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Chat-based instant messaging following a brief intervention diminished drinking in college students at risk of alcohol use disorder, according to a randomized clinical trial from Hong Kong.

In an intention-to-treat analysis, following an alcohol brief intervention (ABI) with 3 months of mobile chat-based instant messaging led to lower weekly alcohol consumption 6 months compared with using SMS text messaging for follow-up (B −11.42 g, 95% CI −19.22 to −3.62 g; P=0.004), according to Man Ping Wang, PhD, MPH, RN, of the School of Nursing at the University of Hong Kong, and colleagues.

The intervention group also had lower weekly alcohol unit consumption (B −1.14, 95% CI −1.92 to −0.36; P=0.004), and less intention to drink (OR 0.66, 95% CI 0.47 to 0.92; P=0.01) at that time point compared with the control group, they reported in .

Participants in the intervention group also had lower from baseline compared with controls at 6 months (B −1.19, 95% CI −1.63 to −0.34; P=0.003), they reported.

The trial is the first to show that chat-based messaging after a brief intervention can reduce drinking in at-risk college students, and that it's more effective than following an intervention with text messages alone, the authors said.

Previous work has shown that the effect of an ABI diminishes over time. However, that effect may be extended by instant messaging services, the researchers said. While text messaging programs may limit interactions with patients, mobile instant messaging applications like WhatsApp, Facebook Messenger, and WeChat allow for "better interactions with users in real time and provide more intervention delivery modalities" such as exchanging voice messages, pictures, and emojis, the researchers wrote.

Indeed, a previous trial using chat-based messaging for smoking cessation led to better outcomes than brief face-to-face advice alone, they noted.

For their study, Wang and colleagues recruited 772 students from eight universities in Hong Kong who had a high risk of alcohol use disorder based on AUDIT scores of 8 or greater. Students had a mean age of 21.1 years and about half were female (51.2%).

Participants in both groups received the same ABI, which included face-to-face or video conferencing with nurses, who delivered feedback on their AUDIT risk level. Each participant also received a 12-page booklet that outlined the benefits of reducing alcohol consumption.

Following the ABI, participants were randomized to the chat-based intervention or the SMS messaging control. Intervention participants received chat-based instant messaging support for 3 months, which focused on reducing alcohol consumption using behavioral change techniques. These messages were led by nurses and were initiated before "happy hours" (between 2 pm and 7 pm) every Friday and on weekends. The control group received text messages for 3 months, focusing on general health topics.

Additional analyses adjusted for baseline characteristics showed that chat-based messaging led to lower estimated alcohol consumption in grams per week (adjusted B −17.87 g, P=0.01) compared with controls at 6 months. Those interactions also resulted in lower weekly alcohol unit consumption (adjusted B −1.79, P=0.02) and lower AUDIT scores (adjusted B −0.53, P=0.01), the researchers reported.

The authors noted that participants with no intention to quit or reduce their drinking had less engagement with the chat-based messaging. Still, they said, the prevalence of engagement with the intervention in this study was greater than in the one about smoking cessation (39% vs 17%).

The study was limited by incomplete follow-up, self-reported data, and by the fact that mechanisms underlying the chat-based instant messaging's effect on drinking outcomes are unknown, the researchers said.

Still, they called for further study of the effects of chat-based instant messaging support on reducing drinking in other demographics.

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