An online support group for problem drinkers: AlcoholHelpCenter.net

https://doi.org/10.1016/j.pec.2007.10.003Get rights and content

Abstract

Objective

Social support networks have been identified as one factor that can help people resolve their problem drinking. A relatively new phenomenon is online support groups, such as the one provided on the Alcohol Help Center (AHC; http://www.alcoholhelpcenter.net). Preliminary use of the AHC support group will be summarized and lessons learned in the initial development of an online support group will be discussed.

Methods

The AHC support group can be viewed by anyone interested in its content. However, only registered users of the AHC can make postings and trained professional staff moderates all support group content. The amount and content of traffic on this support group were recorded. Qualitative analyses were conducted to identify the types of message content.

Results

There were 674 posts on the AHC during the first 10 months of operation, including those made by the professional moderators. Content analyses of these postings identified common themes, including introductions, greetings, general supportive statements, suggested strategies, success stories, and discussion of difficulties. In addition, it appeared that the amount of traffic on the support group varied over time and clustered around nodes that consisted of one or more active users. This variation in traffic may disappear over time as overall use of the AHC support group increases.

Conclusions

Online support groups are developing into a new venue of support for those with drinking problems and other addictions concerns.

Practice implications

Consider referring clients to an online, professionally moderated, support group as another means to help problem drinkers.

Introduction

Internet and web technologies play an increasingly important role in our everyday lives. The proportion of home access to the Internet is consistently growing. According to one study, the proportion of Americans who logged on to the Internet at least once per day from their home rose from 27% in January 2002 to 35% in late 2005. And 45% of Internet users, or approximately 60 million Americans, say that within the past 2 years they consulted the Internet before making important life decisions [1]. Among problem drinkers, Internet access is surprisingly high, with 88% of Ontario adult problem drinkers [Audit score of 8 or more, 2] reporting access to the Internet in 2005, and 81% having access to the Internet from their home [3], [4].

A particular issue for those who recognize, or begin to recognize, that they may require assistance for problem drinking is the stigma associated with alcohol problems [5], [6]. The Internet, mainly due to its anonymity and accessibility, is proving to be a potentially powerful tool in anonymously motivating and assisting problem drinkers [7], [8], [9].

As the Internet medium continues to evolve, real-time member-generated content has emerged as an extremely popular and critical driving force. Currently, the most popular types of online sites fall under the category of member-generated content, as evidenced by the ever-growing popularity of web logs (or “blogs”), YouTube®, Facebook®, MySpace®, web-based instant messaging technologies, discussion boards (or “Support Groups”), Really Simple Syndication feeds (“RSS”—a web format that allows readers to review a summary of content from an associated website) and Podcasts [10], [11]. The rapid adoption of user-generated content and social networking may be attributable to the increased usage and availability of broadband connectivity. In May 2006, nearly three-quarters of active American Internet users connected at home via broadband instead of narrowband (i.e., dialup Internet access), a 15% point increase from May 2005. The same report indicates that due to faster connections, broadband users were beginning to adopt and make better use of new Internet technologies, such as blogs, RSS and Podcast feeds [11].

Expert-moderated online social support networks (support groups) are available 24 h a day, 7 days a week. As access to online support groups can be anonymous, participants may not be subjected to the traditional stigma associated with participation in face-to-face interventions [9]. In surveying members who accessed the Internet-based resources of Moderation Management (MM), Humphreys and Klaw [9] found that participants of MM chose online help for a variety of reasons: (1) I have easy access to a computer (69%); (2) it is important to me to be able to access MM at any time of the day (38%); (3) it is easier for me to write about my feelings and experiences than to speak about them in front of a group (25%; females = 35%, males = 13%); and (4) online participation is easier than attending meetings due to my busy work schedule (23%).

Open-access support groups do not require any form of registration or active participation to permit visitors to browse and read the posts of other participating members. The practice of reading or reviewing web pages of open-access, member-generated content without contributing is commonly known as “lurking.” Another feature of online support groups that may be particularly beneficial for those concerned about the stigma of seeking help is the degree of choice regarding frequency of active participation. If visitors decide to stop lurking and initiate or participate in an online discussion (by registering and becoming a member) they can do so either frequently or infrequently and can at any time resume their past lurking behavior [12].

In the general health-care literature, there has been a limited number of analyses of the content and usefulness of online support groups. Eysenbach et al. noted that there is no empirical support as of yet that demonstrates health outcome benefits of support groups but also emphasized that no studies had been conducted to-date that were appropriately constructed to meet this objective [13]. Other research has emphasized the accuracy and self-correcting nature of information posted on support group websites, speculating that a large network of individuals with an active interest on a similar topic can act as a ‘self-correcting’ source of information (i.e., if one member posts erroneous information, several others are quick to post a correction) [14]. Beyond the pure health-care information that these websites can provide, several authors have noted the central social support role that they can play [15], [16]. Finally, in comparing online and ‘offline’ versions of the same support group, it has been noted that both can provide a similar support and information function with the exception that online users stated they preferred the online version because of the ease of access and 24 h availability [9].

However, while the flexibility and accessibility of member-generated content is appealing, it can also pose unique challenges in the context of offering and maintaining evidence-based health advice. To-date there has been little published guidance on how to initiate online group discussions, create long-lasting and self-sustaining communities, or effectively and efficiently empower participation while simultaneously ensuring the highest quality content. Burri et al. [17] conducted a qualitative analysis of the content of an online support group for smokers. They concluded that the support group was mainly used as a source of support and encouragement during the initial phases of quitting cigarettes. Practical information and quitting tips were less common. This paper is an initial attempt to explore these same issues within a support group for another addictive behavior, i.e., problem drinking. Questions asked included: (1) what type of messages do members post? and (2) is the user-generated content posted by members supportive and topical, or non-topical in nature and of no use in the attempt to change?

Section snippets

Methods

The Alcohol Help Center (AlcoholHelpCenter.net) was officially launched on 1 January 2006. The Internet-based program is available, free-of-charge and provided that users had access to the Internet, use of the program was unrestricted. Any unregistered visitor (or “lurker”) to the program had the ability to anonymously review material or read support group postings and discussion threads. However, to contribute to or initiate support group discussions, lurkers were required to register with the

Results

As of 11 October 2006 or 283 days following the official launch of the AHC, 155 members had registered for the AHC and 32% (N = 50) of members posted at least one message in the support group. The AHC contains other tools to help problem drinkers in addition to the support group, so many users may have signed up to use this content rather than to post on the support group.1

Discussion

The content of the support group postings appeared to have some general therapeutic value. Prominent were sentiments of encouragement and specific suggestions as to what worked for each member, a finding that is common in analyses of other online support groups [15], [17]. Beyond the informational and support content, two other primary themes emerged from the analysis of the AHC support group content. The first comprised of questions and answers about how the support group and the larger AHC

Confirmatory statement

I confirm all patient/personal identifiers have been removed or disguised so the persons described are not identifiable and cannot be identified through the details of the story.

Conflicts of interest

Dr. Cunningham has acted as a paid consultant to V-CC Systems Inc., the owner of the Alcohol Help Centre software platform and WebTriage Operating System. Mr. van Mierlo is the CEO of V-CC Systems Inc. Miss Rachel Fournier is the Director of Business Development of V-CC Systems Inc.

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    A version of this paper was presented at the Symposium of the Society for the Study of Addictions, York, United Kingdom, November 2006.

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