Postel Marloes G, de Haan Hein A, ter Huurne Elke D, Becker Eni S, de Jong Cor A J
Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, Netherlands.
J Med Internet Res. 2010 Dec 16;12(4):e68. doi: 10.2196/jmir.1642.
Online self-help interventions for problem drinkers show promising results, but the effectiveness of online therapy with active involvement of a therapist via the Internet only has not been examined.
The objective of our study was to evaluate an e-therapy program with active therapeutic involvement for problem drinkers, with the hypotheses that e-therapy would (1) reduce weekly alcohol consumption, and (2) improve health status. Reasons for dropout were also systematically investigated.
In an open randomized controlled trial, Dutch-speaking problem drinkers in the general population were randomly assigned (in blocks of 8, according to a computer-generated random list) to the 3-month e-therapy program (n = 78) or the waiting list control group (n = 78). The e-therapy program consisted of a structured 2-part online treatment program in which the participant and the therapist communicated asynchronously, via the Internet only. Participants in the waiting list control group received "no-reply" email messages once every 2 weeks. The primary outcome measures were (1) the difference in the score on weekly alcohol consumption, and (2) the proportion of participants drinking under the problem drinking limit. Intention-to-treat analyses were performed using multiple imputations to deal with loss to follow-up. A dropout questionnaire was sent to anyone who did not complete the 3-month assessment. Reasons for dropout were independently assessed by the first and third author.
Of the 156 individuals who were randomly assigned, 102 (65%) completed assessment at 3 months. In the intention-to-treat analyses, the e-therapy group (n = 78) showed a significantly greater decrease in alcohol consumption than those in the control group (n = 78) at 3 months. The e-therapy group decreased their mean weekly alcohol consumption by 28.8 units compared with 3.1 units in the control group, a difference in means of 25.6 units on a weekly basis (95% confidence interval 15.69-35.80, P < .001). The between-group effect size (pooled SD) was large (d = 1.21). The results also showed that 68% (53/78) of the e-therapy group was drinking less than 15 (females) or 22 (males) units a week, compared with 15% (12/78) in the control group (OR 12.0, number needed to treat 1.9, P < .001). Dropout analysis showed that the main reasons for dropouts (n = 54) were personal reasons unrelated to the e-therapy program, discomfort with the treatment protocol, and satisfaction with the positive results achieved.
E-therapy for problem drinking is an effective intervention that can be delivered to a large population who otherwise do not seek help for their drinking problem. Insight into reasons for dropout can help improve e-therapy programs to decrease the number of dropouts. Additional research is needed to directly compare the effectiveness of the e-therapy program with a face-to-face treatment program.
针对问题饮酒者的在线自助干预显示出了有前景的结果，但仅通过互联网在治疗师积极参与下的在线治疗效果尚未得到检验。
我们研究的目的是评估一项针对问题饮酒者且有积极治疗参与的电子治疗项目，假设电子治疗会（1）减少每周酒精摄入量，以及（2）改善健康状况。还系统地调查了退出治疗的原因。
在一项开放随机对照试验中，将普通人群中说荷兰语的问题饮酒者（根据计算机生成的随机列表，按每组8人分组）随机分配到为期3个月的电子治疗项目组（n = 78）或等待名单对照组（n = 78）。电子治疗项目包括一个结构化的两部分在线治疗项目，参与者和治疗师仅通过互联网进行异步交流。等待名单对照组的参与者每两周收到一次“无回复”电子邮件。主要结局指标为（1）每周酒精摄入量得分的差异，以及（2）饮酒量低于问题饮酒限量的参与者比例。采用多次填补法进行意向性分析以处理失访问题。向所有未完成3个月评估的人发送了一份退出治疗调查问卷。退出治疗的原因由第一作者和第三作者独立评估。
在随机分配的156人中，102人（65%）在3个月时完成了评估。在意向性分析中，电子治疗组（n = 78）在3个月时酒精摄入量的减少幅度显著大于对照组（n = 78）。电子治疗组平均每周酒精摄入量减少了28.8单位，而对照组为3.1单位，每周平均差异为25.6单位（95%置信区间15.69 - 35.80，P <.001）。组间效应量（合并标准差）较大（d = 1.21）。结果还显示，电子治疗组68%（53/78）的人每周饮酒量低于15单位（女性）或22单位（男性），而对照组为15%（12/78）（比值比12.0，需治疗人数1.9，P <.001）。退出治疗分析表明，退出治疗者（n = 54）的主要原因是与电子治疗项目无关的个人原因、对治疗方案的不适以及对取得的积极结果的满意度。
针对问题饮酒的电子治疗是一种有效的干预措施，可用于大量原本不为饮酒问题寻求帮助的人群。深入了解退出治疗的原因有助于改进电子治疗项目以减少退出治疗的人数。需要进一步研究以直接比较电子治疗项目与面对面治疗项目的效果。
