Text Messaging Strategies for Excessive Alcohol Consumption

Overseen By Tina L Boothe, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Virginia

Disqualifiers: Under 18, Not in specified groups

Compensation: Varies

Number of Visits: 61

Duration: 1 week

3000 Participants Needed

Trial Summary

What is the purpose of this trial?

Binge drinking, and its health/social consequences are substantial public health concerns, with a high prevalence in young adults, especially in the US military. Alcohol consumption in the military is very high and normative, but there is zero tolerance for alcohol-related legal trouble, and Air Force Airmen who experience this (e.g., DUI, sexual assault) typically receive a disciplinary action referred to as an Alcohol Related Incident (ARI). Brief Alcohol Interventions (BAIs) for alcohol misuse are effective in young adults who report binge drinking. Many BAI studies targeted young adults who drink hazardously; these individuals are typically not interested in abstaining but may try decreasing the amount or change the manner in which they drink in order to reduce harmful consequences. The investigators previously published the results of a BAI group-based intervention that reduced ARIs in over 150,000 Airmen on average by 16%. Since 2010, the BAI has been disseminated to most USAF Airmen in Technical Training. However, it is clear additional research is needed to enhance the efficacy of the intervention and reduce risks associated with problem drinking. One strategy to improve health outcomes is well-timed, tailored, and automated text messages. Building on the researchers' preliminary study where text messages reduced driving after drinking as well as total drinks consumed before driving, text messaging may be highly effective when sent at the precise time that Airmen gain access to alcohol (the first time they are allowed off base), a standard time for all Technical Trainees. One challenge to conducting alcohol research in the military is the lack of privileged communication. As a result, it is difficult to obtain valid self-reports due to a tendency to deny or minimize use. The investigators recently developed and validated a method for collecting anonymous data over time. This will be the first study in the military, as well as the first large scale, adequately powered trial, where intervention effects will be tracked out to a 6-month follow-up. The study's Specific Aims are to randomize approximately 3000 Airmen to either the current BAI versus the BAI+Text messages timed to occur before, during, and after Airmen have access to alcohol; and to evaluate the efficacy of the intervention at the end of training and 6 months post-training using repeated surveys with unique identifiers allowing researchers to match surveys while maintaining anonymity.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on text messaging interventions for alcohol consumption.

What data supports the effectiveness of the treatment Automated and Tailored Text Messages, Automated Text Messages, Tailored Text Messages, SMS Intervention for excessive alcohol consumption?

Research shows that text message interventions can help reduce alcohol consumption, as seen in studies where supportive text messages improved outcomes for patients with alcohol use disorder and reduced binge drinking episodes among young adults. ^{1 2 3 4 5}

Is text messaging intervention safe for humans?

Text messaging interventions have been used safely in various health behavior studies, including those for alcohol use and other conditions, without any reported safety concerns. ^{6 7 8 9 10}

How is the text messaging treatment for excessive alcohol consumption different from other treatments?

This treatment is unique because it uses automated and tailored text messages to help people reduce their alcohol consumption, offering a convenient and accessible way to support behavior change without needing in-person visits. Unlike traditional treatments, it can be personalized and adapted to individual goals, making it a flexible option for those who may not seek formal treatment. ^{1 4 5 6 11}

Research Team

Kara P Wiseman, MPH, PhD

Principal Investigator

University of Virginia

Eligibility Criteria

This trial is for young adult Airmen in the US Air Force who are at risk of problematic drinking and have not faced severe alcohol-related legal issues. They must be willing to receive text messages and participate in surveys while maintaining anonymity.

Inclusion Criteria

Must be a United States Air Force Technical Training student in one of the following training groups or wings: 37th Training Wing, 81st Training Wing, 82nd Training Wing, or 59th Training Group

Must be able to understand English

Must be able to receive text messages

Exclusion Criteria

Not in the specified Technical Training groups or wings

I am under 18 years old.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive the Brief Alcohol Intervention (BAI) during the 4th week of Technical Training, with additional automated text messages for the experimental group.

1 week

1 session (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment using repeated anonymous surveys.

6 months

Surveys at 60 days and 6 months

Treatment Details

Interventions

• Automated and Tailored Text Messages

Trial Overview The study tests if automated, tailored text messages can enhance a Brief Alcohol Intervention (BAI) to prevent binge drinking among Airmen. Participants will either receive the standard BAI or BAI plus these targeted texts, with follow-up assessments up to six months post-training.

