Evaluating the Efficacy of the Drinks:Ration Mobile App to Reduce Alcohol Consumption in a Help-Seeking Military Veteran Population: Randomized Controlled Trial
Abstract: Background: Alcohol misuse is higher in the UK armed forces (AF) than in the general population. Research demonstrates that alcohol misuse persists after an individual leaves service, and this is notably the case for those who are seeking help for a mental health difficulty. Despite this, there is no work on testing a mobile alcohol reduction intervention that is personalized to support the UK AF. Objective: To address this gap, we investigated the efficacy of a 28-day brief alcohol intervention delivered via a mobile app in reducing weekly self-reported alcohol consumption among UK veterans seeking help for mental health difficulties. Methods: We performed a 2-arm participant-blinded randomized controlled trial (RCT). We compared a mobile app that included interactive features designed to enhance participants' motivation and personalized messaging (intervention arm) with a version that provided government guidance on alcohol consumption only (control arm). Adults were eligible if they had served in the UK AF, were currently receiving or had received clinical support for mental health symptoms, and consumed 14 units (approximately 112 g of ethanol) or more of alcohol per week. Participants received the intervention or the control mobile app (1:1 ratio). The primary outcome was a change in self-reported weekly alcohol consumption between baseline and day 84 assessed using the validated Timeline Follow Back for Alcohol Consumption (TLFB) (prior 7 days), with a secondary outcome exploring self-reported change in the Alcohol Use Disorder Identification Test (AUDIT) score. Results: Between October 2020 and April 2021, 2708 individuals were invited to take part, of which 2531 (93.5%) did not respond, 54 (2%) were ineligible, and 123 (4.5%) responded and were randomly allocated (62, 50.4%, intervention; 61, 49.6%, control). At day 84, 41 (66.1%) participants in the intervention arm and 37 (60.7%) in the control arm completed the primary outcome assessment. Between baseline and day 84, weekly alcohol consumption reduced by -10.5 (95% CI -19.5 to -1.5) units in the control arm and -28.2 (95% CI -36.9 to -19.5) units in the intervention arm (P=.003, Cohen d=0.35). We also found a significant reduction in the AUDIT score of -3.9 (95% CI -6.2 to -1.6) in the intervention arm (Cohen d=0.48). Our primary and secondary effects did not persist over the longer term (day 168). Two adverse events were detected during the trial. Conclusions: This study examined the efficacy of a fully automated 28-day brief alcohol intervention delivered via a mobile app in a help-seeking sample of UK veterans with hazardous alcohol consumption. We found that participants receiving Drinks:Ration reduced their alcohol consumption more than participants receiving guidance only (at day 84). In the short term, we found Drinks:Ration is efficacious in reducing alcohol consumption in help-seeking veterans.
Abstract: Disordered eating is a prevalent and relevant health concern that remains understudied among U.S. military veterans. Avoidant/restrictive food intake disorder (ARFID) is a newly recognized feeding and eating disorder characterized by overly restrictive eating due to (a) picky eating, (b) lack of appetite, and (c) fear of aversive consequences related to eating. The Nine-Item ARFID Screen (NIAS) is a recently developed ARFID screening tool with initial validation studies demonstrating psychometric support. However, the psychometric properties of the NIAS have not been investigated in a veteran sample. To advance our understanding of ARFID screening tools that may be appropriate for use in veterans, the present study examined the factor structure of the NIAS using survey data from a large national sample of recently separated veterans (N = 1,486). Measurement invariance across key subgroups was tested in addition to exploring differential associations between the NIAS and related constructs. Results suggested that a three-factor model provided an excellent fit of the data and demonstrated scalar invariance across self-identified men and women, race and ethnicity, and sexual and gender minority (SGM) identity. Some subgroups had higher latent means on the picky eating (women, SGM, non-Hispanic Black), appetite (women, SGM), and fear (women) factors. The NIAS had some overlap with another measure of disordered eating and was moderately correlated with psychosocial impairment and mental health. Overall, the NIAS may be a useful screening tool for ARFID in veterans, given support for the three proposed subscales and equivalence across diverse identities.