A Digital Intervention Addressing Alcohol Use Problems (the “Daybreak” Program): Quasi-Experimental Randomized Controlled Trial
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.
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 individuals looking to change their relationship with alcohol. In particular, the study compared the effect of adding online coaching via real-time chat messages (intervention group) to an otherwise self-guided program (control group).
The researchers 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. Online surveys at one-month and three-months follow-up was collected. 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 alcohol units 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.
The study 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. The study 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, alcohol consumed per week , days out of role, quality of life and reduced distress. 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 units of alcohol) and hazardous or harmful alcohol users (estimated marginal mean of 22.9 to 11.9 units of alcohol).
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 alcohol users. 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 alcohol users.