Accepted for/Published in: JMIR Mental Health
Date Submitted: Dec 1, 2022
Open Peer Review Period: Dec 1, 2022 - Dec 20, 2022
Date Accepted: Mar 28, 2023
(closed for review but you can still tweet)
Will an Alcohol Resource be a Useful Adjunct to Internet-Delivered Cognitive Behavior Therapy for Depression and Anxiety?: An Observational Study
ABSTRACT
Background:
Alcohol use is common among clients seeking transdiagnostic internet-delivered cognitive behavior therapy (ICBT) for depression or anxiety, but is not often addressed in these treatment programs. The benefits of offering clients a psychoeducational resource focused on alcohol use during ICBT for depression or anxiety are unknown.
Objective:
The objective of the current observational study was to elucidate the impacts of addressing comorbid alcohol use in ICBT for depression and/or anxiety.
Methods:
All clients (N=1333) who started an 8-week transdiagnostic ICBT course for depression and anxiety received access to a resource containing information, worksheets, and strategies for reducing alcohol use including: psychoeducation, reasons for change, identifying risk situations, goal setting, replacing drinking with positive activities, and information on relapse prevention. We assessed clients’ use and perceptions of the resource, client characteristics associated with reviewing the resource, and the effects of reviewing the resource on clients’ alcohol use, depression, and anxiety at posttreatment and 3-month follow-up among clients dichotomized into low-risk and hazardous drinking categories based on pretreatment Alcohol Use Disorder Identification Test (AUDIT) scores.
Results:
Results:
During the 8-week course, 10.8% (144/1333) of clients reviewed the resource, and those who reviewed the resource provided positive feedback (eg, 127/144, 88.2% of resource reviewers found it worth their time). Further, 18.2% (242/1333) of clients exhibited hazardous drinking, with 14.9% (36/242) of these clients reviewing the resource. Compared to non-reviewers, resource reviewers were typically older (P=.004), and separated, divorced, and/or widowed (P<.001); reviewers also consumed more weekly drinks (P<.001), scored higher on the AUDIT (P<.001), and were more likely to exhibit hazardous drinking (P<.001). Regardless of their drinking level (ie, low-risk vs hazardous), all clients showed a reduction on AUDIT-Consumption scores (P=.004), depression (P<.001), and anxiety (P<.001) decreased over time; in contrast, there was no change in clients’ drinks per week over time (P=.81). Reviewing the alcohol resource did not predict changes in AUDIT-Consumption scores or drinks per week.
Conclusions:
Overall, ICBT appears to be associated with a reduction in alcohol consumption scores but this reduction was not greater among alcohol resource reviewers. While there was some evidence that the resource was more likely to be used by clients with greater alcohol-related difficulties, the results suggest that further attention should be given to ensuring that those who could benefit from the resource review it, in order to adequately assess the benefits of the resource. Clinical Trial: N/A
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