Alcohol Use Disorder and Comorbid Depression

A Randomized Controlled Trial Investigating the Effectiveness of Supportive Text Messages in Aiding Recovery

Helen O'Reilly; Aisling Hagerty; Seamus O'Donnell; Aoife Farrell; Dan Hartnett; Edel Murphy; Elizabeth Kehoe; Vincent Agyapong; Declan M. McLoughlin; Conor Farren


Alcohol Alcohol. 2019;54(5):551-558. 

In This Article

Abstract and Introduction


Aim: The aim of this randomized controlled trial was to examine the impact of daily supportive text messages over a 6-month treatment period on mood and alcohol consumption in individuals with a dual diagnosis of alcohol use disorder (AUD) and depression following completion of an inpatient treatment programme.

Method: Ninety-five adult participants with AUD and comorbid depression were recruited into this randomized control trial, which took place after completing a 30-day rehabilitation programme. The intervention group (n = 47) received twice-daily supportive text messages over 6-months while control participants (n = 48) had treatment as usual for a 6-month period, with an added 6-month post-treatment follow-up for both groups. Drinking history in the previous 90 days as well as symptoms of depression, anxiety and stress were measured at baseline, 3- and 6-month treatment points and 6-month post treatment follow up.

Results: Depression scores (P = 0.02) and perceived stress scores (P < 0.01) were significantly reduced at 3-month treatment point in the intervention group relative to control participants with small to medium effect. The intervention group also showed a significantly greater reduction in units per drinking day from baseline to 6-month treatment point compared to the control group with a medium effect size (P = 0.03). There were no differences in drinking or mood measures at 6-month post treatment follow-up.

Conclusions: Supportive text messages provide an early initial benefit in decreasing symptoms of depression and stress, with a further positive impact on alcohol consumption following a longer treatment period. Benefits did not persist six months after the intervention ended.


The significant association between depression and alcohol use disorder (AUD) is well documented (Hasin et al., 2007; Grant et al., 2015; Lai et al., 2015), with one study reporting a prevalence of lifetime depression in individuals with AUD at 35% (Mericle et al., 2012). Individuals with this comorbidity are more disabled and demonstrate less treatment gains than individuals with AUD alone (Burns et al., 2005). Additionally, this dual diagnosis is associated with a greater relapse risk (Greenfield et al., 1998; Driessen et al. 2001). Maintaining early abstinence post treatment is vital as this predicts later abstinence in these comorbid patients (Farren et al., 2014), with abstinence at 6-months predicting abstinence at 2 years (Farren et al., 2013). These studies highlight the importance of support in the initial 6-month period following treatment and need for novel outpatient intervention approaches for this difficult to treat comorbid population.

Interventions delivered via mobile phone technology for a variety of psychological and health conditions have found this to be an effective treatment platform (Heron & Smyth, 2010; Watson et al., 2016). Specifically, research has highlighted the utility of text message support as a psychological intervention for smoking cessation (Rodgers et al., 2005; Abroms et al., 2014), depression (Agyapong et al., 2017), anxiety (Whitton et al., 2015), heavy/hazardous drinking in young adults (Haug et al., 2013; Suffoletto et al., 2014; Bock et al., 2016) and AUD (Agyapong et al., 2018). Furthermore, supportive text messages are simple, low cost, easy to implement and perceived positively by recipients (Agyapong et al., 2016). We previously conducted a pilot trial investigating the efficacy of supportive text messages for post-treatment individuals with a dual diagnosis of depression and AUD, which found mood benefits following a 3-month intervention period as well as a trend for greater abstinence (Agyapong et al., 2012).

Following on from our pilot trial, the aim of the present study was to complete a definitive randomized controlled trial to examine the effectiveness of supportive text messages on the recovery of individuals with a dual diagnosis of AUD and depression. Using a larger sample size, we wished to investigate treatment response to a 6-month intervention with a further 6-month follow-up to evaluate if short-term improvements previously documented are extendable to a longer time frame and to a broader range of outcomes. We expected scores on mood, anxiety and stress outcome measures, as well as number of drinking days and units of alcohol per drinking day, all to be lower at 3-month and 6-month treatment time points in the intervention group compared to the control group. We extended the evaluation to 12-months (6-month post treatment follow up) to ascertain if clinical effects extended beyond the 6-month intervention period.