Computer‐Delivered Screening and Brief Intervention for Alcohol Use in Pregnancy: A Pilot Randomized Trial

Ondersma, Steven J.; Beatty, Jessica R.; Svikis, Dace S.; Strickler, Ronald C.; Tzilos, Golfo K.; Chang, Grace; Divine, George; Taylor, Andrew; Sokol, Robert J.

doi:10.1111/acer.12747

Cited by 57 publications

(111 citation statements)

References 48 publications

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“…Several studies reported on the acceptability of their interventions to participants and generally reported positive to very positive ratings. 79,97,116,117,130 Findings in the current review were generally consistent with the findings of the previous USPSTF review. 176 For test accuracy, the previous reviewers concluded that a single-question screener, the AUDIT-C, and the AUDIT appeared to be the best overall instruments for screening adults for the full spectrum of unhealthy alcohol use in primary care, with ranges of sensitivities and specificities solidly in the range of the sensitivities and specificities seen in this review among studies of adults.…”

Section: Discussionsupporting

confidence: 88%

Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults

O’Connor

Perdue

Senger

et al. 2018

JAMA

179

220

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IMPORTANCE Unhealthy alcohol use is common, increasing, and a leading cause of premature mortality. OBJECTIVE To review literature on the effectiveness and harms of screening and counseling for unhealthy alcohol use to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through October 12, 2017; literature surveillance through August 1, 2018.STUDY SELECTION Test accuracy studies and randomized clinical trials of screening and counseling to reduce unhealthy alcohol use.DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction by 2 reviewers. Counseling trials were pooled using random-effects meta-analyses.MAIN OUTCOMES AND MEASURES Sensitivity, specificity, drinks per week, exceeding recommended limits, heavy use episodes, abstinence (for pregnant women), and other health, family, social, and legal outcomes. RESULTSOne hundred thirteen studies (N = 314 466) were included. No studies examined benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents (10 studies [n = 171 363]), 1 study (n = 225) reported a sensitivity of 0.73 (95% CI, 0.60 to 0.83) and specificity of 0.81 (95% CI, 0.74 to 0.86) using the AUDIT-C (Alcohol Use Disorders Identification Test-Consumption) to detect the full spectrum of unhealthy alcohol use. For adults (35 studies [n = 114 182]), brief screening instruments commonly reported sensitivity and specificity between 0.70 and 0.85. Two trials of the effects of interventions to reduce unhealthy alcohol use in adolescents (n = 588) found mixed results: one reported a benefit in high-risk but not moderate-risk drinkers, and the other reported a statistically significant reduction in drinking frequency for boys but not girls; neither reported health or related outcomes. Across all populations (68 studies [n = 36 528]), counseling interventions were associated with a decrease in drinks per week (weighted mean difference, −1.6 [95% CI, −2.2 to −1.0]; 32 studies [37 effects; n = 15 974]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]; 15 studies [16 effects; n = 9760]), and the proportion reporting a heavy use episode (OR, 0.67 [95% CI, 0.58 to 0.77]; 12 studies [14 effects; n = 8108]), and an increase in the proportion of pregnant women reporting abstinence (OR, 2.26 [95% CI, 1.43 to 3.56]; 5 studies [n = 796]) after 6 to 12 months. Health outcomes were sparsely reported and generally did not demonstrate group differences in effect. There was no evidence that these interventions could be harmful.CONCLUSIONS AND RELEVANCE Among adults, screening instruments feasible for use in primary care are available that can effectively identify people with unhealthy alcohol use, and counseling interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects.Additionally, for the outcome drinks per week, whic...

