Effect of a smartphone intervention as a secondary prevention for use among university students with unhealthy alcohol use: randomised controlled trial

Abstract

Objective To estimate the effects of providing access to an alcohol intervention based on a smartphone. Design Randomised controlled trial.. Setting Four higher education institutions in Switzerland. Participants 1770 students (≥18 years) who screened positive for unhealthy alcohol use (ie, a score on the alcohol use disorders identification test-consumption (AUDIT-C) of ≥4 for men and ≥3 for women) were randomly assigned by 1:1 allocation ratio in blocks of 10. Intervention Providing access to a brief, smartphone based alcohol intervention. Outcome measures The primary outcome studied was number of standard drinks per week at six months and the secondary outcome was number of heavy drinking days (past 30 days). Additional outcomes were maximum number of drinks consumed on one occasion, alcohol related consequences, and academic performance. Follow-up assessments occurred at months three, six, and 12. Data were analysed by intention to treat and by using generalised linear mixed models with random intercepts for the recruitment site and participants nested within the recruitment site, and with intervention ( v control), time (three months v six months; 12 months v six months), and baseline outcome values as fixed effects. Results Between 26 April 26 2021 and 30 May 2022, 1770 participants (intervention group (n=884); control group (n=886)) were included. Mean age was 22.4 years (standard deviation 3.07); 958 (54.1%) were women; and 1169 (66.0%) were undergraduate students, 533 (30.1%) were studying for a master’s degree, 43 (2.4%) were studying for a doctorate, and 25 (1.4%) were students of other higher education programme. The baseline mean number of standard drinks per week was 8.59 (standard deviation 8.18); the baseline number of heavy drinking days was 3.53 (4.02). Of 1770 participants, follow-up rates were 1706 (96.4%) at three months, 1697 (95.9%) at six months, and 1660 (93.8%) at 12 months. Of 884 students randomly assigned to the intervention group, 738 (83.5%) downloaded the smartphone application. The intervention had a significant overall effect on the number of standard drinks per week (incidence rate ratio 0.90 (95% confidence interval 0.85 to 0.96)), heavy drinking days (0.89 (0.83 to 0.96)), and the maximum number of drinks consumed on one occasion (0.96 (0.93 to 1.00), P=0.029), indicating significantly lower drinking outcomes in the intervention group than in the control group during the follow-up period. The intervention did not affect alcohol related consequences or academic performance. Conclusions Providing access to the smartphone application throughout the 12 month follow-up was effective at limiting the average drinking volume of university students who had self-reported unhealthy alcohol use at baseline. Trial registration ISRCTN 10007691.

Randomized controlled trial of a smartphone app designed to reduce unhealthy alcohol consumption

“…For the secondary outcome variables, percent drinking five or more drinks on one occasion weekly or more often and number of consequences related to their drinking, there was no significant ( p > .05) impact of receiving the full app. These results mirror the findings of the other trial examining the efficacy of the SMAART app in a sample of university students with unhealthy alcohol consumption ( Bertholet et al, 2023b ). Taken together, and along with the impact of the earlier version of the app employed in our pilot trial ( Bertholet et al, 2019 ), we conclude that there is reasonable evidence for the effectiveness of this app and similar apps providing personalized feedback to have a small effect among recipients on their weekly alcohol consumption.…”

“…A recent randomized trial conducted by Bertholet et al, 2023a , Bertholet et al, 2023b did find evidence for the effectiveness of an app in university students. As the app may also have utility outside of the college environment, the present study tested the effectiveness in a sample of people with unhealthy alcohol use recruited from the general public.…”

“…To-date, there have been a large number of such apps released for public use ( Hoeppner et al, 2017 ; Rogers et al, 2017 ) though the majority have not been developed with reference to theory or evidence ( Crane et al, 2015 ). Research on these interventions is limited, with inconsistent evidence of efficacy ( Bertholet et al, 2023b ; Colbert et al, 2020 ; Dulin et al, 2022 ; Leightley et al, 2022 ; Oldham et al, 2024 ; Philippe et al, 2022 ).…”

Effectiveness of a smartphone app (Drink Less) versus usual digital care for reducing alcohol consumption among increasing-and-higher-risk adult drinkers in the UK: a two-arm, parallel-group, double-blind, randomised controlled trial

“…One app resulted in a reduction in standard drinks and heavy drinking days among a student sample in Switzerland after one year. 7 In Australia, the Daybreak app resulted in reductions in alcohol consumption relative to baseline amongst users, 8 though due to technical errors a proportion of the control group in this study accessed the intervention.…”

“… 38 A recent trial of an alcohol reduction app among university students in Switzerland found a reduction of one standard drink among app users (equivalent to 2.5 UK units), which is roughly equivalent to the weekly 2.00-unit reduction we see in this study. 7 …”