Participant Groups

Group I: BAI + Texting Experimental Treatment 2 Interventions

Those assigned to this arm will receive the same BAI as the other arm with the addition of automated text messages.

Group II: Brief Alcohol Intervention Placebo Group 1 Intervention

Those assigned to the BAI condition receive the standard BAI, which we have conducted since 2010, during the 4th week of Technical Training, the last week of enforced abstinence. This BAI has become the de-facto standard of care and is part of USAF Training. The BAI is a group-based, one-hour session which includes the following components: Interactive discussion of the positives and negatives of drinking during training and heavy vs. moderate drinking; Discussion of USAF rules on alcohol use and penalties for violations; Discussion of impact of alcohol on military readiness; effects of alcohol and hangover on performance; Review of standard drinks, blood alcohol levels and tolerance; and normative feedback on the Airmen's drinking level compared to others. We will engage in a conversation about whether they have observed concerning patterns of alcohol misuse among other USAF personnel, and how to handle this, along with harm reduction and alcohol refusal strategies.

Who Is Running the Clinical Trial?

University of Virginia

Lead Sponsor

Trials

802

Recruited

1,342,000+

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Collaborator

Trials

865

Recruited

1,091,000+

University of Memphis

Collaborator

Trials

73

Recruited

12,000+

Findings from Research

A 1-year SMS intervention significantly reduced heavy drinking among 462 patients with alcohol dependence after detoxification, with 22.2% in the intervention group compared to 32.3% in the treatment as usual group.

The SMS intervention showed an odds ratio of 1.68 for reducing heavy drinking, indicating it was effective in promoting better drinking outcomes compared to standard treatment alone.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of a 1-year short message service in detoxified alcohol-dependent patients: a multi-center, open-label randomized controlled trial. Lucht, M., Quellmalz, A., Mende, M., et al.[2021]

A study involving 59 patients with alcohol use disorder showed that supportive text messaging after treatment can significantly extend the time before a patient has their first drink, with the intervention group averaging about 60 days compared to 26 days for the control group.

The text messaging intervention also demonstrated small to moderate improvements in cumulative abstinence duration and alcohol consumption, indicating it could be a valuable follow-up care tool for patients after residential treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized controlled pilot trial of supportive text messaging for alcohol use disorder patients. Agyapong, VIO., Juhás, M., Mrklas, K., et al.[2019]

In a study of 54 participants with depression and alcohol use disorder, those receiving supportive text messages showed significantly lower depression scores after three months compared to the control group, indicating improved mood.

While the text message group also tended to have longer periods of abstinence from alcohol, the difference was not statistically significant, suggesting that supportive messaging may help but further research is needed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Supportive text messaging for depression and comorbid alcohol use disorder: single-blind randomised trial. Agyapong, VI., Ahern, S., McLoughlin, DM., et al.[2022]

In a 12-week pilot study with 152 participants, daily remote text messaging interventions significantly reduced alcohol consumption and heavy drinking days compared to weekly self-tracking messages, indicating their potential as effective stand-alone tools for problem drinkers.

Among the different types of messages tested, tailored adaptive texts showed the largest effect sizes in reducing drinking frequency and quantity, suggesting that personalized messaging may enhance the effectiveness of alcohol reduction strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Randomized Controlled Pilot Trial of Different Mobile Messaging Interventions for Problem Drinking Compared to Weekly Drink Tracking. Muench, F., van Stolk-Cooke, K., Kuerbis, A., et al.[2022]

The TRAC2 text message intervention effectively engaged nontreatment-seeking young adults, with an average response rate of 82% to ecological momentary assessments (EMAs) during the first 4-week block, indicating strong participant involvement.

Participants showed high commitment to drinking limit goals (96% commitment rate) and achieved their goals 89% of the time, suggesting that the intervention successfully supported self-regulation and reduced alcohol consumption over a 3-month follow-up period.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Text Message Intervention with Adaptive Goal Support to Reduce Alcohol Consumption Among Non-Treatment-Seeking Young Adults: Non-Randomized Clinical Trial with Voluntary Length of Enrollment. Suffoletto, B., Chung, T., Muench, F., et al.[2020]

An automated text messaging system was tested with 39 adolescents and young adults in a pilot study, showing high feasibility with 63% enrollment and 89.7% retention after baseline assessments.

