Predictors of utilization of an IVR self-monitoring program by problem drinkers with recent natural resolutions

Abstract

Background: As part of a randomized controlled trial, problem drinkers who recently initiated natural recovery on their own were offered access to an interactive voice response (IVR) self-monitoring (SM) system as a sobriety maintenance tool during early recovery when relapse risk is high. Because observed IVR utilization was variable, predictors of utilization were evaluated to inform knowledge of populations likely to access and use IVR services.

Methods: Participants were 87 untreated community-dwelling adults who recently initiated sobriety following longstanding high-risk drinking practices and alcohol-related problems (M=16.58 years, SD=10.95). Baseline interviews assessed pre-resolution drinking practices and problems, and behavioral economic (BE) measures of reward preferences (delay discounting, pre-resolution monetary allocation). Participants had IVR access for 24 weeks to report daily drinking and to hear weekly recovery-focused messages.

Results: IVR use ranged from 0 to 100%. Frequent (n=28), infrequent (n=42), and non-caller (n=17) groups were identified. Non-callers tended to be younger and to report heavier pre-resolution drinking. Frequent callers (≥70% of IVR days) tended to be older, male non-smokers with higher/stable socio-economic status and lower delay discounting compared to infrequent callers. Premature drop-out typically occurred fairly abruptly and was related to extended binge drinking.

Conclusions: Characteristics common in the untreated problem drinker population were associated with higher IVR utilization. This large under-served population segment can be targeted for lower intensity alcohol interventions using an IVR platform.

Figure 1

Percentage of scheduled calls made to the IVR system over the 168 day self-monitoring interval. The x-axis represents each of the 87 participants, and the y-axis is the percentage of their daily calls (0 to 100%).

Figure 2

IVR call frequency versus days until the last call for each of 70 callers. The x-axis shows the total number of call days (168-days maximum), and the y-axis shows the final call day. The dashed lines at Day 118 represent 70% call compliance, the cut-point for categorizing callers into frequent and infrequent groups for analysis. The diagonal solid line represents consecutive daily calling until participants abruptly stopped calling. The area above the diagonal line represents daily calling with missed days. The distance from the diagonal line reflects the number of missed days.