A Text Message Alcohol Intervention for Young Adult Emergency Department Patients: A Randomized Clinical Trial

Abstract

Objective Opportunistic brief in-person Emergency Department (ED) interventions can be effective at reducing hazardous alcohol use in young adult drinkers, but require resources frequently unavailable. Mobile phone text messaging (SMS) could sustainably deliver behavioral support to young adult patients, but efficacy remains unknown. We report 3-month outcome data of a randomized controlled trial testing a novel SMS-delivered intervention in hazardous drinking young adults. Methods We randomized 765 young adult ED patients who screened positive for past hazardous alcohol use to one of three groups: SMS Assessments + Feedback (SA+F) intervention who were asked to respond to drinking-related queries and received realtime feedback through SMS each Thursday and Sunday for 12 weeks (n=384); SMS Assessments (SA) who were asked to respond to alcohol consumption queries each Sunday but did not receive any feedback (N=196); and a control group who did not participate in any SMS (n=185). Primary outcomes were number of binge drinking days and number of drinks per drinking day in the past 30 days collected by web-based Timeline Follow-Back method and analyzed with regression models. Secondary outcomes were the proportion of participants with weekend binge episodes and most drinks consumed per drinking occasion over 12 weekends collected by SMS. Results Using web-based data, there were decreases in the number of binge drinking days from baseline to 3 months in the SA+F group (-.51 [95% confidence interval {CI} -.10 to -.95]), whereas there were increases in the SA group (.90 [95% CI .23 to 1.6]) and the control group (.41 [95% CI -.20 to 1.0]). There were also decreases in the number of drinks per drinking day from baseline to 3 months in the SA+F group (-.31 [95% CI -.07 to -.55]), whereas there were increases in the SA group (.10 [95% CI -.27 to .47]) and the control group (.39 [95% CI .06 to .72]). Using SMS data, there was a lower mean proportion of SA+F participants reporting a weekend binge over 12 weeks (30.5% [95% CI 25% to 36%) compared to the SA participants (47.7% [95% CI 40% to 56%]). There was also a lower mean drinks consumed per weekend over 12 weeks in the SA+F group (3.2 [95%CI 2.6 to 3.7]) compared to the SA group (4.8 [95% CI 4.0 to 5.6]). Conclusion A text message intervention can produce small reductions in binge drinking and the number of drinks consumed per drinking day in hazardous drinking young adults after ED discharge.

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