A pragmatic randomised trial of two counselling models at the Swedish national alcohol helpline

Abstract

Background: Alcohol telephone helplines targeting alcohol consumers in the general population can extend the reach of brief interventions while preserving in-person counselling. So far, studies of client outcomes in the setting of alcohol helplines are scarce. This study aims to compare the 6-months alcohol-related outcomes of two counselling models delivered at the Swedish National Alcohol Helpline. Methods: A pragmatic randomised trial was set up at the Swedish National Alcohol Helpline. First-Time callers with current hazardous or harmful alcohol use who contacted the helpline, from May 2015 to December 2017, were invited to participate. Clients were allocated with 1:1 ratio to two groups: (1) brief, structured intervention (n = 128), including self-help material and one counsellor-initiated call, and (2) usual care (n = 133), i.e. multiple-session counselling using Motivational Interviewing (MI). The primary outcome was a downward change in AUDIT risk-zone between baseline and 6-months follow-up. The analysis followed an intention-To-Treat approach. Results: Recruitment ended in December 2017. At 6-months follow-up, 70% of the enrolled participants had data on the outcome. In the brief, structured intervention (n = 107) 68% changed to a lower risk-level, compared to 61% in the usual care group (n = 117), yielding a risk ratio (RR) of 1.12 (95% CI 0.93 to 1.37) and risk difference of 0.08 (95% CI-0.05 to 0.20). The total AUDIT score and the scores from the AUDIT consumption questions (AUDIT-C) did not reveal any between-group differences in the mean change at follow-up. Conclusions: The counselling at the Swedish National Alcohol Helpline was followed by a significant decrease in alcohol use among clients, without clear superiority for either counselling model. Trial registration: This trial was retrospectively registered with ISRCNT.com (ID: ISRCTN13160878) 18/01/2016.