Tailoring drinking intervention technology to lifestyles of young adults

The idea of just stopping is “a nonstarter for most young adults who drink,” says Robert Leeman, department chair of Northeastern University’s Bouvé College of Health Sciences. Young adult alcohol misuse is a public health crisis. According to the 2022 National Survey on Drug Use and Health, 16.4% of people ages 12 to 25 meet the criteria for alcohol use disorder. This presents many safety concerns, from a range of health issues to increased risk of injury and death from car accidents. On college campuses, at least 50% of student sexual assaults involve alcohol, according to the American Addiction Centers.

Leeman wants to help young adults reduce their alcohol consumption. He is harnessing the power of technology to create interventions that will decrease the number of drinks they consume in a typical drinking day. It’s not the first drink that’s the problem, he says. If you can get someone to reduce their routine by even just one drink, “you’re removing the last and most problematic drink.”

In a 2022 study in the journal Psychology of Addictive Behaviors, Leeman and his team presented three technologies designed to track alcohol consumption in adults ages 21 to 25: a breathalyzer device synched to a phone, an app to manually track drinking and self-texting. For all of these drinking interventions, he emphasized simplicity and accessibility.

Study participants had to meet all of the following criteria: In the prior 30 days, they needed to have had 10 or more days with one or more alcoholic drinks, four or more days of heavy drinking and one or more days with an estimated blood alcohol concentration (BAC) of at least 0.10%.

Of the three interventions presented to the participants, the breathalyzer device was the most accurate for measuring alcohol consumption, Leeman says. It works in concert with an app on the user’s phone and is connected through Bluetooth.

The manual tracking approach also uses an app, where users input their sex, weight and how much they drink. While it’s less accurate than the breathalyzer — since it can’t account for potentially substantial individual differences in alcohol metabolism — it’s simpler and more discrete.

For the self-texting approach, Leeman taught participants to send themselves a text saying “12 ounce IPA” or “shot of vodka” when they had a drink. It’s an even simpler way for participants to track their consumption, and they can use it to make subsequent decisions about their drinking.

“It basically created a vested interest for folks to limit their drinking,” says Leeman. Creating a record of each beverage made participants more aware and feel more accountable for the outcome of their drinking.

The study used a combination of lab and field testing methods. The lab portion came first: In small group sessions, alcohol was self-administered by participants, and they were randomly assigned one of the three technologies to use. In the lab, whichever technology they were assigned to didn’t significantly impact their drinking decisions, but the breathalyzer device and the drinking app had a higher acceptability score than self-texting, meaning participants were more willing to use them.

For a two-week period following, the participants had free access to all three technologies to use as they wanted out in the real world.

At the start of this period, the researchers paid participants $20 to use the technologies at least once outside of the lab. It was found that participants used at least one form of technology on 67% of drinking days during this time. After the study, participants continued to use the technologies for at least eight drinking sessions on average.

“We saw reductions in drinking of a little less than one drink per drinking day and about four drinks per week,” says Leeman.

They also saw that the participants used these technologies in a combined fashion. “That’s not something that really occurred to me. I thought I saw them as individual technologies,” he says.

The availability of multiple technologies could prove helpful for consistency in tracking drinking. Leeman describes how young people have different contexts for drinking, and so one technology might be a better fit for a given environment, like pre-gaming at a friend’s apartment, or drinking at a bar, club or party.

People sometimes feel self-conscious using the breathalyzer in more public settings because it glows when it’s being used, Leeman says. If they want a more discrete method of tracking their drinking, they might opt to text themselves instead of using the very visible breathalyzer.

Another piece of feedback that Leeman received from participants was that at times they simply forgot to use some of the technologies, which may have been a result of them jumping between all three technologies and not having a particular strategy. “We didn’t coach [participants] specifically on using the technologies in a combined fashion, because that’s just not where we saw it going.”

Now, Leeman is working on developing a combined intervention around these three technologies.

He and his team received a grant to develop a multicomponent intervention concerning blood and breath alcohol content for young adults who drink heavily. An ongoing study, the first out of three total, is in its initial stage. It involves a brief telehealth counseling and psychoeducation session as well as the use of the three technologies from Leeman’s 2022 study. The team will use two different approaches to facilitate the young adults’ use of those technologies in drinking situations.

Leeman explains that his team is working on implementing more reminders, both low- and high-tech. The low-tech approach involves meeting with a study staff to discuss the contexts in which the young adult typically drinks on different days of the week. Then, reminders for using the technology can align more precisely with the nature of their drinking. For example, the alarm function on phones can be used to set reminders to take breathalyzer tests or log drinks when hanging out with friends, but if someone is drinking at a bar, they may want a more discreet reminder.

The high-tech method involves an app that Leeman and his team are currently developing. It will provide strategies and tips for the user to reduce their drinking, avoid negative consequences related to drinking and suggest one of the three technologies to use based on various factors, like the person’s current drinking context.

One of Leeman’s takeaways is that it’s important for people to have choices when it comes to measuring their drinking and using interventions. For the same person, “a different intervention might work for them on a different day or a different part of their drinking.”

As for the app used in the study, Leeman says that while there are many similar ones already available, they don’t have the same features as this one — this app allows users to look back at their past estimated BACs.

The app is still under development, but Leeman wants to eventually release it to the public. He hopes to make these intervention technologies readily available to larger populations.

“We’re trying always to think about how this can be done simply and done well in the least amount of time,” he says.

Story from the Science Media Lab.

Last Updated on June 25, 2024