Feasibility and Acceptability of a Trauma-Informed and Peer-Supported Digital Brief Intervention for Heavy Drinking Emerging Adults with Interpersonal Trauma

Abstract

Brief interventions (BIs) are generally effective at reducing heavy drinking and mitigating alcohol-related harms. However, some studies suggest that BIs may be less effective for substance using interpersonal trauma survivors, indicating additional modifications may be needed to improve outcomes for this at-risk demographic. Additionally, given lower engagement and adherence in digital modalities, digital navigators such as peer coaches may help strengthen gains following technology-based BIs. The purpose of the current study was to examine the feasibility and acceptability of a mobile-delivered, trauma-informed BI for undergraduate emerging adults with interpersonal trauma and heavy alcohol use that was augmented with peer coaches. Participants included 52 individuals recruited as part of an ongoing randomized pilot trial. Participants completed a digital BI, peer coaching sessions via synchronous text message at one and two-months post-BI, and a three-month follow-up. Completion rates were high, with approximately 80% of the sample completing the peer coaching sessions and results showed that the majority of participants had positive perceptions of the BI and peer coaching. Findings indicate that BIs supported with peer coaching are feasible and acceptable, although rigorous examinations of its effectiveness relative to existing interventions are needed.

Alcohol is one of the most frequently used substances in the United States, and emerging adults ages 18–25 have the highest rates of heavy alcohol use of any age group (SAMHSA, 2024). Approximately half of all emerging adults report drinking alcohol in the past month, and roughly 30% have had a heavy drinking episode within that same timeframe (SAMHSA, 2024). Heavy and persistent alcohol use is associated with a host of negative outcomes in emerging adult populations. Negative consequences linked with heavy drinking include poor mental health, cognitive impairments, poor academic performance, increased risk for motor vehicle accidents, and substance use disorders (Pérez-García et al., 2022; Patrick et al., 2020, Reich et al., 2015). As such, alcohol-focused preventative efforts, such as brief interventions (BIs) remain an especially important strategy for mitigating the risks and harms of heavy alcohol use (Tanner-Smith & Lipsey, 2015).

BIs represent an evidence-based, individual level strategy for addressing heavy alcohol use. BIs are short-term, harm reduction-focused sessions aimed at reducing substance use and related problems that often include personalized feedback and harm-reduction strategies, typically delivered in two or fewer sessions (Tanner-Smith et al., 2022). Meta-analyses indicate that BIs generally succeed in reducing alcohol use and alcohol-related consequences, albeit with modest effect sizes (McDevitt-Murphy et al., 2014; Miller et al., 2013; Tanner-Smith et al., 2021; Tanner-Smith & Lipsey, 2015). However, preliminary evidence suggests that interpersonal trauma survivors at risk of substance-related problems may benefit from additional components integrated into traditional BIs. Interpersonal trauma, defined as harm intentionally inflicted by another person (e.g., sexual or physical assault, childhood abuse), has been associated with greater alcohol use, substance-related problems, and mental health difficulties relative to non-interpersonal trauma (Friedman et al., 2021; Kessler et al., 2017). Kurtz and colleagues (2019) found that a BI targeting substance use was effective overall, but individuals with histories of childhood abuse did not benefit. Relatedly, the brief intervention literature has frequently examined BI implementation within medical trauma centers, where a high proportion of physical injuries are alcohol- or drug-related and where BIs are routinely delivered as part of injury-prevention efforts (Field et al., 2010). Meta-analytic work indicates that BIs delivered in these settings show smaller and more inconsistent effects compared to those delivered in general medical clinics (Field et al., 2010; Tanner-Smith et al., 2021). Rhodes et al. (2015) also reported no reduction in heavy drinking among female survivors of intimate partner violence following a BI, and Kaysen and colleagues (2022) found that for individuals with unremitted PTSD, motivation enhancement therapy was no more effective in reducing drinking frequency compared to an education only condition. Although few studies have examined samples composed entirely of interpersonal trauma survivors, these findings indicate that this subgroup may respond less robustly to standard BIs.

