Smartphone app helps reduce alcohol consumption among university students

A smartphone-based alcohol intervention has resulted in lower drinking volume and fewer heavy drinking days at 12-month follow-up among university students with self-reported unhealthy alcohol use, reports a study.

“Our study indicates that providing access to the app was associated with lower drinking volume and fewer heavy drinking days at follow-up,” the investigators said. “Among students, smartphones can be used to deliver brief interventions for unhealthy alcohol use.”

In this randomized controlled trial, 1,770 students (aged ≥18 years) who screened positive for unhealthy alcohol use (ie, a score on the alcohol use disorders identification test-consumption [AUDIT-C] of ≥4 for men and ≥3 for women) were randomly assigned by 1:1 allocation ratio in blocks of 10. Participants were provided access to a brief, smartphone-based alcohol intervention.

The number of standard drinks per week at 6 months served as the primary outcome, while the secondary outcome was the number of heavy drink days in the past 30 days. Other outcomes included maximum number of drinks consumed on one occasion, alcohol-related consequences, and academic performance. Follow-up assessments were made at 3, 6, and 12 months.

The investigators performed intention-to-treat analysis using generalized linear mixed models with random intercepts for the recruitment site and participants nested within the recruitment site, and with intervention, time, and baseline outcome values as fixed effects.

Of the participants (mean age 22.4 years), 884 were assigned to the intervention group and 886 to the control group; 958 (54.1 percent) were women; 1,169 (66.0 percent) were undergraduate students, 533 (30.1 percent) were studying for a master’s degree, 43 (2.4 percent) for a doctorate, and 25 (1.4 percent) were students of other higher education program. [BMJ 2023;382:e073713]

At baseline, the mean number of standard drinks per week stood at 8.59 and the mean number of heavy drinking days was 3.53. Follow-up rates were 1,706 (96.4 percent) at 3 months, 1,697 (95.9 percent) at 6 months, and 1,660 (93.8 percent) at 12 months. Of the 884 students randomized to the intervention group, 738 (83.5 percent) downloaded the smartphone application.

Fewer drinks

The alcohol intervention resulted in significant benefits in terms of the number of standard drinks per week (incidence rate ratio [IRR], 0.90, 95 percent confidence interval [CI], 0.85‒0.96), heavy drinking days (IRR, 0.89, 95 percent CI, 0.83‒0.96), and the maximum number of drinks consumed on one occasion (IRR, 0.96, 95 percent CI, 0.93‒1.00; p=0.029).

These results suggested a substantial decrease in drinking outcomes in the intervention group compared with those in the control group during the follow-up period. Moreover, the intervention showed no significant effect on alcohol-related consequences or academic performance.

“One interesting finding was that drinking increased at 3 months in both the intervention and control groups, and we postulate two main explanations for this,” the investigators said.

“The study was conducted during the COVID-19 pandemic (although not at peak incidence), and recruitment started when students were returning to their campuses after a lockdown period, with COVID-19 restrictions being partially lifted,” they added.

As a result, students might have taken advantage of easily available alcohol and of softer social distancing rules, which allowed more opportunities to drink than during the lockdown. [J Behav Addict 2021;10:901-911]

“The 3-month follow-up also coincided with summer, when students are typically on holiday, which may explain the general increases in drinking observed at 3 months in both groups,” the investigators said.