خودیاری با پشتیبانی تلویزیون برای مصرف کنندگان مشکل دار: یک کارآزمایی تصادفی عملگرا

Objectives To test the effectiveness of a television-supported self-help intervention for problem drinking. Methods Dutch television viewers (N = 181) drinking in excess of the guidelines for low-risk alcohol use were randomly assigned either to the Drinking Less TV self-help course (consisting of five televised sessions supplemented by a self-help manual and a self-help website) or to a waitlisted control group. To ensure trial integrity, intervention delivery was mimicked beforehand by sending intervention participants weekly DVDs in advance of the actual telecasts in 2006. Pre-post assessments were carried out on both groups, as well as a 3-month follow-up assessment on the intervention group to study effect maintenance. The primary outcome measure was low-risk drinking. Results The intervention group was more successful than the waitlist group in achieving low-risk drinking at post-intervention (OR = 9.4); the effects were maintained in the intervention group at 3-month follow-up. Conclusions The low-threshold television-based course Drinking Less appears effective in reducing problem drinking.

Numerous publications in recent decades have highlighted the need for brief, low-threshold interventions to reach out to problem drinkers (Institute of Medicine, 1990, Anderson and Baumberg, 2006 and Kaner et al., 2007). This concern is indeed warranted, given the wide prevalence of problem drinking, its consequences in terms of morbidity and mortality (Murray and Lopez, 1996). and World Health Organization (WHO), 2004), and the associated economic costs (Klingemann and Gmel, 2001 and Smit et al., 2006). Brief interventions have meanwhile been thoroughly investigated and shown effective in both primary care settings (Ballesteros et al., 2004 and Kaner et al., 2007) and the general population (Moyer et al., 2002 and Apodaca and Miller, 2003). Most brief interventions in primary care are delivered with some form of therapeutic guidance, whereas those aimed at the public are often without personal therapeutic support (Cuijpers & Riper, 2007). In primary care settings, the dissemination of brief interventions is still hampered by factors like the limited number of professionals who administer them, the difficulty of reaching problem drinkers, and the high costs of implementation (Kaner et al., 1999, Moyer and Finney, 2005 and Raistrick et al., 2006). This has prompted a search for broad-scale dissemination channels for brief interventions outside primary care. Television and the Internet are media that could potentially enable low-threshold, low-cost dissemination. The applicability of the Internet for providing mental health interventions has developed strongly since the turn of the millennium, and a corresponding evidence base has been built (Kypri et al., 2004 and Riper et al., 2008). Radio and television, by contrast, have largely evolved along different lines. Approaches have often been limited to brief, stand-alone mass communication strategies to warn about social and health risks of problem drinking, and these have had little success in effecting behavioral change (Austin and Husted, 1998 and Cuijpers et al., 2005). Yet television does have a potential for health promotion interventions extending far beyond the genre of brief mass media campaigns. It can be used to deliver more in-depth programs on overcoming psychological or behavioral problems and targeting specific groups (Austin and Husted, 1998 and Park et al., 2001). It could be a powerful medium to bring self-help interventions to large audiences. Awareness has also been raised of the impact of alcohol use in non-alcohol-related TV series (Blair, Yue, Singh, & Bernhardt, 2005), particularly soap operas (Breen, 2007). Multi-media interventions using combinations of broadcasts and self-help manuals have been found more effective than single strategies used alone (Jason, Salina, McMahon, Hedeker, & Stockton, 1997). Gradually, television is now being used more widely to promote healthy lifestyles and behavioral change, such as smoking cessation (Jason et al., 1997), physical exercise (Hopman-Rock, Borghouts, & Leurs, 2005) and coping with emotional problems (Barker, Pistrang, Shapiro, Davies, & Shaw, 1993). Television series have also been developed to promote low-risk alcohol consumption by adults (Bennett et al., 1991 and Teleac/NOT, 2006), but little is known yet about their effectiveness. The series evaluated by Bennett et al. (1991), entitled Pssst…. the Really Useful Guide to Alcohol, consisted of six 30-minute installments broadcast by the BBC in 1989. Viewers of the series were compared with matched controls, and results showed improvement in alcohol-related knowledge, but not in attitude or in actual alcohol consumption. This article reports on the effectiveness of Drinking Less? Do It Yourself! ( Teleac/NOT, 2006), a five-week Dutch television self-help intervention designed to reduce problem drinking. To our knowledge, this is the first randomized controlled trial of a television-based self-help intervention for problem drinking in the general population. We hypothesized a beneficial posttreatment effect in terms of lower alcohol consumption as compared to the waitlisted control condition.

Our results show that television can be used effectively to target problem drinkers and curb their alcohol consumption. Moreover, a blend of new technologies and old media such as television and printed self-help manuals could be developed into a multimedia public health approach for the heterogeneous group of adult problem drinkers in the general population. The low-threshold Drinking Less course has shown a potential to reach a large group of problem drinkers and their significant others. This was further reflected in the viewing rates the course received when broadcast on nationwide television after our trial. An average of 1.5% of the Dutch population, or 202,000 viewers per installment, tuned in to each of the five televised sessions ( Visser, 2007). In view of this wide audience, the course has a strong potential for curbing problem drinking at the population level. From a public health perspective, it could serve as a first step in a stepped care approach to problem drinking. The potential reach seems far greater than that of interventions in primary care settings; even when comprehensive screening is carried out in primary care contexts and effective brief interventions are offered, a high percentage of problem drinkers are not in touch with such services at early stages of their drinking problem or avoid discussing their alcohol use when they do have contacts ( Kypri et al., 2005).