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Section: Discussionsupporting

confidence: 88%

Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults

O’Connor

Perdue

Senger

et al. 2018

JAMA

179

220

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“…Studies show that the majority of women reduce their drinking levels during pregnancy [26], but a substantial percentage return to pre-pregnancy levels after having given birth [27]. Few studies have been conducted applying digital BIs to reduce drinking during pregnancy [28,29]; however, postpartum drinking has received limited attention so far. Ondersma et al [30] evaluated the effect of a computer-based BI on 7-day point-prevalence abstinence and drinking days among postpartum women.…”

Section: Brief Interventionsmentioning

confidence: 99%

Digital Mental Health for Alcohol and Substance Use Disorders

Boumparis

Schulte

Riper

2019

Curr Treat Options Psych

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Purpose Only about 20% of people suffering from substance use disorders access available treatments due to various obstacles; digital interventions could potentially overcome some of these. Meta-analyses suggest the strongest evidence for interventions targeting alcohol use reduction, followed by cannabis and illicit substances. However, most randomized controlled trials (RCTs) used unguided standalone interventions compared to non-active controls, with limited follow-up periods and disregarded comorbidity. This review examines the literature published over the last three years (2016-2019), with a focus on recent RCTs and whether they addressed some of these gaps. Recent findings Except for digital interventions targeting alcohol use, the number of RCTs in the last three years is limited. Although there is considerable heterogeneity between the studies, most of them applied unguided add-on interventions compared to active control groups, and a limited number investigated guided interventions. In addition, there is a need for longer follow-up periods, active rather than non-active control groups, outcome standardization, and increased focus on comorbidity. Summary Although the number of studies using guided add-on or blended interventions compared to active controls has increased, future studies should consider our identified gaps and suggestions to further strengthen the evidence of digital interventions for reducing the use of alcohol and other substances.

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“…Research into technology-delivered interventions has grown rapidly in recent years, with meta-analyses showing encouraging evidence for efficacy with respect to substance abuse [18–22] as well as other health-related behaviours [23]. However, although some early studies have considered e-SBI for alcohol use during pregnancy [24,25], none have done so for postpartum drinking.…”

Section: Introductionmentioning

confidence: 99%

“…The e-SBI session for this study was built and delivered using a flexible e-intervention authoring platform that has been used in a number of related trials [25–29], which uses a Tablet PC to deliver screening, assessment, and intervention content as a web application (see intervention section, below, for further details). We hypothesised that women receiving the e-SBI would report higher 7-day point-prevalence abstinence from alcohol and fewer days of alcohol use.…”

Section: Introductionmentioning

confidence: 99%

A randomised trial of a computer-delivered screening and brief intervention for postpartum alcohol use

Ondersma

Svikis

Thacker

et al. 2016

Drug and Alcohol Review

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Introduction and Aims Most women cut down or quit alcohol use during pregnancy, but return to pre-pregnancy levels of use after giving birth. Universal screening and brief intervention (SBI) for alcohol use has shown promise, but has proven challenging to implement and has rarely been evaluated with postpartum women. This trial evaluated a single 20-minute, electronic SBI (e-SBI) for alcohol use among postpartum women. Design and Methods In this parallel group randomised trial, 123 postpartum, low-income, primarily African-American women meeting criteria for unhealthy alcohol use were randomly assigned to either a tailored e-SBI (n=61) or a time-matched control condition (n=62), with follow-up at 3 and 6 months. Hypotheses predicted that 7-day point-prevalence abstinence and drinking days would favour the e-SBI condition. Results No group differences were significant. Blinded follow-up evaluation revealed 7-day point prevalence of 75% for the e-SBI condition vs. 82% for control at 3 months (odds ratio = 1.6) and 72% vs. 73%, respectively, at 6 months. Drinking days in the past 90 and mean number of drinks per week also showed no significant differences. Discussion and Conclusions This pilot trial failed to support a single-session e-SBI for alcohol use among postpartum women, although findings at the three month time point suggested that greater power might confirm transient effects of the e-SBI. As efficacy is likely to vary with e-SBI content and approach, future research should leverage technology’s reproducibility and modularity to isolate key components.

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Computer‐Delivered Screening and Brief Intervention for Alcohol Use in Pregnancy: A Pilot Randomized Trial

Cited by 57 publications

References 48 publications

Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults

Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults

Digital Mental Health for Alcohol and Substance Use Disorders

A randomised trial of a computer-delivered screening and brief intervention for postpartum alcohol use

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