A large-scale Australian randomised controlled trial has found that an online alcohol intervention significantly reduced drinking in adults aged 60 to 75. The findings offer fresh evidence that scalable digital tools can address rising alcohol-related harm among older populations.

The study appeared in The Lancet Public Health in May 2026. It tested the Rethink My Drink programme against an online patient information booklet in 888 participants recruited across Australia. At 12 months, those who completed the online alcohol intervention reduced their monthly drinking by more than five standard drinks compared with the control group.

Rising Alcohol Use Among Older Adults

Alcohol consumption among older Australians has reached concerning levels. People in their 60s now exceed national risk guidelines more frequently than the general population. They also drink daily at higher rates than any other age group. Over the past two decades, rates of alcohol use disorder and alcohol-associated liver disease in those aged 70 and older have climbed sharply across comparable Western nations.

Globally, alcohol contributes to more than 200 health conditions. It is causally linked to premature death, injury and several cancers. Among older adults specifically, one of the most serious long-term consequences is cognitive decline. Alcohol use disorders carry the highest risk of dementia onset of any established risk factor. Research has found they more than triple the likelihood of dementia in both men and women. The global number of people living with dementia is projected to triple from 57.4 million in 2019 to 152.8 million by 2050.

How the Digital Alcohol Programme Worked

The Rethink My Drink digital alcohol programme was designed specifically for older adults. It drew on co-design principles involving 30 adults aged 64 to 75 years. The programme covered 36 lessons across four modules, progressing participants through three phases: decision making, implementing change and relapse prevention. Each phase drew on evidence-based behavioural treatment principles.

Participants joined the trial through national social media recruitment. Crucially, no face-to-face contact or clinical input was required during the active phase. Weekly email reminders were sent over the first four weeks. Participants also retained access to all materials through to the 12-month assessment.

The control group received an eight-page online patient information booklet from New South Wales Health. It covered the effects of alcohol, associated health risks and contact details for support services.

Key Findings

Of the 888 participants randomly assigned, 445 were analysed in the intervention group and 438 in the control group. AUDIT scores at baseline ranged from 5 to 33. Fifty-nine per cent of participants were assessed as likely to have moderate-to-severe alcohol use disorder. The mean age was 65.3 years and 78 per cent of participants were female.

At 12 months, the online alcohol intervention group reduced past-month consumption by 36.47 standard drinks. By contrast, the control group reduced consumption by 31.44 standard drinks. The between-group difference of 5.02 standard drinks per month was statistically significant (p less than 0.0001). The intervention group also recorded fewer high-risk drinking days, reporting 1.1 fewer such occasions per month than controls.

Engagement data showed that 87 per cent of intervention participants logged in and completed at least one lesson. On average, participants spent more than two hours on the platform and completed more than half of all available lessons. Greater lesson completion was directly associated with greater reductions in alcohol use.

Both groups showed substantial reductions from baseline. This may partly reflect the active nature of the control condition. Nevertheless, the benefit of the online alcohol intervention remained consistent across sensitivity analyses.

Cognition Outcomes

The trial also examined whether reduced drinking would improve cognitive function. Prior research has linked alcohol use disorders to widespread and sustained cognitive deficits. Researchers used the Cambridge Neuropsychological Test Automated Battery to assess global cognition at baseline, four weeks and 12 months.

At 12 months, the between-group difference in global cognition did not reach statistical significance. However, participants in the online alcohol intervention group showed a meaningful within-group improvement of 0.14 standard deviations from baseline. Those in the control group showed no equivalent change.

Prior evidence on cognitive recovery comes mainly from studies of full abstinence in people with alcohol dependence, whereas this sample involved older adults with less severe, high-risk drinking in the community. Ceiling effects may therefore have limited detectable cognitive gains. The authors suggested that total abstinence may be necessary to achieve measurable cognitive improvements in this age group.

Scalability and Access

The trial showed that a fully digital alcohol programme can achieve meaningful reach without clinical gatekeeping. Notably, two-thirds of participants were women, a group historically underrepresented in alcohol treatment research. Participants living outside major Australian cities were also over-represented, suggesting the online format helps overcome geographical barriers to care.

The study population was, however, predominantly White and highly educated. This limits generalisability to more diverse communities. Digital literacy and reliable internet access remain barriers for some older adults. The authors highlighted the need for mobile-optimised versions and translated materials to broaden equitable access.

Attrition across the 12-month period was notable, with overall follow-up at 55 per cent. Those lost to follow-up tended to have more severe baseline alcohol use. Although statistical adjustments were applied for missing data, effect estimates may still reflect some attrition bias.

Implications

The Rethink My Drink trial is, to the authors’ knowledge, the first fully online and clinician-free alcohol intervention evaluated in older adults. It is also the first to measure effects on cognitive outcomes in this population. Consequently, the findings add weight to calls for scalable, community-based approaches to reducing alcohol-related disease burden as populations age.

The digital alcohol programme achieved its primary alcohol outcome with minimal infrastructure and no clinical requirement for participation. Whether integrating the programme into a primary care screening framework would further increase engagement remains a question for future research.

The Dementia Centre for Research Collaboration funded the study. Researchers at the University of Sydney and the University of New South Wales conducted it.

Source: dbrecoveryresources