A strong body of research has linked trauma-related distress, such as symptoms of depression, anxiety, and PTSD, to heavy and problematic alcohol use (Jacobsen et al., 2001; Puddephatt et al., 2022). Individuals with PTSD show substantially elevated rates of substance use disorders—up to 14 times higher than those without PTSD (Konkolÿ Thege et al., 2017; McCauley et al., 2012)—and trauma exposure itself, independent of PTSD diagnosis, is also associated with increased substance use risk. Large-scale epidemiological studies have demonstrated that traumatic experiences are associated with subsequent onset of substance use disorders across multiple types of trauma exposure (Degenhardt et al., 2022). Additionally, subclinical trauma-related distress, including symptoms of depression, anxiety, and stress that do not meet diagnostic thresholds, has been consistently linked to heavy and problematic alcohol use (Jacobsen et al., 2001; Puddephatt et al., 2022).

Incorporating trauma-informed elements into BIs, such as techniques to reduce negative affect and promote adaptive coping, may enhance effectiveness of BIs for interpersonal trauma survivors. By trauma-informed, we mean approaches that recognize and are sensitive to the needs and concerns of individuals with trauma histories and trauma-related distress, including promoting safety, trustworthiness, collaboration, support, and empowerment. Techniques for managing trauma-related distress (e.g., anxiety, depression) are not typically part of a standard BI for alcohol use. This may partially explain why BIs tend to be less impactful for interpersonal trauma survivors. This population has been shown to be at greater risk of mental health issues such as PTSD, anxiety, and depression, and alcohol use in this demographic may be partially shaped by attempts to cope with these difficulties (Bountress et al., 2019; Hawn et al., 2020; Kaysen et al., 2007). Similarly, among trauma-exposed substance users, exposure to reminders of a traumatic experience was found to trigger both negative emotions and craving, particularly for those with greater PTSD symptoms (Romero-Sanchiz et al., 2021). Exposure to trauma reminders was more strongly associated with craving than exposure to substance cues, highlighting the salient impact that trauma-related distress has in reinforcing continued use.

Taken altogether, emerging adults with interpersonal trauma represent a demographic especially vulnerable for frequent and heavy alcohol use, alcohol-related problems, alcohol use disorder, and comorbid mental health difficulties. Successful BIs for emerging adults with interpersonal trauma may serve as a preventative measure in mitigating the long-term negative impact of substance use and also have potential to reduce co-occurring mental health issues. Given the information highlighted above, BIs can benefit from being adapted to better target substance use and psychological distress in especially at-risk groups, such as emerging adults with interpersonal trauma.

In addition to enhancing BIs with trauma-informed elements, there is a need to enhance engagement and sustained behavior change, particularly when BIs are digitally delivered. Although advantageous for dissemination efforts, digital health interventions are frequently plagued by poor adherence and high attrition (Kazemi et al., 2017; O’Connor et al., 2016). Enhancing automated digital interventions with peer coaching has been shown to help alleviate issues with adherence and attrition and has been successfully used in interventions targeting mental health and health behavior change (e.g., suicide prevention, PTSD, weight loss, management of rare chronic diseases, schizophrenia; Bowersox et al., 2021; Depping et al., 2021; Fortuna et al., 2018; Lemstra et al., 2016) but has yet to be implemented for BIs targeting alcohol use among emerging adults. Inclusion of peer coaches via text message may serve as beneficial method for further enhancing and/or maintaining these reductions in substance use, particularly for digitally delivered personalized feedback interventions.

Similarly, the effectiveness of alcohol and drug interventions for emerging adults has been found to be moderated by the proportion of substance users in the individual’s social network and a number of studies have shown that emerging adult substance use is heavily influenced by peers (Best & Lubman, 2016; Tucker et al., 2025). This suggests that having peers who support young adult interpersonal trauma survivors’ reductions in alcohol use can help counteract other social influences that serve to encourage or maintain substance use behavior. As such, peer influence may be a relevant treatment component for those at risk of heavy alcohol use, such as interpersonal trauma survivors (Mason et al., 2018). Inclusion of peer coaches to deliver content via text message may serve as a beneficial method for enhancing reductions in alcohol use, particularly for digitally delivered interventions. Additionally, given that trauma-exposed emerging adults often face barriers such as reduced support-seeking and difficulty maintaining behavior change after a single-session BI, the peer-coaching texting element is also expected to reinforce the BI content. Although peer coaching can be delivered via many modalities, peer coaching via text message is likely to be desirable to emerging adults given their preference for text-based communication (Rideout & Robb, 2018).

