Blended Alcohol Depression Ehealth

Objective: To evaluate the (cost-) effectiveness of adding an internet-based alcohol reduction intervention to depression treatment (TAU), in reducing alcohol and depression outcomes compared to TAU alone among young adults aged 18-35 years.

Study design: A multicentre, 2-arm randomized controlled trial. Assessments take place at baseline, 3 months, 6 months (primary endpoint) and 12 months.

Study population: Patients diagnosed with a depressive disorder enrolling for or in depression treatment, age 18-35, and a total score of ≥ 8 for men and ≥ 5 for women on the Alcohol Use Disorder Identification Test (AUDIT).

Intervention: The intervention group receives TAU + guided online alcohol reduction intervention (self-help modules). The content of these modules aimed at reducing alcohol use and is based on existing internet-based self-help materials and on cognitive behaviour therapy and motivational interviewing (CBT/MI) and are tailored for young people in depression therapy. TAU consists regular CBT or other evidence-based psychotherapy combined with medication if necessary. TAU is directed at activation and identification of maladaptive cognitions. Control group receives TAU alone.

Main study parameters/endpoints: The primary outcome is treatment response, a composite score that combines alcohol and depression measures which in indicates whether treatment has been successful or not.

We expect to find an 25% treatment response for TAU and 50% treatment response for TAU + online alcohol reduction intervention.

T0 = Baseline
T1 = 3 months follow-up
T2 = 6 months follow-up (primary endpoint RCT)
T3 = 12 months follow-up

The intervention group receives blended TAU + a guided web-based alcohol reduction intervention. Guidance is focused on process support (no care related guidance). The content of the modules is based on existing internet-based (guided) self-help materials developed by Arkin/Jellinek and is based on cognitive behaviour therapy and motivational interviewing (CBT/MI) and tailored for young people in depression therapy. The online alcohol reduction intervention consist of 5 modules + 1 aftercare module, conceptually in line with the evidence-based brief CBT for adults and exists mainly of information (in text and video) and short assignments and registration of daily alcohol intake and mood. A prototype of the online intervention was evaluated for usability in focus groups by clients and therapists. Based on the input from these focus groups adjustments were made to the final online alcohol intervention. The online alcohol reduction intervention can be accessed on computer and other mobile devices (e.g. smartphone/tablet).

Both groups will receive TAU. The control group will receive TAU alone. The TAU has a duration of 4-6 months. TAU consists of 8 to 16 45-minutes sessions of regular Cognitive-Behavioural Therapy (CBT) or other evidence-based psychotherapy (e.g. interpersonal psychotherapy, problem solving therapy), combined with medication if necessary.