Automated, tailored adaptive mobile messaging to reduce alcohol consumption in help-seeking adults: A randomized controlled trial

Frederick Muench, Sean P. Madden, Sherry Oommen, Sarah Forthal, Aradhana Srinagesh, Gertraud Stadler, Alexis Kuerbis, Robert F. Leeman, Brian Suffoletto, Amit Baumel, Cameron Haslip, Nehal P. Vadhan, Jon Morgenstern

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: To test differential outcomes between three 6-month text-messaging interventions to reduce at-risk drinking in help-seeking adults. Design: A three-arm single-blind randomized controlled trial with 1-, 3-, 6- and 12-month follow-ups. Setting: United States. A fully remote trial without human contact, with participants recruited primarily via social media outlets. Participants: Seven hundred and twenty-three adults (mean = 39.9 years, standard deviation = 10.0; 62.5% female) seeking to reduce their drinking were allocated to 6 months of baseline ‘tailored statically’ messaging (TS; n = 240), ‘tailored adaptive’ messaging (TA; n = 239) or ‘drink tracking’ messaging (DT; n = 244). Interventions: TS consisted of daily text messages to reduce harmful drinking that were tailored to demographics and alcohol use. TA consisted of daily, tailored text messages that were also adapted based on goal achievement and proactive prompts. DT consisted of a weekly assessment for self-reported drinking over the past 7 days. Measurements: The primary outcome measure was weekly sum of standard drinks (SSD) at 6-month follow-up. Secondary outcome measures included drinks per drinking day (DDD), number of drinking days (NDD) per week and heavy drinking days (HDD) at 1-, 3-, 6- and 12-month follow-ups. Findings: At 6 months, compared with DT, TA resulted in significant SSD reductions of 16.2 (from 28.7 to 12.5) drinks [adjusted risk ratio (aRR) = 0.80, 95% confidence interval (CI) = 0.71, 0.91] using intent-to-treat analysis. TA also resulted in significant improvements in DDD (aRR = 0.84; 95% CI = 0.77–0.92) and drinking days per week (b = −0.39; 95% CI = −0.67, –0.10), but not HDD compared with DT at 6 months. TA was not significantly different from TS at any time-point, except DDD at 6 months. All groups made improvements in SSD at 12-month follow-up compared with baseline with an average reduction of 12.9 drinks per week across groups. Conclusions: Automated tailored mobile messaging interventions are scalable solutions that can reduce weekly alcohol consumption in remote help-seeking drinkers over time.

Original languageEnglish
Pages (from-to)530-543
Number of pages14
JournalAddiction
Volume119
Issue number3
Early online date27 Nov 2023
DOIs
StatePublished - Mar 2024

Bibliographical note

Publisher Copyright:
© 2023 Society for the Study of Addiction.

Keywords

  • Adaptive
  • alcohol
  • clinical trial
  • digital
  • personalization
  • text messaging

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Medicine (miscellaneous)

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