Participants reported a positive experience with the text messages, especially those that were supportive and empowering, indicating that text messaging can effectively complement substance use interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Text message reminders as an adjunct to a substance use intervention for adolescents and young adults: Pilot feasibility and acceptability findings. Schwebel, FJ., Larimer, ME.[2022]

This systematic review and meta-analysis aims to evaluate the effectiveness of text messaging interventions in reducing alcohol consumption among harmful drinkers, addressing a gap in existing research that has primarily focused on web-based interventions.

The study will assess key outcomes such as weekly alcohol consumption and frequency of heavy drinking, using rigorous methods to ensure the quality of evidence, which could provide valuable insights for health practitioners and policymakers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Text Messaging Interventions for Reducing Alcohol Consumption Among Harmful and Hazardous Drinkers: Protocol for a Systematic Review and Meta-Analysis. Bendtsen, M.[2020]

Text messaging (SMS) is a highly effective and personal way to deliver behavioral health interventions remotely, leveraging the widespread use of cell phones globally.

Current studies indicate that SMS interventions can successfully promote healthy behaviors and may be more effective than other computerized methods, highlighting the need for future research to optimize SMS features for individual user engagement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Text Message Behavioral Interventions: From Here to Where? Suffoletto, B.[2022]

Parents of overweight and obese children generally find text messaging a promising and acceptable method to support healthy behavior changes, preferring it over traditional communication methods like paper or email.

The study revealed that parents would appreciate receiving text messages 2-3 times a week, especially if the messages are endorsed by their child's doctor and include personalized, actionable strategies for behavior change.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Leveraging text messaging and mobile technology to support pediatric obesity-related behavior change: a qualitative study using parent focus groups and interviews. Sharifi, M., Dryden, EM., Horan, CM., et al.[2021]

The TRAC intervention, which uses SMS text messaging to help reduce heavy drinking, was found to be effective and well-received by young adults aged 18-25, based on focus group discussions with 18 participants.

Key themes identified included the importance of ease of use, comfort and confidentiality, increased awareness of drinking behavior, and accountability, suggesting that enhancing personalization and engagement could further optimize the intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Optimizing a Text Message Intervention to Reduce Heavy Drinking in Young Adults: Focus Group Findings. Suffoletto, B., Kristan, J., Person Mecca, L., et al.[2018]

A meta-analysis of studies published between 2010 and 2018 found that mobile phone text messaging interventions were not effective in reducing alcohol intake among youth and younger adults.

The analysis included randomized control trials and pre-post studies that focused on problem drinking criteria set by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effectiveness of Mobile Phone-Based Text Messaging to Intervene with Problem Drinking in Youth and Younger Adult Population: A Meta-Analysis. Bastola, MM., Locatis, C., Maisiak, R., et al.[2021]

References

1. England pubmed.ncbi.nlm.nih.gov

Effect of a 1-year short message service in detoxified alcohol-dependent patients: a multi-center, open-label randomized controlled trial. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Randomized controlled pilot trial of supportive text messaging for alcohol use disorder patients. [2019]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Supportive text messaging for depression and comorbid alcohol use disorder: single-blind randomised trial. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

A Randomized Controlled Pilot Trial of Different Mobile Messaging Interventions for Problem Drinking Compared to Weekly Drink Tracking. [2022]

5. Canada pubmed.ncbi.nlm.nih.gov

A Text Message Intervention with Adaptive Goal Support to Reduce Alcohol Consumption Among Non-Treatment-Seeking Young Adults: Non-Randomized Clinical Trial with Voluntary Length of Enrollment. [2020]

6. United States pubmed.ncbi.nlm.nih.gov

Text message reminders as an adjunct to a substance use intervention for adolescents and young adults: Pilot feasibility and acceptability findings. [2022]

7. Canada pubmed.ncbi.nlm.nih.gov

Text Messaging Interventions for Reducing Alcohol Consumption Among Harmful and Hazardous Drinkers: Protocol for a Systematic Review and Meta-Analysis. [2020]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Text Message Behavioral Interventions: From Here to Where? [2022]

9. Canada pubmed.ncbi.nlm.nih.gov

Leveraging text messaging and mobile technology to support pediatric obesity-related behavior change: a qualitative study using parent focus groups and interviews. [2021]

10. Canada pubmed.ncbi.nlm.nih.gov

Optimizing a Text Message Intervention to Reduce Heavy Drinking in Young Adults: Focus Group Findings. [2018]

11. United States pubmed.ncbi.nlm.nih.gov

The Effectiveness of Mobile Phone-Based Text Messaging to Intervene with Problem Drinking in Youth and Younger Adult Population: A Meta-Analysis. [2021]