For Problem Drinkers, Check-Up Is in the Mail

Problem drinkers can get the help they need without personal contact with a counselor, a new study indicates. All they need to do is fill in a questionnaire, mail it and follow the printed materials sent to them in return.

"Problem drinkers who participated in the [study] reported a significant decrease in high-risk drinking and related consequences" as a result of these actions, notes lead author Linda Carter Sobell, Ph.D., of Nova Southeastern University. These findings, she observes, demonstrate that a "mail intervention - can reach large numbers of individuals who are otherwise unwilling, not ready or not motivated to access the formal health care system" and could "generate enormous health and related benefits."

"Many studies show that large numbers of problem drinkers resist being called 'alcoholic' and do not enter treatment," Sobell explains. Prior research has shown that more than three-quarters of adults who recover from an alcohol problem for one or more years do so without any formal treatment or help -- a process that psychologists call "natural recovery."

In a study described in the June issue of Alcoholism: Clinical and Experimental Research, Sobell and her colleagues set out to determine what type of written materials might be most effective in catalyzing this natural recovery process when mailed to interested problem drinkers.

The researchers began by placing an advertisement asking adults who wanted to address their problem drinking on their own and in private to send for free materials.

All subsequent contact between researchers and respondents took place anonymously through a post office box. Respondents to the ad received questionnaires asking their drinking patterns during the past year, how problematic their drinking was and how intensely they wanted to change. After reviewing the answers, the investigators sent printed guidance on alcohol consumption to the 825 respondents who reported consuming an average of 12 or more drinks per week or who said they had consumed five or more drinks on single occasion, or binged, at least five times in the past year.

Those who qualified received materials that explained high-risk and lower-risk drinking. Approximately half the subjects were randomly selected to receive materials personalized to their reported drinking habits and level of motivation; the other half received generic pamphlets with no individualized content.

A year later, the investigators sent follow-up questionnaires to all those who had received the printed materials on curbing drinking.

The researchers expected the responses on the 515 returned follow-up questionnaires to reveal greater progress in the group that received personalized materials. Instead, Sobell reports, she and her colleagues found that personalization "did not add value to the intervention beyond that provided by the [generic] pamphlets."

Equally strong improvements in drinking patterns were evident in both groups. On the average, one year after receiving their materials, participants reported drinking 15 percent fewer days per week, consuming 20 percent fewer drinks per day when they did drink, reducing their intake of drinks per week by 28 percent and binging 33 percent less often than they did before joining the study. At the same time, they reported that their new drinking patterns produced 58 percent fewer negative consequences.

"Those individuals who prior to [receiving the materials] reported a stronger desire to change, expressed a greater intent to change and had greater confidence in their ability to change showed larger changes in drinking than other participants," Sobell adds.

The research was supported, in part, by a grant from the National Institute on Alcohol Abuse and Alcoholism.