Reducing Young Adults’ Alcohol Use Using a Smartphone App

Negative Consequences of Alcohol

Many adults drink alcohol in different places and for various reasons because it can make them feel good. But drinking alcohol is like a tricky puzzle. On one side, it can make people happy and fun, but on the other side, it can make them feel dizzy and sick. Drinking too much can cause short-term problems like hangovers (feeling sick and tired the next morning) or alcohol poisoning (a dangerous condition that can cause vomiting and seizures). Over time, drinking too much can lead to serious diseases and health problems like heart disease, liver disease, and cancer [1]. It can also lead to alcohol addiction.

To keep people healthy, many countries have set guidelines to limit risky drinking. In the Netherlands, the legal drinking age is 18 years, and the guideline is to not drink at all, but if you do, to drink no more than one glass a day [2]. Sadly, not everyone follows these guidelines, including young adults between 18 and 30 years old. For example, 9% of young adults are so-called problem drinkers, meaning they drink too much and have health and social problems [3]. There is also something called binge drinking, which means drinking a lot of alcohol on one occasion. Binge drinking affects 24% of young adults and can lead to serious problems [4]. Figure 1 shows when a person is considered a problem drinker and how many drinks in 1 day count as binge drinking. If you look closely, the numbers are lower for women than for men because women’s bodies are usually smaller and have less water, so the same amount of alcohol affects them more strongly. This is why men can drink more than women before it becomes a problem.

Figure 1 - The Dutch guidelines for drinking and an overview of drinking behaviors by gender.

Young adults who drink too much risk accidents, hurting others, damaging things, and doing poorly in school or work. It is important to find these problems early and help young adults make better choices. Doctors, psychologists, and counselors can help people with these issues, using methods like motivational interviewing, where people discover their reasons for wanting to change, and cognitive behavioral therapy, which targets unhealthy thoughts and behaviors related to drinking. While these methods work well, the biggest problem is that young adults often do not seek help. About 75% of young adult problem drinkers do not get the support they need [5]. So, we need another way for young adults to get the help that fits their needs and preferences.

Using Smartphones to Tackle Problem Drinking

In our fast-paced world, young adults often use technology to improve their health and wellbeing. For example, if you want to know what a healthy diet looks like, you can look it up online and find an answer. You can do the same for responsible drinking behavior. Smartphones are like powerful guides in your pocket, where you can access information about health and alcohol use anytime, anywhere. They can teach you how alcohol affects your life and guide you to make safe and responsible decisions. This is why researchers want to use smartphones to find ways to lower young adults’ alcohol consumption. However, as we explore digital solutions, we find something interesting. While mobile apps can be great tools, many young adults are not very excited about only receiving information about alcohol to reduce their drinking. It is like being handed a book with only one exciting chapter—you can lose interest quickly. This is why it is important to make these digital tools exciting for young adults. And this is exactly what researchers did!

Introducing the Boozebuster App

A smartphone app called Boozebuster was created to help Dutch young adults drink less alcohol, so they do not exceed the Dutch low-risk drinking guidelines. Since young adults like to use smartphone apps for health and fitness, this app was designed to focus on being healthy. To make Boozebuster more interesting and appealing for young adults, the scientists who developed it included features to promote a healthy lifestyle. The Boozebuster app has several modules, or steps, that help you understand and change your drinking, along with other health-related modules. The app uses special techniques, like personalized normative feedback. This method helps young adults recognize that their drinking behavior may be different from the recommended guidelines and from how much their peers are drinking. The Boozebuster app also teaches you strategies to drink less. In one module, you can choose a goal like saving money, being healthier, or dealing with peer pressure, and the app will give you tips to reach that goal. Another section is about mindfulness and includes four guided meditations to help you relax and reduce stress. Since sleep is important for everyone, the app also has a section to help you sleep better. There is a diary section where you can track how much you drank, your mood, and your sleep every day. Finally, there is an emergency button that gives advice on what to do when you really want a drink. Users can customize this button with tips that are specifically useful for them. An overview of the app and some of its modules is displayed in Figure 2.

Figure 2 - The smartphone app called Boozebuster, which was used in this study. Participants in the Boozebuster group used this application for 6 weeks during the study. Boozebuster contains seven modules that helped participants not exceed Dutch low-risk drinking guidelines. Participants could choose between several modules such as mindfulness, goal setting, sleeping better, and more.

The Boozebuster Study

This was an intervention study, which means that researchers tried out something new to see if it could help people change their behavior. The goal of this study was to see if the Boozebuster app would help reduce alcohol consumption in young adults. The people who participated in this study were 18–30 years old and wanted to reduce their drinking, improve their mood, and sleep better as part of a healthy lifestyle.

They also needed access to a smartphone with internet. In total, 506 young adults were split evenly into two groups: the Boozebuster group and the website group. The Boozebuster group got a link to download the app, with instructions on how to use its modules for 6 weeks. The website group got a link to an educational website with information about the effects and consequences of alcohol use, which they could use whenever they wanted. Both groups answered questionnaires at the beginning of the study, 6 weeks later, and 3 months later. The questions asked about how often (frequency) and how much they drank (quantity). Researchers also asked about binge drinking and their motivation to reduce drinking. By comparing the two groups over 3 months, the researchers could see if using the Boozebuster app led to a greater decrease in alcohol use compared to using the educational website.

