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Online program helps older Australians cut risky drinking in major national trial

Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney and Matilda Centre for Research In Mental

Key Facts:

• An online self-help program for alcohol use is effective for reducing alcohol use and binge drinking in older adults – we have an effective intervention especially tailored to this age group
• There may be some downstream effects on cognitive functioning but this needs to be tested further
• We are actively looking at ways to make this program available to all older adults in Australia

A major Australian trial published in The Lancet Public Health has found that a tailored online program can help older adults aged 60-75 years significantly reduce risky alcohol use, by cutting consumption by an average of five standard drinks per month.

High-risk alcohol use among older Australians is an emerging issue. While overall drinking rates have declined in recent decades, risky drinking has remained steady or increased in later life. National data show nearly one in five Australians in their 60s exceed recommended guidelines, placing them at greater risk of long-term harms. This is particularly important as alcohol is a key modifiable risk factor for dementia yet remains under-recognised in older adults.

Rising alcohol consumption among older adults has been accompanied by a parallel increase in alcohol-related disease and mortality There have also been substantial increases in both the prevalence of alcohol use disorder, alcohol-associated liver disease, and liver cancer from alcohol in those aged 70 years and older. Globally, premature deaths related to alcohol use are concentrated in those aged 50–69 years.

The Rethink My Drink trial was undertaken at UNSW and the University of Sydney. It was commenced by Dr Louise Mewton at UNSW Sydney’s Centre for Healthy Brain Ageing (CHeBA), before moving to The University of Sydney’s Matilda Centre for Research in Mental Health and Substance Use, where she is the Program Lead in Lifespan and Brain Health Research.

The study tested a four-module online self-help program specifically designed for older adults, compared with a standard information-only control. Developed with clinician input, these online modules emulated the information and skills that an individual may receive if seeking therapy from a clinician.

Dr Mewton said the findings address a critical gap in prevention strategies for older adults.

“High-risk alcohol use in older adults is increasing, but there are few effective treatments tailored to this life stage, despite clear links with serious health conditions like dementia,” Dr Mewton said.

The large-scale randomised controlled trial included 888 participants across Australia. After 12 months, those who completed the Rethink My Drink program reduced their alcohol use by over 36 drinks per month, on average. Those in the treatment group five fewer standard drinks per month on average, compared with the control group. The researchers say this is a meaningful reduction at a population level given the cumulative health risks of alcohol use.

“We found that an online self-help program that we designed specifically for older adults is effective in reducing alcohol use in adults aged over 60 years,” Dr Mewton said.

Alcohol use is a major contributor to global disease burden and is associated with more than 200 health conditions. In later life, it is also a key modifiable risk factor for dementia, with alcohol use disorders linked to a more than threefold increase in dementia risk.

The study also explored whether reducing alcohol intake could improve cognitive function. Participants who completed the online program showed improvements in cognitive performance over time; however, these improvements were not significantly greater than those seen in the control group, suggesting larger studies are needed.

“We also found that those in the treatment group improved their cognitive function significantly, however this was not improved relative to a control condition. We may need larger trials to test this more robustly,” Dr Mewton said.

The Rethink My Drink program was developed through a co-design process involving older adults, ensuring the content was relevant, accessible and easy to use. Delivered entirely online, it represents a low-cost, scalable approach that could be rolled out nationally, including those in rural or underserved communities.

“Rethink My Drink is ready for large-scale dissemination among older adults in the community and has the potential for substantial beneficial effects on alcohol-related burden of disease in older adults,” said Dr Mewton.

Dr Louise Mewton, a visiting Centre for Healthy Brain Ageing researcher and chief investigator on the project at the University of Sydney’s Matilda Centre, was awarded a World Class Research Large Grant from the Dementia Centre for Research Collaboration (DCRC) to lead the work.

The broader aim of the Rethink My Drink project is to determine whether brief, accessible self-help programs can reduce alcohol consumption, minimise alcohol-related harms, and ultimately help protect brain health and quality of life in older adults.

Co-Director of CHeBA and UNSW co-author Professor Perminder Sachdev AM said: “This study shows that scalable digital programs can help address one of the most important modifiable risk factors for dementia at a population level.”

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Heidi Douglass
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