Alcohol and Depression

Web-based self-help programs that reduce problematic substance use are able to reach “hidden” consumer groups in the general population who often fear stigmatization. These programs are characterized by their low treatment threshold, non-restrictive setting for intervention and remarkably positive cost-benefit relation, which is of interest for both low-income and high-income industrialized countries suffering from exorbitant health costs. There is substantial co-occurrence of mental disorders and substance use disorders. Prevalence of dual disorders, the condition of suffering from a mental illness and a co-morbid substance abuse problem, is probably highest in the general population for individuals with depression disorders and problematic alcohol use. Co-morbidity of alcohol misuse is two to three times higher for those who suffer from depression disorders compared to the general population. A meta-analysis shows that, Internet-based self-help programmes to reduce subclinical alcohol use disorders or ameliorate moderate to mild depression symptoms have been reported to be effective. A cost-effective intervention that is able to reach at-risk individuals in early stages of potentially more pronounced alcohol use and depression disorders is of great importance from a public health point of view. Therefore we aim to develop the first web-based dual disorder self-help intervention for harmful or hazardous alcohol users with mild to moderate co-occurring symptoms of depression. 

The aim of this study is to test the effectivesness of a web-based self-help intervention for the combined reduction for the combined reduction of alcohol consumption and depressive symptoms. This will be compared to the effectiveness of: 1) a web-based self-help intervention aimed at reducing alcohol consumption and 2) a control group (waiting list) of persons with harmful and problematic and alcohol consumption and mild to moderate depressive symptoms. 

We are planning a three-arm, international, controlled-randomized study that will compare the effectiveness of an intervention aimed at reducing alcohol consumption and depressive symptoms with an intervention aimed only at reducing alcohol consumption. Both interventions are designed as web-based self-help programmes and include a diary and numerous modules based on the principles of motivational interviewing, self-controled practices and methods of cognitive-behavioural therapy. For the alcohol intervention, the modules focus on both topics and the diary records mood and positive activities in addition to consumption, Different data collection is done at baseline, after 6 weeks and after 3 and 6 months. The primary outcome variables will be alcohol consumption (AUDIT - Alcohol, Use Disorders Identification Test), the amount of standard drinks and the number of alcohol-free days per week. The secondary outcome variables will be depressive symptoms, use of tobacco and illegal drugs, changes in mental health, treatment retention, a cost-benefit analysis and cost-effectiveness analysis. 

The expected findings will extend the knowledge of designing effective Internet based treatment on dual diagnoses in and more specifically for co-morbid alcohol and depression disorders. Especially otherwise well integrated individuals who suffer from depression symptoms and fear stigmatization for their harmful or hazardous alcohol consumption and thus do not show up in addiction counseling and treatment centers may profit from this easy to access and anonymous intervention. In case of effectiveness confirmation, the intervention will be implemented in the Swiss addiction portal Safe Zone. Individuals sseking help on Safe Zone will be offered to be screened and receive access to the corresponding self-help intervention (one for problematic alcohol use and comorbid depression symptoms or one for those with problematic alcohol use but without depression symptoms). Thus, the planned interventions possess a high potential to help many problematic alcohol users in the general population with and without depression symptoms in a very cost-effective way. To our best knowledge, this is the first “dual diagnosis” Internet-based self-help research conducted. It is likely that proven intervention effectiveness will stimulate other research groups to conduct similar research on further comorbid substance use and mental health disorders of public health relevance.