This study addresses key gaps in the existing literature by 1: testing the feasibility and acceptability of incorporating trauma-informed elements in a digital BI in a sample of heavy drinking undergraduate emerging adults with interpersonal trauma, and 2: examining the feasibility and acceptability of incorporating peer coach follow-ups to enhance engagement and support participants in sustaining their alcohol use goals. It was hypothesized that the enhanced brief intervention would be feasible as demonstrated by retention rates during peer coaching and follow-up greater than or equal to 70%, which is consistent with completion rates from similar approaches (e.g., Gex et al., 2023). It was also hypothesized that the majority of participants (≥ 50%) would perceive the feedback and peer coaching as satisfactory, relevant, helpful, and a low burden.

Method

Participants

The sample for this study comes from an ongoing randomized pilot trial examining efficacy of a mobile-delivered, trauma-informed and peer supported brief intervention aimed at reducing heavy drinking among emerging adults with histories of interpersonal trauma (clinicaltrials.gov NCT05414344). The primary specific aim of the pilot trial is to determine feasibility and acceptability of the enhanced BI in undergraduate emerging adults, as well as whether the enhanced, trauma-informed BI results in significantly greater reductions in drinking outcomes compared to a standard (non-adapted) BI and an assessment-only control condition. For the present study, preliminary data comes from the trauma-informed, peer-supported brief intervention condition (TIPSBI; the condition that received an intervention including adaptive coping skills and peer coaching, described below), with a primary focus on feasibility and acceptability of the BI.

Participants were 52 young adult heavy drinkers at a southeastern university (see Table 1 for demographic data). Participants were recruited voluntarily through a university-based study pool, university-wide emails, and campus flyers. Participants primarily identified as female (80.8%), White, (89.1%), and straight (75.0%), with a mean age of 19.8 years old (SD = 2.0). Participants reported drinking an average of 11.9 (SD = 10.4) drinks per week and engaging in 4.9 (SD = 4.6) heavy drinking episode in the past month. Participants reported drinking on an average of 2.35 days per week (SD = 1.26), consuming an average of 4.99 drinks per drinking day (SD = 3.81), and having approximately 8.19 drinks per heavy drinking day (SD = 5.85). Average total score on the PTSD symptom measure (PCL-5) was 27.34 (SD = 18.96).

Table 1.

Sample Demographics

	Overall Sample (n = 52)
Age (Years)	19.8 (2.0)
Gender
Woman	80.8% (n = 42)
Man	15.4% (n = 8)
Non-binary	3.8% (n = 2)
Sexual Orientation
Straight	75.0% (n = 39)
Bisexual	19.2% (n = 10)
Pansexual	3.8% (n = 2)
Questioning	1.9% (n = 1)
Race/Ethnicity
White	88.5% (n = 46)
Black	7.7% (n = 4)
Hispanic or Latinx	13.5% (n = 7)
Other	5.8% (n = 3)
# of drinks/week	11.9 (10.4)
# of past-month heavy drinking episodes	4.9 (4.6)
Depression	12.5 (9.4)
Anxiety	12.2 (9.6)
Stress	17.5 (8.6)
PTSD	27.34 (19.0)

Note. Numbers in parentheses for non-categorical items represent standard deviations. Additional demographic indicators related to gender, sexual orientation, and race/ethnicity were assessed but were not endorsed by any participants and as such were omitted from the table.

Inclusion criteria included: 1) being between the ages of 18 and 25, 2) enrollment as a part- or full-time college student, 3) having the ability to speak, read and understand English, 4) a lifetime history of interpersonal trauma exposure, and 5) two or more past-month heavy drinking episodes. Endorsing a lifetime history of directly experiencing or witnessing physical or sexual assault, captivity, the sudden violent death of a loved one, or relationship violence were considered to meet the inclusion criteria for interpersonal trauma exposure, as assessed using the Life Events Checklist for DSM-5 (LEC-5, Grey et al., 2004; Weathers et al. 2013). Exclusion criteria included currently receiving psychotherapy, medication, or other treatment services specifically for substance-related issues. Participants were compensated with gift cards for completion of the baseline assessment, brief intervention, and three-month follow-up.

Measures

Demographics.

For the baseline survey participants completed a brief demographics measure including age, ethnicity, sex, gender, and sexual orientation.

Trauma Exposure.

To assess trauma exposure, participants completed the Life Events Checklist for DSM-5 (LEC-5; Grey et al., 2004; Weathers et al., 2013). This measure is designed to evaluate whether a person had experienced or witnessed a number of potentially traumatic events, such as physical assault, sexual assault, combat or exposure to a war zone, life-threatening illness or injury, and/or natural disasters. Participants selected from various levels of exposure to each of the 16 events listed (e.g., “Happened to me,” “Witnessed it.”). Past psychometric evaluation demonstrated strong test-retest reliability (r = .82) and convergent validity (Grey et al., 2004).

