JMIR Publications

ABSTRACT

Background:

Alcohol use disorder （AUD） is a severe health issue that profoundly affects ethnic minority young adults due to their unique stressors, like acculturation challenges and discrimination. Our prior studies found that experiential avoidance behavior and discrimination significantly contributed to AUD. These findings warranted third-wave interventions, such as Acceptance and Commitment Therapy （ACT）. Nonetheless, barriers to engagement with value-based activities may affect ACT efficacy. Behavioral Activation （BA） may be an alternative for this shortcoming. Integrating these interventions has shown a promising effect. However, no studies evaluated its effectiveness in this group. Therefore, evaluating the preliminary effectiveness and feasibility of an internet-based self-help program integrating ACT and BA was needed.

Objective:

The primary objective of this study was to evaluate the feasibility measures. The secondary objective was to examine the preliminary effectiveness and effect sizes of the intervention on cumulative abstinence duration （CAD）, drinks day （DD）/per drinking day （DDD）, heavy drinking days （HDD）, alcohol abstinence self-efficacy （AASE）, readiness to change （RTC）, psychological flexibility (AAQ-II), and everyday discrimination score （EDS）.

Methods:

A pilot randomized controlled trial （RCT） was conducted. Forty participants were randomly assigned to either the ACT-BA （n = 20） or Treatment-as-Usual （TAU） group （n = 20）。 Outcomes were assessed at baseline （T0） and post-intervention （T1）. The analysis method used in this study includes descriptive statistics, independent samples t-test, chi-square and/or Fisher’s exact test, paired t-test, intention-to-treat analysis, and generalized estimating equations with multiple imputations. To further supplement findings, a qualitative interview was conducted.

Results:

A total of 148 ethnic minority young adults were screened, with an eligibility rate of 38.5%. Of these,85.9%consented to participate, and among these,81.6%were randomized to either the ACT-BA or TAU. The retention rate was 82.5%, of which 75% completed post-intervention assessment (ACT-BA:80%; TAU:70%）with an adherence rate of 81.7%. The intervention group showed a promising improvement in DD (B = -4.12,95%Confidence Interval [CI]: -8.10, -0.13, P =。043, d = -0.57）， and DDD (B = -1.56,95%CI: -3.06, -0.07, P = .041, d = -1.89), AASE (B = 11.95, 95% CI,23.81, P =。048, d = 0.81), and AAQ-II (B = -6.41, 95% CI: -12.77, -0.06, P = .041, d = -0.65). However, significant improvement was not observed in CAD, DDD, RTC, and EDS.

Conclusions:

This pilot RCT provides preliminary evidence that the intervention is feasible and shows promise for drinks day/drinking day, alcohol abstinence self-efficacy, and psychological flexibility. The main implication is to conduct a fully powered RCT to further examine the effectiveness of such an intervention, with longer follow-up to capture the long-term effect on different drinking outcomes, and to incorporate objective measures to assess the drinking outcomes. Clinical Trial: ClinicalTrials.gov NCT06779006; https://clinicaltrials.gov/study/NCT06779006