Participant Flow
RECRUITMENT
A total of 240 individuals registered to participate in the adaptive clinical trial during the recruitment period. Of the 240 applicants, 75 (31.3%) were not contactable after registration, 6 (2.5%) were excluded during the prescreening phone interview stage, and a further 46 (19.2%) were excluded during the prediagnostic assessment interview because they met the exclusion criteria (see the exclusions in Of the 73 participants who met the stepped-care criteria, 36 (49%) were randomized to low-intensity therapist assistance, and 37 (51%) were randomized to high-intensity therapist assistance. Of the 36 participants allocated to low-intensity therapist assistance, 7 (19%) remained uncontactable, and 7 (19%) scheduled therapist-assisted sessions but did not attend, leaving 22 (61%) who actively attended low-intensity therapist-assisted sessions adjunctive to the Life Flex program. Of the 37 participants allocated to high-intensity therapist assistance, 3 (8%) remained uncontactable, 2 (5%) preferred to stay in the DMH intervention program–only condition, and 5 (14%) scheduled therapist-assisted sessions but did not attend, leaving 27 (73%) who actively attended high-intensity therapist-assisted sessions adjunctive to the Life Flex program.Progress on the Life Flex program of the 16% (12/73) of participants who did not attend the scheduled therapist sessions was also assessed. Of these 12 participants, 1 (8%) engaged with the program for a further 3 days after the offer of therapist assistance, and 1 (8%) engaged for a further week before disengaging from the Life Flex program. A total of 35.4% (40/113) of the participants did not meet the stepped-care criteria at week 3; however, 37.2% (42/113) of the participants continued in the DMH intervention program–only condition as 1.8% (2/113) of the participants, who were initially randomized to high-intensity therapist assistance, preferred to remain in the program-only condition. Participant flow chart. AOD: alcohol and other drugs; DMH: digital mental health.