Abstract
What Do You Drink (WDYD) aims to detect and reduce heavy drinking of adolescents and young adults who are willing to decrease their alcohol consumption. The first part of
the WDYD focuses on increasing the users’ awareness of the potential problems, consequences, and risks associated with their drinking behavior. It contains a home page and a screening test with personalized feedback.
The screening test assesses users’ self-reported name, sex, age, education level, weight, alcohol use, readiness to change alcohol use, average expenses for consumed alcohol beverages, and descriptive social norms. The personalized feedback contains advice about drinking according to low-risk drinking guidelines, personal drinking profile, estimates of calorie intake, increases in weight, money expenses because of drinking, and a comparison of personal use rates with the national norms of same-sex peers to correct misperceptions of descriptive social norms. The second part of WDYD focuses on setting and maintaining drinking goals and strengthening users’ drinking refusal self-efficacy to succeed and maintain drinking goals by providing tips to resist alcohol in different drinking situations.
To determine the effectiveness of WDYD on alcohol outcomes (i.e., heavy drinking, weekly alcohol consumption, and binge drinking) two randomized controlled trials were conducted: 1) a two-arm parallel group randomized controlled trial using an Ecological Momentary Assessment approach with multiple follow-up time-points (i.e., 30) among 908 heavy drinking college students (18-24 years) and 2) a two-arm parallel group cluster randomized controlled trial using a traditional approach with few follow-up time-points (i.e., 2) among 750 low-educated, heavy drinking adolescents (15-24 years).
There were no main intervention effects in weekly alcohol consumption (WAC), frequency of binge drinking (BD), and heavy drinking (HD) among students at one and six months follow-up. However, WDYD had a preventive effect on WAC on the short term for students who 1) are ready to change drinking behaviour, 2) show more severe symptoms of alcohol abuse or dependence, or 3) participate in carnival. Moreover, WDYD was effective in preventing an increase in WAC and BD among students directly after the intervention using EMA and latent growth curve modelling techniques. These effects sustained at three and six months follow-up, respectively. WDYD was not effective in reducing WAC, BD, and HD among heavy drinking adolescents and young adults with a low educational background at one and six months follow-up.
Intervention details
Heavy drinking adolescents and young adults (15-24 years) who are willing to decrease their alcohol consumption
Practitioners and organisations in the field of alcohol prevention and health promotion (e.g., Trimbos-institute, STAP, Dutch Institute for Alcohol Policy).
Self-Assessment, Self-Help
WDYD is developed by using Intervention Mapping (IM), a stepwise approach to describe the process of theory and evidence-based development, implementation, and evaluation of health promotion intervention. The core elements of WDYD are based on principles of Motivational Interviewing (Miller & Rollnick, 2002) and parts of the I-Change model (De Vries et al., 1988), in which knowledge, social norms, and self-efficacy are included as the most changeable determinants of behavioural change.
ICT specialist is needed for updates, database administration, etc.
Evaluation details
The effectiveness of the web-based brief alcohol intervention ‘What Do You Drink’ in reducing alcohol outcomes (i.e., heavy drinking, weekly alcohol consumption, binge drinking) among heavy drinking adolescents and young adults has been evaluated applying a traditional approach with few follow-up time-points (i.e., 1 and 6 months followup: 15 to 20 years olds with a low educational background) versus an ecological momentary assessment approach with multiple follow-up time-points (30 weekly assessments: 18 to 24 years olds attending higher education colleges or universities).
Study 1: Heavy drinking college students aged 18-24 years using an Ecological Momentary Assessment (EMA) approach: - There were no main intervention effects in weekly alcohol consumption, frequency of binge drinking, and heavy drinking among heavy drinking college students aged 18-24 years at one and six months follow-up. - The WDYD intervention was found to have a preventive effect on weekly alcohol consumption on the short term for subgroups of heavy drinking college students who 1) are ready to change drinking behaviour, 2) show more severe symptoms of alcohol abuse or dependence, or 3) participate in carnival. - The use of EMA showed that the effects of the WDYD intervention on weekly alcohol consumption, frequency of binge drinking, and heavy drinking among heavy drinking college students varied in terms of both the frequency and timing of the effects when analysing the outcome measures at 25 follow-up time-points separately. Not using multiple follow-up time-points by means of EMA might bring forth erroneous conclusions on intervention effectiveness due to increased recall bias and ignoring the fluctuating nature of alcohol use among individuals over time.
- Testing the effectiveness of the WDYD intervention using the advantages of multiple assessments (EMA) and of latent growth curve (LGC) modelling techniques showed that the intervention was effective in preventing an increase in weekly alcohol consumption and frequency of binge drinking among heavy drinking college students directly after the intervention. The effects sustained at three and six months follow-up, respectively. This would remain undetected when using a traditional approach with few follow-up time points to test intervention effectiveness. - The WDYD intervention changed the level of social pressure drinking refusal self-efficacy (DRSE) directly after the intervention and this effect sustained at six months follow-up. This change is likely to be accountable for the sustained preventive effects of the WDYD intervention on weekly alcohol consumption and frequency of binge drinking among heavy drinking college students at three and six months follow-up, respectively. - DRSE was negatively related to weekly alcohol consumption and frequency of binge drinking among heavy drinking college students: high emotional relief, opportunity, and social pressure DRSE were associated with lower weekly alcohol consumption and less frequency of binge drinking. The WDYD intervention did not affect the strength in these relationships. Study 2: Heavy drinking adolescents and young adults aged 15-20 years with a low educational background using a traditional approach: - The WDYD intervention was not effective in reducing weekly alcohol consumption, frequency of binge drinking, and heavy drinking among heavy drinking adolescents and young adults aged 15-20 years with a low educational background at one and six months follow-up.
