Abstract

Background. Excessive alcohol consumption in Estonia is a major problem with significant healthcare costs. In 2019 the overall alcohol consumption was estimated up to 10.4 litres per adult, almost 9,000 persons sought medical advice due to illnesses caused by excessive alcohol consumption and overall number of deaths from alcoholrelated illnesses exceeded over 500.
Aim. The study was designed to estimate the efficacy of a minimal-guidance online self help intervention “Selge” aimed at reducing alcohol misuse in Estonia. The primary outcome was a change in the Alcohol Use Disorders Identification Test (AUDIT) score between the 6-month follow-up and baseline assessments. Main secondary outcomes include the number of standard drinks consumed, alcohol-free days per week and share of people who reached to a nonhazardous (AUDIT < 8) level of consumption.
Methods. Study design was a randomized controlled trial (RTC) involving an intervention and control group with three assessments: baseline, after 8 weeks and 6 months. Into the study were recruited Estonian speaking adults whose alcohol consumption exceeded a hazardous level (AUDIT score ≥8). Alcohol consumption was estimated using AUDIT test and alcohol consumption diary and for monitoring possible side-effects on mental health MHI-5 was used. All instruments were completed at baseline and at six months follow-up. Data analysis employed
complete case analysis (CCA).

Results. A total of 589 people were involved based on the baseline study, of whom 358 (including 159 in the intervention and 199 in the control group) answered on the next two measurement questionnaires and were included in data analysis. A similar AUDIT score (average 18, p=0,612) by both groups in the baseline study decreased statistically significantly in 6 months in the intervention group than in the control group (average) 10,6 and 14,0 respectively, p<0,001. By the time of the 6-month follow-up survey, the number of standard drinks consumed of
the intervention group was convincingly lower (medians 8 and 14, p<0.001) and the number of alcohol-free days per week was higher (medians 5 and 4, p=0.002) than in the control group. Among the users of the programme, there was a decrease in both stress levels (MHI-5 score increased by 9 points) and the proportion of people with symptoms of depression (almost 14
percentage points).

Conclusions. Online self-help intervention program „Selge“ had an impact on reducing problem alcohol use including reducing the number of consumed drinks while increasing the number of weekly alcohol-free days and the prevalence of non-hazardous level of alcohol consumption. Program is available for those in need, both in Estonian and Russian, on a webpage: https://alkoinfo.
ee/et/programm-selge-2/programm-selge.