Engagement With Motivational Interviewing and Cognitive Behavioral Therapy Components of a Web-Based Alcohol Intervention, Elicitation of Change Talk and Sustain Talk, and Impact on Drinking Outcomes: Secondary Data Analysis

Abstract

Background: Down Your Drink (DYD) is a widely used unguided online alcohol moderation program for the general public based on cognitive behavioural therapy (CBT) and motivational interviewing (MI), with many opportunities for free-text responses. / Objective: To assess participants’ use of key CBT and MI components, the presence of change and sustain talk within their responses, and whether these are associated with drinking outcomes after three months. / Methods: A secondary data-analysis was conducted on data from the definitive randomized trial of DYD, collected in 2008 (n=503). Past week alcohol use at baseline and three month follow-up was measured with the TOT-AL. Covariates included baseline alcohol use, age, gender, education level and word count of responses. Use of MI and CBT components and presence of change and sustain talk was coded by two independent coders (Cohen’s kappa range = 0.91-1). Linear model regressions on the full sample and a subsample of active users (n=411) are presented. / Results: Most commonly used components were the listing of pros and cons. Number of listed risky situations was associated with lower alcohol use at three months follow-up in both the full sample and the subsample (Badj = −2.10 95%CI −3.88 - −0.31, P = 0.02). Number of listed pros of drinking was only associated with higher alcohol use in the subsample (Badj = 3.12, 95%CI −0.55-6.80, P = 0.095). When the primary measure for alcohol use was log-transformed, number of strategies to deal with risky situations (Badj = 0.03, 95%CI 0.00 - 0.06, P = 0.02) and presence of any change talk (Badj =−0.46, 95%CI −0.86 - −0.06, P = 0.02) also predicted alcohol use. / Conclusions: An unguided online alcohol moderation program can elicit change and sustain talk. Number of noted risky situations can predict alcohol use at three month follow-up. Other components, namely number of strategies to deal with risky situations, number of listed pros, sustain talk and any presence of change talk, are also of interest, but need further research. Clinical Trial: Original trial registration: ISRCTN registry, ID ISRCTN31070347, http://www.isrctn.com/ISRCTN31070347