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Intervention Summary

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ModerateDrinking.com and Moderation Management

ModerateDrinking.com and Moderation Management are complementary online interventions designed for nondependent, heavy-drinking adults who want to reduce the number of days on which they drink, their peak alcohol use on days they drink, and their alcohol-related problems. ModerateDrinking.com (MD) is a Web-based behavioral self-control skills training program, and Moderation Management (MM) is an online support group network.

The MD Web site guides participants in setting, reaching, and maintaining drinking reduction goals by providing both personalized feedback on self-reported drinking behavior and online training in behavioral self-control skills. The skills training modules address motivation and self-confidence, identifying and managing drinking triggers, developing alternatives, problem solving, dealing with drinking lapses and relapses, considering alcohol abstinence, and mood self-monitoring. Although the MD Web site recommends that users access the online training modules sequentially, participants may choose to use only the training modules that meet their needs. Each participant starts the program by making a 30-day commitment to either total alcohol abstinence or a moderation target. At the start of each subsequent login to the online program, the participant enters information on his or her drinking since the previous visit and receives a detailed feedback report on progress toward the established drinking goal.

The separate MM Web site is a support resource offering online and face-to-face mutual support meetings, a listserv, and an online forum to connect concerned drinkers trying to make positive lifestyle changes. Other features of the MM Web site include a calendar participants can use to input and monitor their drinking behavior, as well as drinking limit guidelines recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Descriptive Information

Areas of Interest Substance abuse prevention
Substance abuse treatment
Outcomes Review Date: November 2010
1: Alcohol abstinence
2: Alcohol-related problems
3: Peak alcohol use on drinking days
Outcome Categories Alcohol
Ages 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
Genders Male
Female
Races/Ethnicities Hispanic or Latino
White
Race/ethnicity unspecified
Settings Home
Geographic Locations Urban
Suburban
Rural and/or frontier
Tribal
Implementation History ModerateDrinking.com was made available to the public in December 2009. Since then, 580 individuals have registered to use the Web application. The program has been used by people across the United States as well as in Australia, Bermuda, Canada, the Netherlands, and New Zealand. ModerateDrinking.com was first evaluated in a randomized clinical trial with heavy drinkers in New Mexico. The Moderation Management Network, Inc., which coordinates and supports live meetings and provides online support through its Moderation Management Web site, opened its first national office in 2000.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Indicated

Quality of Research
Review Date: November 2010

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Hester, R. K., Delaney, H. D., & Campbell, W. (2010). ModerateDrinking.com and Moderation Management: Outcomes of a randomized clinical trial with non-dependent problem drinkers. Manuscript submitted for publication.

Supplementary Materials

Carroll, K. M., Ball, S. A., Martino, S., Nich, C., Babuscio, T. A., Nuro, K. F., et al. (2008). Computer-assisted delivery of cognitive-behavioral therapy for addiction: A randomized trial of CBT4CBT. American Journal of Psychiatry, 165(7), 881-888.  Pub Med icon

Carroll, K. M., Ball, S. A., Martino, S., Nich, C., Babuscio, T. A., & Rounsaville, B. J. (2009). Enduring effects of a computer-assisted training program for cognitive behavioral therapy: A 6-month follow-up of CBT4CBT. Drug and Alcohol Dependence, 100(1-2), 178-181.  Pub Med icon

Hester, R. K., Delaney, H. D., Campbell, W., & Handmaker, N. (2009). A Web application for moderation training: Initial results of a randomized clinical trial. Journal of Substance Abuse Treatment, 37(3), 266-276.  Pub Med icon

Humphreys, K., & Klaw, E. (2001). Can targeting nondependent problem drinkers and providing Internet-based services expand access to assistance for alcohol problems? A study of the Moderation Management self-help/mutual aid organization. Journal of Studies on Alcohol, 62(4), 528-532.   Pub Med icon

Miller, W. R., & Marlatt, G. A. (1984). Comprehensive Drinker Profile (CDP) manual supplement for use with Brief Drinker Profile, Follow-Up Drinker Profile, Collateral Interview Form. Retrieved from http://casaa.unm.edu/inst/CDPmana.pdf

Miller, W. R., Tonigan, J. S., & Longabaugh, R. (1995). Scale construction and item analysis. In The Drinker Inventory of Consequences (DrInC): An instrument for assessing adverse consequences of alcohol abuse. Project MATCH Monograph Series, Vol. 4 (DHHS Publication No. 95-3911, pp. 5-16). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism.

