervention, entitled 'What Do You Drink' (WDYD), was developed using the intervention mapping (IM) protocol (see Voogt et al., 2011), which is a stepwise approach for theoretical and evidence-based development, implementation, and evaluation of effective behavior change interventions (Bartholomew et al., 2001). The WDYD intervention was intended to reduce alcohol consumption among heavy drinking young adults by (a) increasing their awareness of potential problems, consequences, and risks associated with drinking behavior through providing personalized normative feedback and (b) strengthening drinking refusal self-efficacy through providing tips to maintain drinking goals in situations in which it is hard to resist alcohol. Personalized normative feedback comprised comparative information about personal drinking levels and drinking levels of same-sex peers. The underlying idea was to correct misperceptions of descriptive drinking norms, which conforms to social influence models. Moreover, the personalized normative feedback was delivered in a non-judgmental, non-confrontational and non-aversive manner to meet Motivational Interviewing principles.

The aim of the present study was to evaluate the effectiveness of the WDYD intervention among heavy drinking students at 1- and 6-month post-intervention. It was hypothesized that exposure to the WDYD intervention would be more effective in reducing heavy drinking, frequency of binge drinking and weekly alcohol consumption compared with no intervention at the 1- and 6-month follow-up.

Because the population of heavy drinking students is not likely to be a homogeneous group, we further explored whether certain theory-based subgroups would benefit more than others from the WDYD intervention to improve the intervention and to identify the needs of different subgroups (Chiauzzi et al., 2005; Carey et al., 2007a; Riper et al., 2008; Turrisi et al., 2009). Six moderators were identified on the basis of moderators previously reported in the literature.

Gender

The moderating role of gender in web-based brief alcohol interventions remains ambiguous. In some studies, males show better outcomes than females (e.g. Spijkerman et al., 2010), yet other studies indicate the opposite pattern (e.g. Chiauzzi et al., 2005; Riper et al., 2008) and yet others indicate that males and females are equally receptive (Ballesteros et al., 2004; Bewick et al., 2008; Carey et al., 2009; Kypri et al., 2009). The differential gender effectiveness of web-based brief alcohol interventions necessitates further research.

Readiness to Change

Readiness to change is a proximal predictor of behavior change in multiple cognitive-behavioral theories, such as the Theory of Planned Behavior (Ajzen, 1991) and the Transtheoretical Model (Prochaska and Velicer, 1997). Evidence regarding the moderating role of readiness to change in web-based brief alcohol intervention effectiveness has been mixed, with some studies showing that a high degree of readiness to change resulted in alcohol consumption reductions (Carey et al., 2007a; Mun et al., 2009), whereas other studies showed opposite effects (e.g. Maisto et al., 2001). The inconsistent findings of differences in readiness to change support further investigation of readiness to change as a moderator of web-based brief alcohol intervention effectiveness.

Problem Drinking

Several studies have found that severity of alcohol consumption acted as moderator in the effectiveness of alcohol interventions (e.g. Lewis et al., 2007; Sher and Rutledge, 2007), yet other studies did not (e.g. Riper et al., 2008; Barnett et al., 2010). Those with higher levels of alcohol consumption, might be more inclined to seek help or advice when they receive personalized feedback and normative comparisons with alarming content (White et al., 2010; Fraeyman et al., 2012). The contradicting findings of previous studies and the limited research on the impact of the severity of alcohol consumption on web-based brief alcohol intervention response in a student population warrants investigation of problem drinking as a moderator.

Freshmen

Freshmen are at high risk of developing and adopting heavy drinking patterns due to increased independence and decreased parental monitoring in the transition from high school to college or university. Moreover, freshmen are found to perceive alcohol consumption as a way to make new friends (Borsari et al., 2007). Considering that perceived peer norms of alcohol consumption are influential, interventions providing personalized normative feedback about drinking levels of same-sex peers might be especially beneficial for freshmen (Borsari et al., 2007).

Fraternity or Sorority Membership

The moderating role of fraternity or sorority membership in web-based brief alcohol intervention effectiveness has not been well evaluated. Students affiliated with fraternities or sororities engage in heavy drinking more often than those who are not members of fraternities and sororities, partly due to selection and socialization processes (Maalsté, 2000; Park et al., 2008; Ragsdale et al., 2011). Fraternity or sorority members who are frequently exposed to situations where alcohol is present might benefit more than others from guidelines to resist alcohol in high-risk drinking situations provided by the WDYD intervention.

Carnival Participation

Most web-based brief alcohol interventions do not take into account the fluctuating nature of alcohol consumption among students during the year (Del Boca and Darkes, 2003; Maggs et al., 2011) and merely focus on reducing heavy drinking in general rather than heavy drinking associated with specific events (Neighbors et al., 2011). Carnival, a 4-day event celebrated in February before spring in the southern provinces in the Netherlands and associated with excessive drinking, coincided with our 1-month follow-up. Although the WDYD intervention was not designed as a prevention strategy for specific high-risk drinking events, it is worthwhile to explore whether carnival participants benefit more than others from the WDYD intervention.

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