Effectiveness of a standalone telephone-delivered intervention for reducing problem alcohol use: a randomized clinical trial

Despite the magnitude of alcohol use problems globally, treatment uptake remains low. Telephone-delivered interventions have potential to overcome many structural and individual barriers to help-seeking, yet their effectiveness as a standalone treatment for problem alcohol use has not been established. We recently examined the effectiveness of the Ready2Change (R2C) telephone-delivered intervention in reducing alcohol problem severity among a general population sample with alcohol use problems. This double-blind randomized clinical trial recruited 344 participants (R2C n=173, active control n=171) with an Alcohol Use Disorders Identification Test (AUDIT) score of >6/7 (female/male). Assessments occurred at baseline and 3-months (84.9% retention). The R2C cognitive and behavioral intervention comprised 4-6 telephone sessions with a psychologist; the active control comprised four 5-minute researcher-delivered telephone check-ins and alcohol/stress management pamphlets. Participants’ mean age was 39.9 years (SD=11.4, 18-73 years), 51.5% were male. Fewer than one-third (29.4%) had previously sought alcohol treatment, despite a high mean baseline AUDIT score of 21.5 (SD=6.3) and 63.4% scoring in the probable dependence range. Both arms showed a significant decrease in AUDIT total score from baseline to 3-months (R2C=-8.22, 95% CI 7.11, 9.32, p<0.001; control=-7.13, 95% CI 6.10, 8.17, p<0.001), but change over time was not different between arms (difference=1.08, 95% CI -0.43, 2.59, p = 0.161). The R2C arm showed a greater reduction in AUDIT hazardous use (AUDIT-C) relative to control at 3-months (difference=0.58, 95% CI 0.02, 1.14, p = 0.042). When adjusting for exposure to ≥2 sessions, significant time-by-treatment interactions were observed for AUDIT total score (difference=3.40, 95% CI 0.36, 6.44, p=0.029), AUDIT hazardous use and dependence symptoms, and Timeline Follow-back drinking days, days with >2/>4 standard drinks consumed, and total standard drinks (all p<0.01). Trial outcomes demonstrate the benefits of this highly scalable model of alcohol treatment, with potential to reduce the treatment gap for problem alcohol use.