The objective of this study was to conduct a preliminary evaluation of an Internet-based intervention for problem drinkers, comparing changes in drinking between respondents who only received the intervention to those who also received a self-help book. After receiving a personalized feedback summary on the Internet, 83 respondents provided complete baseline information and volunteered to participate in a 3-month follow-up survey. Half of the respondents were randomized to receive an additional self-help book. The follow-up was returned by 48 respondents (69% female). Repeated measures ANOVAs were conducted to compare drinking levels at baseline and 3-month follow-up among respondents who only received the Internet-based intervention. There was minimal support for an impact of the Internet intervention alone. In addition, hierarchical regression analyses were conducted to compare respondents in the two intervention conditions on their drinking at follow-up, controlling for baseline consumption. Respondents who received the additional self-help book reported drinking less and experiencing fewer consequences at follow-up as compared to respondents who received only the Internet-based intervention. While the results are promising, they cannot be taken as evidence of the efficacy of Internet-based personalized feedback as a stand-alone intervention because of the absence of a control group that did not receive the intervention. Further research on this topic should be a priority because of the potential for Internet-based interventions to reach problem drinkers underserved by traditional treatment.
As many as one in four adults in the United States and Canada experience some problems due to alcohol consumption (Institute of Medicine., 1990). Most of these problem drinkers will never seek treatment for their alcohol concerns (Cunningham & Breslin, 2004), and thus will continue to place themselves and society at high risk for alcohol-related harm. However, many of these individuals have voiced an interest in materials to help them evaluate their drinking (Koski-Jännes & Cunningham, 2001). The Internet may prove an ideal vehicle for distributing such materials. Access to the Internet is widespread and growing. As many as 75% of the general population have access to the Internet (Ipsos-Reid., 2002). Further, one of the primary uses of the Internet is accessing health information. Given the widespread use of the Internet, the ability to provide well-designed and personalized resources free of charge, and the high level of interest in such services by problem drinkers, Internet-based interventions have the potential to make a major impact on public health.
Many providers appear to have recognized this potential because services for problem drinkers continue to proliferate on the Internet (Copeland & Martin, 2004 and Toll et al., 2003). A limited number of pilot studies have reported on participants' initial evaluations of Internet sites providing self-help materials for problem drinkers (Cloud & Peacock, 2001, Cunningham et al., 2000, Lieberman, 2003, Linke et al., 2004, Squires & Hester, 2002 and Westrup et al., 2003). Many other sites are available on the Internet with no research evaluation. However, there have been no evaluations of the efficacy of such interventions to date. Thus, although Internet-based interventions may have huge public health potential for a number of reasons-worldwide access including developing countries, as a way to help underserved populations such as female problem drinkers, young adults, those living in rural areas or who have limitations with transportation—there is also the potential for harm because the efficacy of these interventions remains unevaluated.
The present study reports on an initial outcome evaluation of an Internet-based intervention (Cunningham et al., 2000). There were three hypotheses for the study. Hypothesis 1 stated that respondents who receive an additional self-help book would display greater reductions in their drinking, as compared to those who only received the Internet-based intervention, at a 3-month follow-up. Hypothesis 2 stated that respondents who reported that they were surprised about some aspect of the personalized feedback presented to them would report significantly greater reductions in drinking at a 3-month follow-up as compared to respondents who were not surprised by anything on the feedback. Personalized feedback interventions, such as the one included on this Internet site, provide normative feedback to individuals—creating a personalized summary of an individual's drinking and comparing it to the consumption of the average male or female in the general population. Normative feedback is theorized to promote change in alcohol use because many heavy drinkers overestimate the consumption of others. Consequently, normative feedback acts as a powerful source of social comparison, motivating heavy drinkers to re-evaluate their consumption patterns (Agostinelli & Miller, 1994). Thus, hypothesis 2 was generated based on the assumption that the personalized feedback provided by this Internet-based intervention would be most effective for individuals who learnt something new or for whom the feedback contradicted previous beliefs (i.e., they were surprised by something). Finally, hypothesis 3 stated that respondents who only received the Internet-based intervention would be drinking less at 3-month follow-up as compared to baseline.
