Effectiveness of a digital alcohol intervention as an add-on to depression treatment for young adults: Results of a pragmatic randomized controlled trial

Background Problematic drinking frequently co-occurs with depression among young adults, but often remains unaddressed in depression treatment. Evidence is insufficient on whether digital alcohol interventions can be effective in this young comorbid population. In a randomized controlled trial, we examined the effectiveness of Beating the Booze (BtB), an add-on digital alcohol intervention to complement depression treatment for young adults. Methods Participants were randomized to BtB + depression treatment as usual (BTB + TAU, n = 81) or TAU (n = 82). The primary outcome was treatment response, a combined measure for alcohol and depression after 6-month follow-up. Secondary outcomes were number of weekly drinks (Timeline Follow-back) and depressive symptoms (Center for Epidemiologic Studies Depression scale). Treatment response was analyzed using generalized linear modeling and secondary outcomes using robust linear mixed modeling. Results Low treatment response was found due to lower than expected depression remission rates. No statistically significant between-group effect was found for treatment response after 6-month follow-up (odds ratio 2.86, p = 0.089, 95% confidence interval [CI] 0.85-9.63). For our secondary outcomes, statistically significant larger reductions in weekly drinks were found in the intervention group after 3-month (B = -4.00, p = 0.009, 95% CI -6.97 to -1.02, d = 0.27) and 6-month follow-up (B = -3.20, p = 0.032, 95% CI -6.13 to -0.27, d = 0.23). We found no statistically significant between-group differences on depressive symptoms after 3-month (B = -0.57, p = 0.732, 95% CI -3.83 to 2.69) nor after 6-month follow-up (B = -0.44, p = 0.793, 95% CI -3.69 to 2.82). Conclusions The add-on digital alcohol intervention was effective in reducing alcohol use, but not in reducing depressive symptoms and treatment response among young adults with co-occurring depressive disorders and problematic alcohol use. Trial registration: Pre-registered on October 29, 2019 in the Overview of Medical Research in the Netherlands (OMON), formerly the Dutch Trial Register(https://onderzoekmetmensen.nl/en/trial/49219).