Exploring reasons behind the initiation of and compliance with proactive alcohol e-therapy: A qualitative study

This paper is embedded in a randomized controlled trial that examined the effectiveness of psychosocial alcohol therapy delivered either via video conference (proactive alcohol e-therapy) or face-to-face (standard care). The trial demonstrated that proactive alcohol e-therapy increased treatment initiation and treatment compliance compared to standard care while achieving comparable reductions in alcohol intake among individuals with problematic alcohol use. In this study, we explored why participants initiated and complied with proactive alcohol e-therapy.

A thematic analysis was completed based on ten semi-structured interviews with participants engaged in proactive alcohol e-therapy and observations of 21 therapy sessions.

Participants initiated proactive alcohol e-therapy because the recruitment process framed problematic alcohol use and alcohol treatment in a way that aligned with their self-image. The framing also helped alleviate the stigmatizing and prejudiced perceptions participants held about problematic alcohol use and treatment. Participants' treatment compliance relied on the flexibility of the online format, which allowed for seamless and discreet integration into daily life. Additionally, treatment compliance depended on the establishment of a trustful dialogue with the therapist and the participants' perception of therapy.

Effective communication was crucial in the decision-making process leading to treatment initiation. Treatment compliance was driven by the online format's capacity to meet individual preferences and needs and by a strong therapist-client alliance. These findings highlight the practical dynamics of proactive alcohol e-therapy and illustrate the value of qualitative research methods within the field of online alcohol treatment.