Drinks:Ration The role of a smartphone application in reducing alcohol consumption in a veteran population seeking formal mental health support of Military Life and Experiences of Help-seeking and Support

Abstract: Alcohol misuse is higher in the UK Armed Forces than in the general population. Research has shown that this is also evident among those who have left service. It has been estimated that more than 50% of those who have left the Armed Forces meet the criteria for hazardous alcohol use - defined as drinking more than 14 units of alcohol per week - this compares with around 12% for the general population. Research from Combat Stress has suggested that personnel who have left service and who are seeking support for mental health problems often consume alcohol to cope. It is important to recognise that many do not seek help for their alcohol problems. To support those drinking hazardously, we can harness the latest digital technologies to manage and reduce alcohol consumption. Smartphone-based interventions allow the user to monitor their drinking, allow for real-time messaging and targeted supportive messaging. To date, no smartphone app exists to support the UK Armed Forces community in reducing their alcohol intake. In this project, we investigated the efficacy of Drinks:Ration, a 28-day brief alcohol intervention delivered via a smartphone app, in reducing self-reported alcohol consumption among UK veterans seeking help for mental health difficulties. We also conducted a systematic review of notification methodology to inform further refinement of Drinks:Ration. We performed a randomised controlled trial where we compared a smartphone app that included interactive features designed to reduce the amount of alcohol they consume (intervention arm) with a version that only provided standard UK guidance on alcohol consumption (control arm). We randomly assigned participants to either the intervention or control smartphone app. We asked all participants to use the app for a minimum of 28 days (the personalised messaging was switched off after 28 days), after which we compared the drinking behaviours in the two groups (intervention and control) at day 84. Between October 2020 and April 2021, we invited 2708 individuals to take part in this project, of whom 2531 did not respond, 54 were ineligible, 123 responded and they were randomly allocated. When we compared drinking behaviours between the two groups at day 84, we found that those in the intervention arm consumed 10.5 fewer units of alcohol compared with the control group. We also found a similar pattern for AUDIT score – a test designed and validated by the WHO to measure risky drinking – the intervention group had a score which was 3.9 points lower than the control group. This is a significant reduction that could have a positive impact on clinical outcomes. Not only did we observe reductions in alcohol consumption, but we also found that quality of life in areas such as physical health, psychosocial and environment were improved in the intervention app compared with the control app. Overall, our findings demonstrated that Drinks:Ration was efficacious in reducing alcohol consumption in helpseeking veterans. These effects were only observed in the short-term when participants were still actively using the app (at 28 days) and lasted until 84 days from baseline but were no longer present by day 168.