A Digital Intervention Addressing Alcohol Use Problems (the “Daybreak” Program): Quasi-Experimental Randomized Controlled Trial

Background: Alcohol use is prevalent in many societies and has
major adverse impacts on health, but the availability of effective
interventions limits treatment options for those who want
assistance in changing their patterns of alcohol use. Objective:
This study evaluated the new Daybreak program, which is accessible
via mobile app and desktop and was developed by Hello Sunday
Morning to support high-risk drinking individuals looking to change
their relationship with alcohol. In particular, we compared the
effect of adding online coaching via real-time chat messages
(intervention group) to an otherwise self-guided program (control
group). Methods: We designed the intervention as a randomized
control trial, but as some people (n=48; 11.9%) in the control
group were able to use the online coaching, the main analysis
comprised all participants. We collected online surveys at
one-month and three-months follow-up. The primary outcome was
change in alcohol risk (measured with the alcohol use disorders
identification test–consumption [AUDIT–C] score), but other
outcomes included the number of standard drinks per week,
alcohol-related days out of role, psychological distress
(Kessler-10), and quality of life (EUROHIS-QOL). Markers of
engagement with the program included posts to the site and comments
on the posts of others. The primary analysis used Weighted
Generalized Estimating Equations. Results: We recruited 398 people
to the intervention group (50.2%) and 395 people to the control
group (49.8%). Most were female (71%) and the mean age was 40.1
years. Most participants were classified as probably dependent
(550, 69%) on the AUDIT–10, with 243 (31%) classified with
hazardous or harmful consumption. We followed up with 334 (42.1%)
participants at one month and 293 (36.9%) at three months. By three
months there were significant improvements in AUDIT–C scores
(down from mean 9.1 [SD 1.9] to 5.8 [SD 3.1]), alcohol consumed per
week (down from mean 37.1 [SD 28.3] to mean 17.5 [SD 18.9]), days
out of role (down from mean 1.6 [SD 3.6] to 0.5 [SD 1.6]), quality
of life (up from 3.2 [SD 0.7] to 3.6 [SD 0.7]) and reduced distress
(down from 24.8 [SD 7.0] to 19.0 [SD 6.6]). Accessing online
coaching was not associated with improved outcomes, but engagement
with the program (eg, posts and comments on the posts of others)
were significantly associated with improvements (eg, in AUDIT–C,
alcohol use and EUROHIS-QOL). Reduced alcohol use was found for
both probably dependent (estimated marginal mean of 40.8 to 20.1
drinks) and hazardous or harmful alcohol users (estimated marginal
mean of 22.9 to 11.9 drinks). Conclusions: Clinically significant
reductions in alcohol use were found, as well as reduced alcohol
risk (AUDIT–C) and days out of role. Importantly, improved
alcohol-related outcomes were found for both hazardous or harmful
and probably dependent drinkers. Since October 2016, Daybreak has
reached more than 50,000 participants. Therefore, there is the
potential for the program to have an impact on alcohol-related
problems at a population health level, importantly including an
effect on probably dependent drinkers. Trial Registration:
Australian New Zealand Clinical Trials Registry:
ACTRN12618000010291;
https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373110
International Registered Report Identifier (IRRID):
RR2-10.2196/9982

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A Digital Intervention Addressing Alcohol Use Problems (the “Daybreak” Program): Quasi-Experimental Randomized Controlled Trial