Therapist-guided internet treatment for alcohol use disorders

Background: Alcohol Use Disorders (AUD) are among the most common psychiatric disorders but the vast majority never receive treatment. Internet interventions have the potential to reach some of those who currently do not seek or receive treatment. Such interventions for alcohol problems of varying forms have been shown to be effective, generally rendering small effect sizes, and some studies suggest that adding therapist guidance to these interventions can augment their effects.

Aims: The general aim of this thesis was to develop and evaluate therapist-guided internetbased treatment for AUD. Specifically, we aimed to investigate the added effect of therapist guidance to a previously evaluated internet treatment (study I), test feasibility and preliminary effects of a newly developed high-intensity internet treatment (study II), evaluate effects of high- as compared to low-intensity internet treatment and a wait-list control group (study III) and investigate predictors of adherence and low-risk drinking in the internet treatments in study III (study IV).

Methods: In Study I, we conducted a randomized controlled trial (RCT) where all groups received access to the same internet treatment, with one group receiving therapist guidance via messages, one group receiving therapist guidance via messages or chat (choice) and one group not receiving any therapist guidance (n=80). In Study II, a newly developed highintensity therapist-guided internet treatment was tested in a pilot study among participants to investigate feasibility and preliminary effects (n=13). Study III was a second RCT where the high-intensity internet treatment from study II was tested against a low-intensity internet treatment and a wait list control group (n=166). In Study IV, we used data from study III to investigate predictors of 1) treatment adherence and 2) low-risk drinking at post-treatment and three-month follow-up.

Results: The results from study I showed that the groups that received therapist guidance reduced their number of standard drinks to a significantly higher degree than the group receiving no guidance. Study II showed that the newly developed high-intensity treatment was feasible and acceptable, and was associated with a significant reduction in number of standard drinks among participants. Study III showed that the high-intensity group reduced the number of standard drinks and heavy drinking days significantly more than the wait-list control-group, and reduced their number of heavy drinking days significantly more than the low-intensity group at post-treatment but not at three-month follow-up. Study IV showed that participants’ rating of treatment credibility was predictive of treatment adherence, and that pre-treatment abstinence, male gender and two personality variables (a high degree of alexithymia and a low degree of antagonism) were predictive of low-risk drinking.

Conclusion: The results in this thesis, provide support for the feasibility and efficacy of internet treatment for AUD, and offer interesting findings on predictors of outcome that should be investigated further. Overall, participants were satisfied with the treatments, and few negative effects were reported.

List of scientific papers

I. Sundström C, Gajecki M, Johansson M, Blankers M, Sinadinovic K, Stenlund-Gens E, Berman AH. Guided and Unguided Internet-Based Treatment for Problematic Alcohol Use - A Randomized Controlled Pilot Trial. PLOS ONE. 2016;11(7).
https://doi.org/10.1371/journal.pone.0157817

II. Sundström C, Kraepelien M, Eék N, Fahlke C, Kaldo V, Berman AH. High-intensity therapist-guided internet-based cognitive behavior therapy for alcohol use disorder: a pilot study. BMC psychiatry. 2017;17(1):197.
https://doi.org/10.1186/s12888-017-1355-6

III. Sundström C, Eék N, Kraepelien M, Fahlke C, Gajecki M, Jakobson M, Beckman M, Kaldo V, Berman AH. High- versus low-intensity internet treatment for alcohol use disorders: a randomized controlled trial. [Manuscript]

IV. Sundström C, Eék N, Kraepelien M, Fahlke C, Kaldo V, Berman AH. What predicts treatment adherence and what predicts low-risk drinking? An exploratory study of internet treatment for alcohol use disorders. [Manuscript]