“Down Your Drink” (DYD): a digital intervention to reduce harmful drinking

Excessive alcohol consumption contributes to significant individual and societal harms. Screening and Brief Interventions are effective in reducing consumption and digital versions, delivered online, have the potential to reach large numbers of people, who would not otherwise receive help, at low marginal costs.
Downyourdrink (DYD) is a digital intervention based on Cognitive Behaviour Therapy, Motivational Interviewing and Social and Behaviour Network Therapy. DYD was evaluated using the Medical Research Council’s framework for complex interventions. Several studies showed that large numbers of users registered with the programme and were willing to provide data, but levels of attrition were high. Users were largely in their mid to late thirties, half were female, just over a third were single, nearly half lived with children and they were predominantly white British and of higher socioeconomic status. An online pragmatic randomised controlled trial found that weekly alcohol consumption reduced by 20 standard units, but there was no advantage for the group that had access to DYD. These results are discussed in relation to findings from other studies, methodological issues raised by online research and the common finding that control groups in alcohol studies reduce consumption following baseline assessments.
Implementation trials were conducted in different health, occupational and community settings. Mixed methods studies and process evaluations examined the challenges encountered in each of these settings. Conceptual models, such as that of Freeman and Sturdy (2014), were used to identify different types of knowledge involved in developing interventions and policy frameworks that enable successful deployment.
The direction of DYD’s development was determined by overlapping contexts. Research funding through health and university bodies required adherence to a scientific framework. Public services set goals for the reduction of harms, equity of access and the efficient use of resources. The personal context included professional development, values and interests.