One of the primary challenges in health behaviour change is to promote accessibility of efficacious tools and services that promote reductions in risk behaviours. When the interventions are psychosocial in nature, the Internet is one promising option. Portnoy and colleagues’ (2008
) recent review identified 75 research trials to-date of computer-based interventions for different health behaviours and concluded that such interventions had significant evidence for their efficacy. In the field of addictions, many people with substance abuse concerns never access any type of formal health care services. The ratio of treated to untreated problem drinkers is estimated to be anywhere between 1 in 3 and 1 in 14, even when attendance at Alcoholics Anonymous or a brief discussion with one’s family doctor is counted as having received treatment (Roizen et al., 1978
; Hasin, 1994
; Burton and Williamson, 1995
; Cunningham and Breslin, 2004
). There are many reasons for this unmet need. Current alcohol and drug abusers cite concerns about stigma as well as a desire to deal with their problems on their own as barriers to seeking treatment (Cunningham et al., 1993
; Grant, 1997
). Other factors include geographic limitations (i.e. the person lives in a rural location far from any specialized addictions treatment services) or mobility issues (e.g. among the elderly or physically disabled). These barriers are not insurmountable obstacles to improving the accessibility of care to all those in need. Rather, they are a challenge to the creative development of a diversity of different treatment options that can promote the accessibility of care while maintaining treatment fidelity and quality.
There are many advantages to the Internet as a modality to promote access to efficacious health behaviour change interventions. Its use is widespread and growing, making it a potentially useful means of providing psychosocial treatments to those in need. Recent surveys indicate that between 73% and 84% of adults in the USA and Canada use the Internet (Internet World Stats, 2009
), many for accessing health-related information. Other advantages of the Internet include its accessibility and availability 24 hours a day, 7 days a week. Further, Internet-based interventions (IBIs), once developed and evaluated, can be made available at very little additional cost. IBIs can also incorporate the latest research on effective interventions. In addition, as long as the materials are amenable to translation into a no-contact format, IBIs can employ complex algorithms that allow the personalization of the intervention to a wide range of individuals. In the area of problem drinking, the majority of research conducted to-date has employed college student samples (Elliott et al., 2008
), but there is a rapidly growing literature demonstrating efficacy in randomized controlled trials conducted with the general population (Murray et al., 2007
; Doumas and Hannah, 2008
; Riper et al., 2008
; Cunningham et al., 2009
The Check Your Drinking screener (CYD, Cunningham et al., 2006
) is a brief, personalized assessment feedback screener with a growing body of evidence supporting its efficacy in reducing harmful and hazardous alcohol consumption. Three small randomized controlled trials conducted by Doumas and colleagues (Doumas and Hannah, 2008
; Doumas and Haustveit, 2008
; Doumas et al., 2009
) have employed the CYD in face-to-face settings with young adults and found that use of the CYD resulted in significant reductions in alcohol consumption among young adult problem drinkers 30
days following exposure to the intervention. In addition, Cunningham and colleagues have reported on 3- and 6-month follow-up results from a randomized controlled trial where the CYD was accessed via the Internet by a general population sample in their own homes (Cunningham et al., 2009
). For problem drinkers in this sample, those provided access to the CYD displayed a six- to seven-drinks-per-week reduction in their drinking (a 30% reduction in quantity of drinks consumed) relative to controls (who reported an average one-drink-per-week reduction) at both 3- and 6-month follow-ups. Low risk drinkers displayed no impact of being provided access to the CYD, suggesting that providing personalized feedback to those drinkers does not result in iatrogenic effects, i.e. increasing alcohol consumption.
While the CYD appears able to reduce drinking at a 6-month follow-up, can the impact of this brief intervention be sustained? This paper reports on 12-month follow-up results from this same trial to assess whether reductions in drinking are sustained or diminished.