Mental Health Symptoms.

Sample descriptors describing mental health symptoms including depression, anxiety, and stress were assessed using the Depression, Anxiety, Stress Scale (DASS-21; Lovibond & Lovibond, 1995), which is a 21-item measure corresponding to three separate subscales. PTSD symptoms were assessed using the PTSD Checklist (PCL-5, Weathers et al., 2013), a common self-report measure of PTSD.

Alcohol Consumption.

Participants reported frequency and quantity of alcohol use over the past month using the Daily Drinking Questionnaire (DDQ; Collins et al., 1985), which was used to assess the number of past month heavy drinking episodes. The DDQ has been found to have high reliability (Allen & Wilson, 2003).

Acceptability of the Brief Intervention.

Participants were asked to report their perceptions of the BI immediately following its completion using five survey items created by the lead author that were consistent with items from past studies with a similar focus (Gex et al., 2023). Acceptability items were selected to capture core domains commonly emphasized in early-stage feasibility and acceptability evaluations of digital interventions. Specifically, items assessing satisfaction, helpfulness, and relevance were chosen to capture overall appraisal of the intervention content and perceived value, which are widely used indicators of acceptability across behavioral intervention studies. Burdensomeness was included to directly assess perceived effort and time demands, a key feasibility consideration for digitally delivered, low-intensity interventions. Finally, confidence in ability to cope with stress was included to assess perceived immediate impact on a proximal, theoretically relevant target of the intervention.

Items included statements measuring satisfaction, helpfulness, relevance, burdensomeness, and confidence in ability to cope with stress. Statements include items such as “I found the information presented today to be helpful” and “After today’s session I feel more confident in my ability to cope with stress.” Items were rated from 1 (“Strongly Disagree”) to 7 (“Strongly Agree”).

Acceptability of Peer Coaching Sessions.

A similar rationale as described above was used to select the acceptability items for the peer coaching component of the study. At the three-month assessment, participants were asked to report their perceptions of the peer coaching exchanges using the same 1 (“Strongly Disagree”) to 7 (“Strongly Agree”) scale. Items included 5 statements gauging satisfaction, helpfulness, support, making positive changes, and burdensomeness. Statements include items such as “I felt supported by my peer coach”, “The text message exchanges with my peer coach helped motivate me to make positive changes in my behavior”, and “I found the text message exchanges with my peer coach to be helpful.”

Procedure

All study procedures were reviewed and approved by the Institutional Review Board (IRB) of the local institution. Participants were college students recruited at a mid-sized university in the southeastern United States. Participants in the pilot trial were recruited through the university subject pool and flyers posted on campus. Potential participants initially completed an online screener assessing inclusion and exclusion criteria. If eligible, participants were contacted via text message by trained lab personnel and invited to participate. Eligible participants who wished to participate were then sent a 30-minute baseline questionnaire via text-message to be completed remotely on their mobile phone via a secure web server. A total of 1458 individuals were screened for eligibility in the larger study, of whom 290 (19.9%) were deemed to be eligible. Of the 290 invited to participate in the study, 172 (59%) enrolled in the larger trial. Enrollment averaged approximately 2 individuals per week.

After completing the baseline survey, participants were randomly assigned to one of three intervention conditions: the trauma-informed, peer-supported, brief intervention (TIPSBI), a standard brief alcohol intervention (BAI) and an assessment only control condition (AO). Given that the present study primarily focuses on the feasibility and acceptability of the adapted intervention (TIPSBI), the trauma-informed, peer-supported brief intervention is described in more detail below. Data included in this manuscript come from the baseline assessment and 3-month follow-up assessments of participants in the adapted intervention condition (TIPSBI).

