The Impacts of a Psychoeducational Alcohol Resource During Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety: Observational Study (Preprint)

Abstract

Problematic alcohol use is common among clients seeking transdiagnostic internet-delivered cognitive behavioral therapy (ICBT) for depression or anxiety but is not often addressed in these treatment programs. The benefits of offering clients a psychoeducational resource focused on alcohol use during ICBT for depression or anxiety are unknown.

This observational study aimed to elucidate the impacts of addressing comorbid alcohol use in ICBT for depression and anxiety.

All patients (N=1333) who started an 8-week transdiagnostic ICBT course for depression and anxiety received access to a resource containing information, worksheets, and strategies for reducing alcohol use, including psychoeducation, reasons for change, identifying risk situations, goal setting, replacing drinking with positive activities, and information on relapse prevention. We assessed clients’ use and perceptions of the resource; client characteristics associated with reviewing the resource; and whether reviewing the resource was associated with decreases in clients’ alcohol use, depression, and anxiety at posttreatment and 3-month follow-up among clients dichotomized into <i>low-risk</i> and <i>hazardous</i> drinking categories based on pretreatment Alcohol Use Disorders Identification Test (AUDIT) scores.

During the 8-week course, 10.8% (144/1333) of clients reviewed the resource, and those who reviewed the resource provided positive feedback (eg, 127/144, 88.2% of resource reviewers found it worth their time). Furthermore, 18.15% (242/1333) of clients exhibited hazardous drinking, with 14.9% (36/242) of these clients reviewing the resources. Compared with nonreviewers, resource reviewers were typically older (<i>P</i>=.004) and separated, divorced, or widowed (<i>P</i>&lt;.001). Reviewers also consumed more weekly drinks (<i>P</i>&lt;.001), scored higher on the AUDIT (<i>P</i>&lt;.001), and were more likely to exhibit hazardous drinking (<i>P</i>&lt;.001). Regardless of their drinking level (ie, low risk vs hazardous), all clients showed a reduction in AUDIT-Consumption scores (<i>P</i>=.004), depression (<i>P</i>&lt;.001), and anxiety (<i>P</i>&lt;.001) over time; in contrast, there was no change in clients’ drinks per week over time (<i>P</i>=.81). Reviewing alcohol resources did not predict changes in AUDIT-Consumption scores or drinks per week.

Overall, ICBT appeared to be associated with a reduction in alcohol consumption scores, but this reduction was not greater among alcohol resource reviewers. Although there was some evidence that the resource was more likely to be used by clients with greater alcohol-related difficulties, the results suggest that further attention should be given to ensuring that those who could benefit from the resource review it to adequately assess the benefits of the resource.