Apps and Alcohol
As the proportion of the UK population owning a smartphone steadily rises, the use of apps is becoming increasingly widespread.
The ever-growing popularity of apps brings with it the opportunity to reach and engage with people in a new way. From a health and wellbeing perspective this means exciting opportunities to promote and support health-related behaviours.
Researchers are keen to understand whether, and how, apps might work to improve health. We report on some of the key studies to explore the use of alcohol-related apps and the potential benefits, as well as possible harms, which the proliferation of these apps may bring.
Who's using apps?
Apps are widely used – most smartphone or tablet owners now use them.
In 2014, 61% of UK adults were going online using a smartphone. Of those, 9 in 10 (91%) used apps on their smartphone. 39% reported using a tablet to go online, with 9 in 10 (86%) using apps on the tablet (1).
What kinds of health apps are there?
There are apps available which claim to support a huge range of health and wellbeing issues. These include apps to support blood sugar control in diabetes, medication reminder apps, and weight loss apps. Apps can have a huge range of functionalities, from just providing information, to allowing input of personal data, issuing reminders or messages of support, and monitoring of physiological signs such as heart rate or blood pressure (2).
What alcohol-related apps are out there?
A recently published study by David Crane and colleagues at University College London explored popular alcohol-related apps available in the UK. Their searches of iTunes and Google Play during May and April 2014 identified 662 unique alcohol related apps, and grouped them based on what they do. Interestingly, whilst 357 (54%) of these were entertainment apps (including drinking games, cocktail recipes and bar finders) and 125 (19%) related to blood alcohol measurement, just 91 (14%) focused on alcohol reduction (3).
Work by academics from Australia and the UK reported a similar imbalance between apps promoting drinking and apps supporting alcohol moderation. Their research identified 282 apps, of which 221 (78%) were categorised as pro-consumption, and only 61 (22%) anti-alcohol consumption or drinking moderation (4).
What do we know about these alcohol-reduction apps?
The team at University College London set about understanding how the alcohol reduction apps they identified might work in reducing alcohol consumption and changing behaviours. To do this they looked at the behaviour change techniques contained within the apps – that is, the possible active ingredients which might work to change behaviours.
A list of 42 behaviour change techniques had been identified in previous work (5) and each alcohol-reduction app was assessed to see which of these techniques it used. The study authors found that the average number of behaviour change techniques used in the apps was 3.6, with seven apps not containing a single behaviour change technique.
The team also looked to see how many of these apps mentioned evidence or theory, finding evidence to be mentioned in less than one in five of the apps (16%), whilst theory was not mentioned in a single app.
How do I know which health-related apps to use?
Much of our understanding about how to support people change their behaviours come from evidence of programmes and techniques which were not delivered via apps. However, it is thought that the principles of how to effectively support behaviour change still apply. Research tells us that interventions which require interaction are associated with higher levels of behaviour change than those that just present information.
There is also evidence to suggest that some techniques work more effectively when grouped together. For example, interventions which include goal setting, self-recording, and reviewing of goals are more likely to be effective than those which use just one of these techniques (3).
As for avoiding apps which might be potentially harmful, the National Health Board is currently undertaking work to develop a rigorous endorsement process for patient-focussed health apps (6, 7).
The Drinkaware App
In August 2014 Drinkaware launched its own app to help people wishing to monitor and cut down their drinking. The app allows individuals to accurately track the units and calories in their drinks by including an extensive database of alcohol brands. It includes information about the health benefits of cutting down, and offers support and motivation with regular and personalised feedback. Informed by feedback from users, the app was updated in September 2015 to include a cost tracking feature, allowing users to add the price of their drinks to see how much they have saved by cutting back (8).
 Husain, S., & Spence, D. (2015). Can healthy people benefit from health apps? BMJ 350:h1887.
 Crane, D., Garnett, C., Brown, J., West, R., & Michie, S. (2015). Behavior change techniques in popular alcohol reduction apps: content analysis. JMIR 17(5).
 Eagle, L., Dahl, S., Low, D.R., & Mahoney, T. (2014). Alcohol Promotion via Mobile Phone Apps: Gaps in Impact Evaluation and Regulatory Coverage. AMZAC Conference Proceed
 Michie, S., Whittington, C., Hamoudi, Z., Zarnani F., Tober, G., & West, R. (2012). Identification of behaviour change techniques to reduce excessive alcohol consumption. 107(8): 1431-40.
 Armstrong, S. (2015) Which app should I use? BMJ. 351:h4597.