Review and special article
Curbing Problem Drinking with Personalized-Feedback Interventions: A Meta-Analysis

https://doi.org/10.1016/j.amepre.2008.10.016Get rights and content

Context

The effectiveness of personalized-feedback interventions to reduce problem drinking has been evaluated in several RCTs and systematic reviews. A meta-analysis was performed to examine the overall effectiveness of brief, single-session personalized-feedback interventions without therapeutic guidance.

Evidence acquisition

The selection and analyses of studies were conducted in 2008. Fourteen RCTs of single-session personalized-feedback interventions without therapeutic guidance were identified, and their combined effectiveness on the reduction of problematic alcohol consumption was evaluated in a meta-analysis. Alcohol consumption was the primary outcome measure.

Evidence synthesis

The pooled standardized-effect size (14 studies, 15 comparisons) for reduced alcohol consumption at post-intervention was d=0.22 (95% CI=0.16, 0.29; the number needed to treat=8.06; areas under the curve=0.562). No heterogeneity existed among the studies (Q=10.962; p=0.69; I2=0).

Conclusions

The use of single-session personalized-feedback interventions without therapeutic guidance appears to be a viable and probably cost-effective option for reducing problem drinking in student and general populations. The Internet offers ample opportunities to deliver personalized-feedback interventions on a broad scale, and problem drinkers are known to be amenable to Internet-based interventions. More research is needed on the long-term effectiveness of personalized-feedback interventions for problem drinking, on its potential as a first step in a stepped-care approach, and on its effectiveness with other groups (such as youth obliged to use judicial service programs because of violations of minimum-age drinking laws) and in other settings (such as primary care).

Introduction

Problem drinking is a major public health issue, particularly due to its high prevalence in adult1, 2 and student populations.3, 4 It is these groups of problem drinkers—and not those with severe alcohol dependence, as is often thought—who account for the bulk of the alcohol-related harm in the general population.5, 6 Problem drinking causes a formidable array of serious health problems7 and a heavy social and economic burden.8, 9 Besides short-term and long-term morbidity1, 2 and mortality,10 the consequences include acute unintended injuries, sexual and physical assault, violence-related trauma, vandalism, and poor academic or work performance.11, 12

Early identification and brief interventions have been increasingly advocated as cost-effective strategies to curb problem drinking.8, 13, 14, 15 Evidence is strongest for brief interventions in primary and secondary care,6, 16, 17, 18 but effectiveness has also been shown in settings such as the general population19, 20, 21 or student communities.22, 23, 24, 25 Less encouraging is the fact that the implementation of brief interventions is still hampered by constraints such as a limited number of professionals who administer them, the difficulty of contacting problem drinkers, and the high costs of implementation and delivery.21, 26, 27 As a consequence, as many as 80% of problem drinkers are not yet receiving help.28, 29, 30 Innovative ways are needed for reaching out to them.

Brief personalized feedback (i.e., personalized-feedback interventions) could be one such strategy,31 providing personal feedback regarding an individual's alcohol-consumption patterns. This feedback may consist of different components, such as an overview of mean weekly alcohol consumption; blood alcohol concentration levels (BAC); associated health and social risks of problem drinking; or self-help guidelines to change problematic alcohol consumption. Normative feedback is another important component of many personalized-feedback interventions. It enables problem drinkers to compare their own alcohol consumption (in terms of frequency, quantity, or other measures) to the level of their own cohort—such as the average man or woman in the general population or their student peer group32, 33, 34—as well as to the recommended guidelines for sensible drinking. The rationale of normative feedback is that such comparisons trigger an awareness in problem drinkers of their own drinking patterns and the risks they are taking, thus motivating them to reduce their alcohol use.33 One underlying explanation for such behavioral change is that many problem drinkers overestimate the alcohol consumption of others while underestimating their own.35, 36, 37 Personalized-feedback interventions may consist only of normative feedback.38

Personalized feedback began as a component of evidence-based, face-to-face individual or group motivational-enhancement interventions.17, 39 Today, personalized-feedback interventions are being successfully provided as autonomous, face-to-face self-help interventions in both individual and group formats. Technologic advances also now enable the delivery of automated mail, computer, and Internet-based personalized feedback. This includes individual single-session interventions without therapeutic guidance, provided in various settings and to various populations.22, 24, 31, 40 The systematic review by White25 on personalized feedback for college students has shown that mail- or web-based personalized-feedback interventions without professional guidance were as effective in student populations as brief face-to-face interventions. Studies38, 41 on needs assessment in problem-drinking populations also suggest that personalized feedback is a highly practical method for the target groups concerned. Both adults and students often prefer to use self-help interventions without therapeutic involvement to address their problem drinking instead of more-intensive individual or group treatments.41, 42 Given these promising results with single-session, stand-alone, personalized-feedback interventions, it was decided to assess their effectiveness in a meta-analysis. To the best of our knowledge, this is the first meta-analysis to focus on brief personalized-feedback interventions without professional guidance for young and adult problem drinkers. The expectation was that personalized-feedback interventions for problem drinkers would be more effective than non-intervention in reducing problem drinking.

Section snippets

Identification and Selection of Studies

The relevant studies were identified in 2008, using several systematic search strategies:

  • 1

    Systematic searches were carried out in the following bibliographical databases: MEDLINE; PsycINFO (1985 to present); Science Citation Index Expanded; Social Sciences Citation Index; Arts & Humanities Citation Index® (1988 to present); CINAHL®; EMBASE; the Cochrane Drug and Alcohol Group Specialised Register; the Cochrane Effective Practice and Organisation of Care Group; the Alcohol and Alcohol Problems

Description of the Primary Analyzed Studies

The combined literature search generated 406 abstracts and yielded 14 studies (Boon B, Institute for Addiction Research, unpublished findings, 2006; Boon B, Institute for Addiction Research, unpublished findings, 2008)38, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64 (15 comparisons) that met the inclusion criteria (Table 138, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64). The analysis involved a total of 3682 participants (1904 in personalized-feedback conditions and 1778 in control conditions).

Main Findings

This meta-analysis shows that single-session, individually personalized feedback without professional guidance can be an effective intervention for reducing risky alcohol consumption in young and adult problem drinkers. Adverse consequences in terms of increased alcohol use among participants resulting from their exposure to personalized-feedback interventions were not identified.12 These results may indicate that personalized feedback is an effective intervention for different target groups

Conclusion

Personalized feedback without therapeutic guidance may be cost effective in view of the minimal time and financial investments needed to make it widely available. It is expected that this potential cost effectiveness, the attractiveness of personalized feedback for participants,77 and the diffusion potential could be greatly expanded by delivering it over the Internet. Many of the traditional impediments to implementing brief interventions could be overcome thereby.27, 57 The advantages of

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