Individualized treatment effects of a digital alcohol intervention and their associations with participant characteristics and engagement

• Published in: Alcohol and alcoholism (Oxford) 2024-07, Vol.59 (5)
• Main Authors: Crawford, Joel, Collier, Elizabeth S, Bendtsen, Marcus
• Format: Article
• Language: English
• Subjects: Adult; Aged; Alcohol Drinking - psychology; Alcohol Drinking - therapy; Binge Drinking - psychology; Binge Drinking - therapy; Female; Humans; Male; Middle Aged; Original Manuscript; Sweden; Text Messaging; Treatment Outcome; Young Adult
• ISSN: 0735-0414; 1464-3502; 1464-3502
• DOI: 10.1093/alcalc/agae049

Abstract Aims Conditional average treatment effects are often reported in intervention studies, in which assumptions are made regarding how effects are similar across a heterogeneous sample. Nonetheless, differing factors, such as genetics, age, and sex, can impact an intervention’s effect on outcomes. The study aimed to estimate the individualized effects of a digital alcohol intervention among individuals looking online to reduce their drinking. Methods We used data from a randomized controlled trial (RCT), including 2129 adults from the Swedish general population. The RCT concerned a text message-based alcohol intervention that sought to engender change through increasing knowledge on how to change and instilling confidence in changing behaviour. Outcomes were total weekly alcohol consumption and monthly heavy episodic drinking. Individualized treatment effects were modelled using baseline characteristics (age, gender, alcohol consumption, and psychosocial variables) and engagement with the intervention content. Results We found evidence that the effects of the digital alcohol intervention were heterogeneous concerning participants’ age, baseline alcohol consumption, confidence, and importance. For heavy episodic drinking, there was evidence that effects were heterogeneous concerning age, sex, and baseline alcohol consumption. Overall, women, older individuals, and heavier drinkers benefitted more from the intervention in terms of effect size. In addition, participants who engaged more with the goal-setting and screening content reported better outcomes. Conclusions The results highlight how different individuals respond differently to a digital alcohol intervention. This allows insight into who benefits the most and least from the intervention and highlights the potential merit of designing interventions adapted to different individuals’ needs. Short Summary: Individualized treatment effects were discernible for older participants, women, and those who consumed higher quantities of alcohol and engaged with more heavy episodic drinking at baseline. Furthermore, those who deemed it of greater import to change behaviour and had more confidence in their ability to change benefited more from the intervention.