Text Messages Reduce Problem Drinking in Adults

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Frederick Muench, PhD, associate professor at the Feinstein Institute and director of Northwell Health's Digital Health Interventions in Psychiatry and his team has found that text messaging is an effective tool to reduce heavy drinking in adults seeking help on the internet.

MANHASSET, NY - Researchers at The Feinstein Institute for Medical Research at Northwell Health have found that text messaging is an effective tool to reduce heavy drinking in adults seeking help on the internet. The results of the first-of-its-kind study, published in PLOS ONE, show that when drinkers received adaptive tailored texts, their drinking reduction was similar to many in-person moderation treatments. 

Cutting down on social or binge drinking can be challenging, especially when undertaken alone. Many support groups, therapists and counselors are available to help those diagnosed with alcohol dependency, but for those who aren't diagnosed or don't want to seek help from others, it is a struggle to find adequate resources to effectively reduce drinking. Behavioral health issues such as heavy drinking often require multiple support systems, and recent evidence suggests that text messaging may help to reduce problem drinking as an extension to in-person services. But very little is known about the effectiveness of remote messaging on problem drinking as a stand-alone intervention. There also is little known about how different types of messages may improve outcomes in those seeking to moderate their alcohol consumption.

Frederick Muench, PhD, associate professor at the Feinstein Institute and director of Northwell Health's Digital Health Interventions in Psychiatry, and his team conducted a 12-week, single-blind, randomized, controlled pilot study with 152 participants seeking to reduce their drinking. This was the first study of its kind to recruit a remote population from across the country and deliver an automated mobile intervention for problem drinking. They compared four different types of alcohol reduction-themed text messages that were sent daily to weekly drinking tracking messages. The four types of text messages were 1) loss-framed texts, 2) gain-framed texts, 3) static tailored texts, and 4) adaptive tailored texts.

  • Control group: Weekly drink self-tracking mobile assessment texts: This group was designed to be a self-monitoring control. Participants in this condition were informed that they were in a drink-tracking program and received four questions about the past week's drinking once weekly. If participants did not respond to the first text within a half hour, the system resent the text up to three more times over the course of the next two hours. If participants did respond to the first text, the system would then send the second question. Participants in all messaging conditions received the weekly drink self-tracking mobile assessment texts as their base program.
  • Loss-framed texts: Loss-framed texts were sent at 6 p.m. daily and focused on the consequences of problem drinking. For example: "Think of all you have lost as a result of drinking too much. Make today a day that sets the stage for change."
  • Gain-framed texts: Gain-framed texts were sent at 6 p.m. daily highlighting the benefits of reducing drinking to safe guidelines. For example: "Think of all you can achieve if you can control your drinking. Make today a day that sets the stage for change."
  • Static tailored texts: Static tailored texts were tailored text messages sent at 6 p.m. daily and were based on individual responses to the baseline assessment. Tailoring included conforming to the day of the week (e.g. a specific message on Friday night referencing the weekend) and modifying to the day in the program (e.g. "It's been three weeks since you've signed up…"). Approximately 50 percent of messages were tailored based on participant gender, age, binge vs. daily drinking habits, solitary vs. social drinking habits, consumption severity, etc.
  • Adaptive tailored texts: Adaptive tailored texts included all static tailored texts features along with three additional components. First, messages individuals received over the course of a week varied based on their goal achievement in the prior week. Second, two additional messages were sent that at their heaviest typical drinking times. Third, participants were able to proactively text the automated system key words in order to receive just-in-time support, followed by a number of text-based check-ins. Key words included: tempt for support to manage a craving to drink, drink for support when the participant had started drinking, heavy for support when the participant had started drinking heavily, win for support either when the participant succeeded at managing a craving or when the participant succeeded in drinking no more than their moderate drinking goal for the situation, and regret for support after failing to moderate.

Results from the study show that all groups significantly reduced different aspects of problem drinking compared to weekly tracking, but that adaptive tailored texts had the largest effect sizes in helping adult problem drinkers reduce drinking frequency and quantity. Those who received adaptive tailored texts reduced their weekly alcohol consumption by 9.64 drinks, compared with a 2.5-drink decrease in the control group. Furthermore, remote automated text messages delivered daily were more effective than once-a-week self-tracking messages. When asked if they would like to continue receiving messages for an additional 12 weeks at the end of the study, 80 percent of participants said yes.

"I am very encouraged by what I see in this study, especially for individuals with limited resources," noted Dr. Muench. "Today, text messaging is part of our daily routine. If we could find a way to make this subtle but effective communication help those who are trying to drink less succeed when they need encouragement most, we have created something that can positively impact the 15 million American adults living with an alcohol use disorder."

"Dr. Muench's study is a great example of how the Feinstein Institute harnesses the power of technology to better understand and treat health conditions," said Kevin J. Tracey, MD, president and CEO of the Feinstein Institute.

About the Feinstein Institute

The Feinstein Institute for Medical Research is the research arm of Northwell Health, the largest healthcare provider in New York. Home to 50 research laboratories and to clinical research throughout dozens of hospitals and outpatient facilities, the 3,500 researchers and staff of the Feinstein are making breakthroughs in molecular medicine, genetics, oncology, brain research, mental health, autoimmunity, and bioelectronic medicine – a new field of science that has the potential to revolutionize medicine. For more information about how we empower imagination and pioneer discovery, visit FeinsteinInstitute.org.