Background: Down Your Drink (DYD) is a widely used unguided web-based alcohol moderation program for the general public based on cognitive behavioral therapy (CBT) and motivational interviewing (MI); it provides users with many opportunities to enter free-text responses. Objective: The aim of this study was to assess participants' use of key CBT and MI components, the presence of change talk and sustain talk within their responses, and whether these data are associated with drinking outcomes after 3 months. Methods: An exploratory secondary data analysis was conducted on data collected in 2008 from the definitive randomized trial of DYD (N=503). Past week alcohol use at baseline and 3-month follow-up were measured with the TOT-AL. Covariates included baseline alcohol use, age, gender, education level, and word count of the responses. Use of MI and CBT components and presence of change talk and sustain talk were coded by two independent coders (Cohen κ range 0.91-1). Linear model regressions on the subsample of active users (n=410) are presented along with a negative binomial regression. Results: The most commonly used component was the listing of pros and cons of drinking. The number of listed high-risk situations was associated with lower alcohol use at 3-month follow-up (Badj −2.15, 95% CI −3.92 to −0.38, P=.02). Findings on the effects of the percentage of change talk and the number of listed strategies to deal with high-risk situations were inconsistent. Conclusions: An unguided web-based alcohol moderation program can elicit change talk and sustain talk. This secondary analysis suggests that the number of listed high-risk situations can predict alcohol use at 3-month follow-up. Other components show inconsistent findings and should be studied further.
Bibliographical noteFunding Information:
This study was funded by the Erasmus Trust Fund Foundation (the Netherlands), Foundation “De Drie Lichten” (the Netherlands), and Foundation “Jo Kolk Studiefonds” (the Netherlands). The funders had no role in the design, analysis, or interpretation of the data nor in the writing and publication of the scientific paper or the results. We are grateful to Elizabeth Murray for initiating the collaboration between the authors and Richard McGregor (Codeface Ltd) for extracting the data needed for the analyses. The authors acknowledge the contributions of Elizabeth Murray, Paul Wallace, Jim McCambridge, Ian R White, Simon G Thompson, Eleftheria Kalaitzaki, and Christine Godfrey to the original DYD trial.
© Ajla Mujcic, Stuart Linke, Fiona Hamilton, Alexandria Phillips, Zarnie Khadjesari. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.09.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.