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A Technological Approach to Reaching a Hidden Population of Problem Drinkers

OBJECTIVE: The most common obstacle to the treatment of individuals with drinking problems is that most do not seek treatment. This study compared a group of treatment-seeking patients with users of an alcohol-evaluation Web site to determine whether an Internet application could reach a population of problem drinkers who are distinct from those served by currently available forms of care. METHODS: An open-source application was developed that was modeled on the Drinker's Check-Up, which has been shown to increase motivation for behavior change while presenting itself as a nonthreatening evaluation. To recruit non-treatment seekers, the program was offered as a way to increase understanding of the effects of alcohol, rather than as a way to initiate change. RESULTS: Most of the 1,060 Internet study participants had serious alcohol-related pathology, although the pathology was less than that found in the treatment-seeking comparison group of 952 patients. Members of the online group were younger, and a larger proportion was female and employed. Online users had lower levels of problem recognition than did persons in the comparison group, according to the recognition subscale of the Stages of Change Readiness and Treatment Eagerness Scale. The ranked scores of the comparison group were divided into ten equal parts, and the online group's average was in the lowest decile. Online users were also less likely to take steps to change their drinking behavior and were in the lowest decile on the taking steps subscale in relation to the comparison group. The level of concern about the possibility of harm from alcohol use was comparable in both groups. CONCLUSIONS: Problem drinkers who do not use available forms of treatment will engage with an interactive Web site. Despite low levels of illness recognition, significant concern among the online group about their alcohol use indicates a potential role for an Internet application designed to increase motivation for change.

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