A Text Message Intervention with Adaptive Goal Support to Reduce Alcohol Consumption Among Non-Treatment-Seeking Young Adults: Non-Randomized Clinical Trial with Voluntary Length of Enrollment

Abstract

BackgroundStand-alone text message–based interventions can reduce binge drinking episodes (≥4 drinks for women and ≥5 drinks for men) among nontreatment-seeking young adults, but may not be optimized. Adaptive text message support could enhance effectiveness by assisting context-specific goal setting and striving, but it remains unknown how to best integrate it into text message interventions.ObjectiveThe objective of this study was to evaluate young adults’ engagement with a text message intervention, Texting to Reduce Alcohol Consumption 2 (TRAC2), which focuses on reducing weekend alcohol consumption. TRAC2 incorporated preweekend drinking-limit goal-commitment ecological momentary assessments (EMA) tailored to past 2-week alcohol consumption, intraweekend goal reminders, self-efficacy EMA with support tailored to goal confidence, and maximum weekend alcohol consumption EMA with drinking limit goal feedback.MethodsWe enrolled 38 nontreatment-seeking young adults (aged 18 to 25 years) who screened positive for hazardous drinking in an urban emergency department. Following a 2-week text message assessment-only run-in, subjects were given the opportunity to enroll in 4-week intervention blocks. We examined patterns of EMA responses and voluntary re-enrollment. We then examined how goal commitment and goal self-efficacy related to event-level alcohol consumption. Finally, we examined the association of length of TRAC2 exposure with alcohol-related outcomes from baseline to 3-month follow-up.ResultsAmong a diverse sample of young adults (56% [28/50] female, 54% [27/50] black, 32% [12/50] college enrolled), response rates to EMA queries were, on average, 82% for the first 4-week intervention block, 75% for the second 4-week block, and 73% for the third 4-week block. In the first 4 weeks of the intervention, drinking limit goal commitment was made 68/71 times it was prompted (96%). The percentage of subjects being prompted to commit to a drinking limit goal above the binge threshold was 52% (15/29) in week 1 and decreased to 0% (0/15) by week 4. Subjects met their goal 130/146 of the times a goal was committed to (89.0%). There were lower rates of goal success when subjects reported lower confidence (score <4) in meeting the goal (76% [32/42 weekends]) compared with that when subjects reported high confidence (98% [56/57 weekends]; P=.001). There were reductions in alcohol consumption from baseline to 3 months, but reductions were not different by length of intervention exposure.ConclusionsPreliminary evidence suggests that nontreatment-seeking young adults will engage with a text message intervention incorporating self-regulation support features, resulting in high rates of weekend drinking limit goal commitment and goal success.

Real-Time Mobile Monitoring of Drinking Episodes in Young Adult Heavy Drinkers: Development and Comparative Survey Study

“…These data suggest that young adults can use smartphones to monitor their drinking even during very heavy drinking episodes, with average consumption approximately double (or more) that of previous work in this field [10,11,14,35]. Future research could use this technology to further study the dynamics of binge drinking behavior, refine EMA-based treatment approaches targeting risky drinking specifically [42,43], or develop “just-in-time” interventions to reduce heavy drinking and associated risks in young adults [44]. In sum, smartphone-based EMA has great potential to provide a practical, inexpensive, and efficient way to capture a large amount of data on real-world drinking behavior and associated consequences, which may inform future research on the epidemiology of and intervention for AUD.…”

A Qualitative Evaluation of the Acceptability of a Tailored Smartphone Alcohol Intervention for a Military Population: Information About Drinking for Ex-Serving Personnel (InDEx) App

“…A relevant technique from a previous study used an algorithm that prompted a drinking limit goal via tailored text messaging based on an ecological momentary assessment. These suggested limits were set to be slightly lower than participants’ self-reported alcohol consumption to ensure that the goal was relevant and realistic [43].…”

Adaptive Text Messaging for Postpartum Risky Drinking: Conceptual Model and Protocol for an Ecological Momentary Assessment Study

“…A growing body of literature demonstrates support for TMIs in reducing risky drinking in non–treatment-seeking adults [ 20 , 26 - 30 ]. In a recent review of mobile health interventions for unhealthy alcohol use, over half of the TMIs reviewed were effective in reducing alcohol use or increasing readiness to change [ 31 ].…”