Did Boozebuster Work?

After 3 months, the researchers analyzed the data from the participants. They found that, 6 weeks after the study started, both the Boozebuster group and the website group drank less alcohol each time they drank (quantity). However, they did not change how often they drank (frequency) [6]. You can see the results in Figure 3. Interestingly, in the group that used the Boozebuster app, participants who were motivated to change their drinking habits at the beginning of the study reduced their alcohol quantity more compared to those who did not want to change or compared to the group that used the educational website. In other words, when young adults were motivated to lower their alcohol consumption, they actually did so!

Figure 3 - This figure shows the results of the study. The blue line represents the Boozebuster group, and the green line represents the educational website group. The Y-axis shows the average number of drinks per month, and the X-axis shows the time points of the study. You can see that, after 6 weeks after the study started, both the Boozebuster group and the website group drank less alcohol each time they drank.

What Have We Learned?

In this study, young adults in both the website and the Boozebuster groups improved their alcohol habits. They drank less alcohol each time they drank, but they did not change how often they drank. Even though the Boozebuster app did not work better than the website, the study is still important because it shows that giving young adults easy and interesting information about alcohol can help them make healthier choices. The study also showed that people who were motivated to change their drinking habits benefited the most, which is useful for designing future experiments. Sharing studies like this is valuable, even when the results are not surprising, because other researchers can learn from them and create better ways to help young people in the future. Our recommendation for future research is to explore how mobile apps can support responsible drinking and what encourages young adults to use these tools.

Glossary

Alcohol Addiction: ↑ When someone cannot stop drinking alcohol even if they want to and even if it is causing problems like feeling sick, hurting relationships, or making them feel bad.

Motivational Interviewing: ↑ A method in which someone like a doctor asks you all sorts of questions to helps you find your own reasons to change a behavior.

Cognitive Behavioral Therapy: ↑ A therapy that helps you notice unhelpful thoughts, change them into more positive ones, and practice actions that make you feel more in control.

Module: ↑ A section of an app or program that focuses on one topic. For example, one module of Boozebuster helps you learn about your drinking habits.

Personalized Normative Feedback: ↑ A method that helps people see how their behavior compares to what most others do.

Intervention Study: ↑ In an intervention study, scientists test if a new treatment or activity helps people. They try something out, compare the results, and see if it truly makes a difference.

Conflict of Interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

This work was supported by a grant from the European Foundation for Alcohol Research (ERAB; grant: EA172). ERAB had no influence over the design, the evaluation or the publication of the results.

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↑Schulte, M. H. J., Boumparis, N., Kleiboer, A., Wind, T. R., Olff, M., Huizink, A. C., et al. 2022. The effectiveness of a mobile intervention to reduce young adults' alcohol consumption to not exceed low-risk drinking guidelines. Front. Digit. Health 4:1016714. doi: 10.3389/fdgth.2022.1016714

[1] ↑ Rehm, J., Baliunas, D., Borges, G., Graham, K., Irving, H., Kehoe, T., et al. 2010. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction. 105:817–43. doi: 10.1111/j.1360-0443.2010.02899.x

[2] ↑ Ministerie van Volksgezondheid, Welzijn en Sport. (2023, November 8). Alcohol: Achtergronddocument bij Richtlijnen goede voeding 2015. Gezondheidsraad. Retrieved from: https://www.gezondheidsraad.nl/documenten/adviezen/2015/11/04/alcohol-achtergronddocument-bij-richtlijnen-goede-voeding-2015 (Accessed September 15, 2024).

[3] ↑ Castagna, G. (2023, July 12). Cijfers Alcohol. Trimbos-instituut. Retrieved from: https://www.trimbos.nl/kennis/cijfers/cijfers-alcohol (Accessed September 15, 2024).

[4] ↑ Bohm, M. K., Liu, Y., Esser, M. B., Mesnick, J. B., Lu, H., Pan, Y., et al. 2021. Binge drinking among adults, by select characteristics and State - United States, 2018. MMWR. Morb. Mortal. Wkly Rep. 70:1441–6. doi: 10.15585/mmwr.mm7041a2

[5] ↑ Tucker, J. A., Chandler, S. D., and Witkiewitz, K. 2020. Epidemiology of recovery from alcohol use disorder. Alcohol Res. Curr. Rev. 40:02. doi: 10.35946/arcr.v40.3.02

[6] ↑ Schulte, M. H. J., Boumparis, N., Kleiboer, A., Wind, T. R., Olff, M., Huizink, A. C., et al. 2022. The effectiveness of a mobile intervention to reduce young adults’ alcohol consumption to not exceed low-risk drinking guidelines. Front. Digit. Health. 4:1016714. doi: 10.3389/fdgth.2022.1016714