NDARC Technical Report No. 6 (1990)
SUMMARY
This study was designed to examine the validity of previous findings relating to the effectiveness of a self-help manual for problem drinkers and also to investigate the hypothesis that telephone contact supplementary to self-help manual would increase its effectiveness.
107 subjects who had responded to a newspaper advertisement offering help to cut down drinking and who had agreed to the conditions of the study were randomly assigned to : a) a control group that received a general advice and information booklet through the post (n = 32); b) a group that received a controlled drinking self-help manual through the post (n = 24); c) a group that received, in addition to the self-help manual, the opportunity to make telephone reports of progress to an answering service (n = 26); and d) a group that received, in addition to the self-help manual, the opportunity to make telephoned reports of progress to a trained interviewer (n = 25).
Initial assessment was by telephone but follow-up assessment was by personal interview. 87 (81.3%) subjects were successfully followed up, with a significantly lower proportion being followed up in the two groups receiving the opportunity for telephone contact. Collateral reports were available for 54 ( 62.1%) of those followed up and general correspondence between self reports and collateral reports of change in consumption was good, with only one case where a self-report of decreased consumption was contradicted by a collateral report of increased drinking.
Results showed that the overall sample reported significant reductions in level of alcohol consumption, frequency of drinking and maximum daily intake, and significant improvements in alcohol-related problems, level of alcohol dependence, physical health and well-being and degree of social interaction. Although there were no significant differences between groups in an analysis of covariance of consumption scores, a significantly higher proportion of subjects was drinking above recommended levels at follow-up in the control group than in the combined groups receiving the self-help manual. This same finding was obtained when subjects lost to follow-up were ignored in the analysis, when they were all assumed to be failures (i.e. drinking above recommended levels at follow-up) and when they were all.assumed to be successes.
There was no evidence from the study that the benefits of the brief intervention (including the control intervention) were restricted to subjects reporting less serious problems, defined either in terms of level of consumption or of dependence. Although mean follow-up consumption in more seriously impaired groups was still high, roughly one-third of subjects under each definition of seriousness reported consumption below recommended levels at follow-up. There was a trend in the data for subjects reporting high consumption at initial assessment (i.e. over 100 units/week) to benefit relatively more from the self-help manual than the control material but this was not statistically significant.
The hypothesis that telephone contact would add to the effectiveness of the self-help manual was not confirmed. Also, there was no evidence that access to an interviewer in making telephone progress reports was more effective than access to an answering service. Unexpectedly little use was made of the opportunity for telephone contact and subjects who made no use of telephone facilities tended to be those who refused a follow-up interview despite having previously agreed to one. It is concluded that there is little to be gained by adding telephone contact to self-help approaches for problem drinkers and that the most likely explanation for this is that many of those who respond to newspaper advertisements offering help to cut down drinking are especially sensitive to the stigma attached to the admission of a drinking problem and wish to avoid contact with helping agencies.
It is also speculatively concluded that self-help manuals, in addition to their general role in early intervention and secondary prevention, may have a particularly important role in assisting those "closet" problem drinkers who are unwilling to approach helping agencies.