Squires, D. D., & Hester, R. K. (2002). Computer-based brief intervention for drinkers: The increasing role for computers in the assessment and treatment of addictive behaviors. Behavior Therapist, 25(3), 59-65.

Outcomes

Outcome 1: Alcohol abstinence
Description of Measures Alcohol abstinence was measured as the percentage of days abstinent (PDA) in the past 90 days. It was assessed using a self-administered, online version of the Brief Drinker Profile (BDP) and independently verified by collateral report from a significant other on the Collateral Interview Form (CIF). The BDP, derived from the Comprehensive Drinker Profile, is a 50-minute structured interview that measures the quantity and frequency of current drinking and the severity of risk factors across eight life domains: demographics, family and employment status, history of problem development, alcohol-related problems, severity of dependence, other drug use, additional life problems, and motivation for treatment. Participants completed the BDP in the clinic where the study was conducted using a Web application separate from ModerateDrinking.com. The CIF, with items that parallel those in the BDP, is administered to a significant other for verification of self-reported drinking behavior. Assessments occurred at baseline and at 3-, 6-, and 12-month follow-ups. Study participants received phone calls reminding them to return to the clinic to complete the BDP follow-up assessments (to ensure sobriety), and a research assistant administered the CIF by telephone to the identified significant other a few days after completion of the BDP.
Key Findings Individuals concerned about their drinking were recruited for a 12-month randomized clinical trial. After phone and in-person screening to exclude individuals with alcohol dependence or comorbid conditions, participants were randomly assigned to one of two intervention conditions: MD plus MM or MM only. For both groups, PDA averaged across the three follow-ups was higher than PDA at baseline (p < .001); however, the increase in PDA was greater for MD plus MM participants than for MM-only participants (28.6% vs. 7.8%; p = .004). This group difference was associated with a medium effect size (Cohen's d = 0.65).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.0 (0.0-4.0 scale)
Outcome 2: Alcohol-related problems
Description of Measures Alcohol-related problems were measured using an online version of the Drinker Inventory of Consequences (DrInC), a 50-item self-report questionnaire that measures the consequences of both lifetime and recent (past 90 days) drinking behavior across five life domains: interpersonal, physical, social, impulsive, and intrapersonal. Participants completed the DrInC in the clinic where the study was conducted using a Web application separate from ModerateDrinking.com. Assessments occurred at baseline and at 3-, 6-, and 12-month follow-ups. Study participants received phone calls reminding them to return to the clinic to complete the DrInC follow-up assessments (to ensure sobriety).
Key Findings Individuals concerned about their drinking were recruited for a 12-month randomized clinical trial. After phone and in-person screening to exclude individuals with alcohol dependence or comorbid conditions, participants were randomly assigned to one of two intervention conditions: MD plus MM or MM only. For both groups, the number of alcohol-related problems averaged across the three follow-ups was fewer than the number of alcohol-related problems at baseline (p < .001); however, the decrease in alcohol-related problems was greater for MD plus MM participants than for MM-only participants from baseline to the 3-month follow-up (p = .011). This group difference was no longer significant at the 6- and 12-month follow-ups.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.0 (0.0-4.0 scale)
Outcome 3: Peak alcohol use on drinking days
Description of Measures Peak alcohol use on drinking days was measured as the median peak blood alcohol content (BAC) per drinking day during the past 90 days. Median peak BAC per drinking day was estimated using a self-administered, online version of the BDP and independently verified by collateral report from a significant other on the CIF. The BDP, derived from the Comprehensive Drinker Profile, is a 50-minute structured interview that measures the quantity and frequency of current drinking and the severity of risk factors across eight life domains: demographics, family and employment status, history of problem development, alcohol-related problems, severity of dependence, other drug use, additional life problems, and motivation for treatment. Participants completed the BDP in the clinic where the study was conducted using a Web application separate from ModerateDrinking.com. The CIF, with items that parallel those in the BDP, is administered to a significant other for verification of self-reported drinking behavior. Assessments occurred at baseline and at 3-, 6-, and 12-month follow-ups. Study participants received phone calls reminding them to return to the clinic to complete the BDP follow-up assessments (to ensure sobriety), and a research assistant administered the CIF by telephone to the identified significant other a few days after completion of the BDP.

