DrinksRation trial highlights: a digital health app to reduce hazardous drinking in women who have served

Hazardous drinking is a persistent and often under-recognised issue for women who have served in the UK Armed Forces. While digital tools for veterans do exist, most have historically been designed with male veterans in mind. That leaves a real gap for women who have served, particularly where drinking is intertwined with stress, transition and mental health.

To help address this, we evaluated a tailored version of DrinksRation, a fully automated digital health app adapted with women-specific content, behaviour change techniques and push messaging. Alongside the trial, we also ran a companion systematic review to understand what wider evidence exists for digital substance use interventions for women in frontline public service roles.

What is DrinksRation?

What we tested

We conducted a participant-blinded randomised controlled trial comparing:

• DrinksRation (tailored app).
• BeAlcoholSmart (digital control presenting standard NHS advice).

Recruitment, screening, consent, randomisation and data capture were all completed online, with follow-up over 12 weeks (84 days). Participants reported drinking at baseline, 28, 56 and 84 days.

The primary outcome was to explore changes in weekly alcohol units between baseline and day 84 using the 7-day timeline follow-back. Secondary outcomes included change in alcohol use disorder identification test (audit) scores, usability at day 28, engagement metrics (in-app analytics) and safety monitoring (adverse events and technical issues).

Who took part

Between January and July 2024, we recruited 88 women who had served and who reported drinking at or above 15 UK units of alcohol per week.

Our key results

Compared with the digital control (BeAlcoholSmart), DrinksRation participants showed larger reductions in alcohol consumption and risky drinking. Our headline outcomes were:

• Weekly drinking reduced by 11.6 UK units more than controls.
• Audit scores reduced by 3.9 points more than controls.
• Engagement was sustained, with a median 132.5 sessions across the trial window.
• Usability ratings were high (6.2 out of 7 for DrinksRation vs 5.2 for BeAlcoholSmart).
• Follow-up completion at day 84 was strong (84% in the intervention arm).
• No serious adverse events were reported in either arm.

In practical terms, this indicates meaningful reductions over 12 weeks, alongside sustained use and good acceptability.

Why this matters for policy and commissioning

This study was designed with real-world scalability in mind. We tested an automated digital intervention against a digital comparator, with outcomes that can inform commissioning decisions. Key implications include:

• Health impact: rapid, meaningful reductions in hazardous drinking.
• Efficiency: a fully automated tool can reduce clinician time while widening access.
• Equity and reach: supports an underserved cohort and reduces barriers linked to stigma, geography and service fit.
• Readiness to scale: the app is already deployable via mainstream channels and can be integrated into existing pathways.

What the systematic review adds

Alongside the trial, we conducted a prospero-registered systematic review of digital substance use interventions for women in frontline public service roles (military, police, fire, healthcare).

Across 14,831 records screened, 13 studies (eight interventions) were included. Overall, effects were typically modest, evidence quality was mixed and longer-term follow-up was uncommon. Most interventions were not truly tailored for women’s lived experience and veteran-specific evidence was particularly limited.

This is where the DrinksRation trial contributes: it strengthens the evidence base with a controlled evaluation in the target community and with a more intentional approach to tailoring and engagement measurement.

Recommended next steps

Based on the trial findings and gaps identified in the wider evidence, our suggested next steps are:

• Deploy DrinksRation through veteran-facing digital touchpoints and track real-world outcomes at 6 and 12 months.
• Integrate referral links into relevant NHS and veterans’ health pathways to support stepped-care delivery.
• Secure funding to expand into multi-substance modules (e.g. tobacco, vaping, prescription drug misuse), reflecting the priorities emerging from the review.

Acknowledgements

Funded by the Office for Veterans’ Affairs (veterans’ health innovation fund), with delivery in collaboration with King’s College London, Combat Stress and Lancaster University.