Calling for change : the effectiveness of helpline counselling and spontaneous change in problematic alcohol use

Sammanfattning: Population studies have estimated the remission rate from alcohol use disorders as well as the life course trajectory of alcohol consumption. However, less is known about the spontaneous change to low-risk use in populations of hazardous and heavy drinkers. There are many pathways to change problematic alcohol use, and most people seem to do so without seeking formal help or treatment. Even so, effective prevention and treatment strategies have the potential to minimise the consequences caused by alcohol. For populations with hazardous and harmful use, such interventions can be brief and delivered in healthcare or digital settings. Another commonly implemented strategy is counselling via population-based telephone helplines. Until now, telephone counselling has mainly been evaluated in healthcare settings, and the evidence for helplines as stand-alone interventions for problematic alcohol use is sparse. Thus, this thesis aims to evaluate a population-based alcohol helpline, investigating the relative effectiveness of two counselling models delivered to a help-seeking population; and to compare the rates of change from levels of problematic alcohol use to low-risk levels in this help-seeking population to the spontaneous change occurring in the general population. Data for study 1 was derived from the Stockholm Public Health Cohort. We included data from two of the sub-cohorts: 2002 (follow-up 2010 and 2014) and 2010 (follow-up 2014). The study included participants who had at least hazardous alcohol consumption at baseline, measured by average volume or frequency of heavy drinking occasions (n=8946). Study 2 was based on a randomised controlled trial at the Swedish National Alcohol Helpline, which included two counselling groups 1) brief structured intervention; and 2) usual care at the helpline. First-time callers with at least hazardous use, who sought help for problematic alcohol use, and who gave consent to participate, were randomly allocated to one of the two groups (n=261). Participants were followed at six months for the collection of outcome data. The primary outcome was a downward change in AUDIT risk level (Alcohol Use Disorders Identification Test). In the general population, change from problematic use to low-risk consumption was frequent in the medium- to long-term (study 1). The majority who changed sustained low-risk consumption over time. In the help-seeking population, the superiority of one counselling model over the other could not be established (study 2). However, both groups displayed high proportions of change to lower AUDIT risk levels at six months follow-up. In conclusion, brief structured and tailored models of counselling seem to provide similar effects when delivered in a population-based helpline setting. Further, help-seeking seemed to increase the rate of change to low-risk alcohol use in comparison to that ofproblem drinkers in the general population. This justifies the continued delivery of easily accessible self-help interventions, such as the alcohol helpline.