Discussion
non-alcoholic, alcoholism, non-alcoholic beverages consumed, non-alcoholic beverage, alcohol-related problems, non-alcoholic beverages
DISORDER
In this study, the provision of free non-alcoholic beverages for 12 weeks significantly reduced alcohol consumption. In the intervention group, this effect persisted not only during the intervention period but also up to 8 weeks following completion of the 12-week intervention. Our study is the first to suggest that providing non-alcoholic beverages reduces alcohol consumption.At Week 12, alcohol consumption was reduced by an average of 11.5 g per day. On the other hand, the average volume of non-alcoholic beverages consumed per day was 314.3 mL. Correlation analysis showed a significant and moderate negative correlation between changes from baseline in alcohol consumption and non-alcoholic beverage consumption, but only in the intervention group. This suggests that the reduced alcohol consumption in the intervention group may have been caused by the replacement of alcoholic beverages with the provided non-alcoholic beverages. A previous study demonstrated that greater availability of non-alcoholic beverages increased the odds of selecting non-alcoholic beverages rather than alcoholic beverages [However, the correlation between the changes in alcohol consumption and non-alcoholic beverage consumption in the intervention group gradually weakened after Week 8, and the significant correlation between them disappeared at Week 20. Although the reason remains unclear, it is possible that some of the non-alcoholic beverages provided at Weeks 0, 4, and 8 were consumed by the participants in the intervention group even after Week 12. Thus, although the effect of replacing alcoholic beverages lasted for a certain period, it was weakened when all the available non-alcoholic beverages were consumed. While the participants were not restricted from purchasing either alcoholic or non-alcoholic beverages throughout the study period, we could not distinguish whether the consumed non-alcoholic beverages were provided or voluntarily purchased because our information from the participants pertained only to the consumption amount. Thus, further studies are warranted to clarify this hypothesis. Nevertheless, the reduction of alcohol consumption in the intervention group was not affected by time and was still observed at Week 20 (8 weeks after completion of the intervention). This suggests that a certain degree of behavioral modification may have occurred, in addition to the effect of replacing alcoholic with non-alcoholic beverages, and this may have contributed to the persistent reduction in alcohol consumption in the intervention group after the intervention was complete. As this study was not conducted in a blinded manner, the Hawthorne effect, which refers to behavioral changes driven by attention or expectation from others, including investigators, may have affected the results [Although there was no significant difference in the intervention group between alcohol consumption at Week 12 and that at Week 20, the mean value did increase slightly, suggesting that the alcohol consumption-reducing effect of providing non-alcoholic beverages did not persist long term after the intervention was complete. However, the reduction of alcohol consumption over at least 20 weeks is considered beneficial in terms of public health.The control group in this study also exhibited reduced alcohol consumption at Week 12, on average 2.7 g/day. This change may have been caused by the requirement to keep a drinking diary. According to a systematic review, self-monitoring of substance use disorder was effective in 29% of the analyzed studies, ineffective in 63%, and harmful in 8% [Since the purpose of this study was to investigate whether increased availability of non-alcoholic beverages would change the amount of alcohol consumption, we first examined the effect of providing non-alcoholic beverages purchased by the research group. The fact that alcohol consumption decreased when these non-alcoholic beverages were provided to the participants indicates that this strategy may be useful as a public health policy (e.g., providing price incentives for non-alcoholic beverages) in the real world [From a clinical point of view, it will be beneficial to examine whether alcohol use changes if individuals purchase non-alcoholic beverages themselves. However, as the non-alcoholic beverages delivered to the intervention group were selected from a list specified by the participants based on their own preferences, we believe that this study serves as a valuable foundation for future studies.In this study, the number of participants differed between the two groups because of simple randomization, but there was no significant bias in basic attributes or baseline data, and the low percentage of dropouts (1.6%) contributed to the validity of the study. However, there are roughly five major limitations to this study. The first is that almost all participants were Japanese, and therefore, caution should be exercised when generalizing the results across different races. Information was collected on alcohol metabolism-related genes as well as on body size (height and body weight), and these data are considered to be helpful for interpreting the results of this study. The second limitation is the narrowly defined target population in this study. Since none of the participants had a history of alcoholism, it remains unknown whether the results of this study can be applied to individuals with alcoholism or those at high risk of other alcohol-related problems [