Study participants were dichotomized as "binge" or "nonbinge" drinkers on the basis of NIAAA's binge drinking definition: more than five drinks per drinking occasion for men or more than four drinks per drinking occasion for women.
Key Findings Individuals concerned about their drinking were recruited for a 12-month randomized clinical trial. After phone and in-person screening to exclude individuals with alcohol dependence or comorbid conditions, participants were randomly assigned to one of two intervention conditions: MD plus MM or MM only. Among the findings from this study were the following:

  • From baseline to the 12-month follow-up, MD plus MM participants had a greater decrease in median peak BAC per drinking day than MM-only participants (p = .018). This group difference was associated with a medium effect size (Cohen's d = 0.62).
  • Among nonbinge drinkers, the decrease in median peak BAC per drinking day from baseline to the average across the three follow-ups was greater for MD plus MM participants than for MM-only participants (85 mg% to 46 mg% vs. 51 mg% to 42 mg%; p = .008). This group difference was associated with a large effect size (Cohen's d = 1.0).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.0 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
56.3% Female
43.8% Male
78.8% White
18.8% Hispanic or Latino
2.5% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Alcohol abstinence 2.3 3.0 3.5 2.5 3.0 3.5 3.0
2: Alcohol-related problems 2.8 3.0 3.5 2.5 3.0 3.5 3.0
3: Peak alcohol use on drinking days 2.3 3.0 3.5 2.5 3.0 3.5 3.0

Study Strengths

The BDP and the DrInC are well-known assessment instruments in the field and have excellent psychometric properties. The study used collateral reports from significant others to establish convergent validity of self-reported drinking behavior on the BDP. The Web-based format of the intervention strengthened intervention fidelity in that the content delivered to each participant was identical; additionally, participants were queried by email on how much they accessed the Web sites. Attrition and missing follow-up data were handled by imputation and a sophisticated mixed-model analysis approach. Separate analyses were performed for study completers and noncompleters to rule out significant between-group differences. Potential confounds were limited by the use of randomization and a comparison condition that provided a good attention control to the target intervention. The analysis used an intent-to-treat approach with an adequate sample size based on a prospective power analysis, and it included effect sizes for condition contrasts in addition to traditional tests of significance.

Study Weaknesses

The conversion of the BDP, a structured interview, to an online, self-administered questionnaire was of concern because no sample reliability data were provided to show comparability to the original interview instrument. Convergent validity of the BDP self-reports with collateral reports was weak (correlations of .41-.48) for the baseline and 3- and 6-month follow-up assessments. The study had an overall attrition rate of 25% and differential attrition across conditions (21% for the intervention group and 31% for the comparison group). A potential confound and design limitation was the absence of an assessment-only control group. The investigators did not fully justify the decision to average outcome-specific measures across the three follow-up assessments rather than use a more customary growth-curve modeling approach, which would have examined change over time across multiple follow-ups.

Readiness for Dissemination
Review Date: November 2010

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Moderate Drinking Web site, http://www.ModerateDrinking.com

Moderation Management Web site, http://www.moderation.org

Rotgers, F., Kern, M. F., & Hoeltzel, R. (2002). Responsible drinking: A moderation management approach for problem drinkers. Oakland, CA: New Harbinger.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
4.0 4.0 4.0 4.0

Dissemination Strengths

The two program Web sites provide comprehensive information and practical and downloadable tools for individuals to chart their use of alcohol and identify triggers and problems. The sites also provide a listserv, online chats, and forums that offer opportunities for peer-to-peer support, as well as resources to help individuals find local therapists and support groups. Tools and checklists to help individuals with self-assessment are available to support quality assurance.

Dissemination Weaknesses

No weaknesses were identified by reviewers.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
ModerateDrinking.com Web subscription $19.95 per month or $59 for 12 months Yes
Moderation Management Web site Free Yes
Replications

No replications were identified by the developer.

Contact Information

To learn more about implementation or research, contact:
Reid K. Hester, Ph.D.
(505) 345-6100
reidhester@behaviortherapy.com

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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