Trauma Informed, Peer-Supported Brief Intervention (TIPSBI)

The intervention was designed as a trauma-informed adaptation of a standard brief alcohol intervention, intended to be responsive to the needs of individuals with histories of interpersonal trauma. Although the intervention was not developed using a formal trauma-informed care framework, it incorporated several principles commonly associated with trauma-informed practice, including normalization of trauma-related distress, emphasis on present-focused coping skills, participant choice and autonomy, and avoidance of intensive trauma processing or exposure-based content in the absence of clinician oversight. The participants that were randomized to the TIPSBI condition were texted a link to a secure site containing personalized feedback (a personalized substance use profile, information on peer norms, prior substance-related consequences experienced by the participant, practical costs, and standard protective behavioral strategies to limit substance-related risk) along with psychoeducation about the link between trauma and alcohol use. In addition to the standard brief intervention elements (personalized feedback, alcohol risk information, and harm-reduction strategies), the trauma-informed BI incorporated several components specifically targeting trauma-related distress and adaptive coping. These included: 1) personalized feedback about current stress levels, 2) adaptive coping skills training, guiding participants to identify and practice strategies for managing negative emotions (e.g., physical exercise, breathing techniques, relaxation training), 3) emotion regulation strategies, based on evidence-based approaches such as CBT and mindfulness, to help tolerate distress without alcohol (e.g., self-compassion, expressive writing, cognitive restructuring, and mindfulness meditation), 4) goal setting and planning related to use of emotion regulation strategies, and 5) personalized feedback related to trauma history, including highlighting connections between interpersonal trauma experiences and alcohol use.

These components were designed to complement the standard BI content and address the unique needs of emerging adults with histories of interpersonal trauma. These brief modules included written, audio, and video resources on use of the tools. Participants were asked to select their preferred strategy and to set goals related to practicing the strategy over the next month. Participants were provided with a means to access these modules at any time. Participants were also given the option of setting an alcohol-use-related goal. The BI session, encompassing both assessment and feedback, was a single session that took 47 minutes on average to complete. Immediately following the BI, participants were asked to complete questions assessing perceptions of the intervention.

Peer coaches then contacted participants one and two months post-BI via text message to complete peer coaching sessions that were intended to last for approximately 15 to 20 minutes, with most exchanges being between 20–25 messages in total. Sessions were scheduled in advance. See Table 2 for an example peer coaching exchange. Peer coaches were graduate (n = 4) and undergraduate research assistants (n = 3). All peer coaching exchanges were conducted via synchronous text message. Regarding training of peer coaches, peers read multiple chapters from Motivational Interviewing (Miller & Rollnick, 2013), underwent an approximately 15-hour training program covering motivational interviewing principles with video demonstrations, and read assigned literature on models of supportive accountability. Training included reviewing prior peer coaching exchanges from other peer coaches, role-playing exercises, feedback sessions, and completion of a final competency evaluation via role-play with the lead author. All exchanges were reviewed by the primary author, a licensed clinical psychologist, and reviewed as a group in bi-weekly supervision meetings to provide ongoing feedback. The lead author reviewed exchanges to ensure that peer coaches followed the protocol, including module re-direction, goal-setting and goal adherence, and appropriate use of scripted prompts. Protocol adherence was assessed via review of each peer coaching exchange and a checklist that evaluated whether peer coaches completed a set of key items (e.g., assessed current stress levels, reviewed adherence to past month goals related to stress management tools, asked participant to set future goals, summarized future goals for the upcoming month). No issues were noted with adherence to the peer coaching protocol.

Table 2.

Sample Peer Coaching Exchange

Peer Coach	Participant
Hey [participant name], this is [peer coach name] from [name of the project]. You completed a survey for us a month ago, and I wanted to take a couple of minutes to check in with you via text. Is now still an ok time for a quick 15-minute check in?	Yep, it is.
Great! I’m a research assistant and fellow student at WKU and I’ll be working with you as your peer coach. My role is to check in with you periodically over the next several months. I’ll ask about your current stress and review the goals you set in the survey you completed last month. Each check-in will take about 15 minutes. Do you have any questions about my role as your peer coach?	I don’t.
Let’s start by reviewing your recent stress levels. If you were to rate your stress levels over the past month on a 0 (not at all) to 10 scale (extreme stress), what number would you give?	I’d give it a 7.
Seems like you’ve had a fair amount of stress over the past month. What’s been your major sources of stress?	A lot of school stuff preparing for finals and staying on top of things. And trying to maintain a job on top of that has been challenging.
That’s understandable! It sounds like you’ve got a lot you’re juggling right now. The end of the semester is making everything really stressful for me as well but I hope it gets better for you!	Thanks! You too!
Let’s talk about the stress management strategies we sent you. In the survey you took last month you set a goal to practice exercising 3 times a week. How was that?	It was great. I’ve been going to the gym pretty regularly and it’s been a good way to take my mind off things.
Wonderful! We’d like you to keep practicing these strategies over the next month. Which of the strategies that we gave you would you be most interested in doing this next month? You can review the strategies if needed by going to [link to strategies].	I’d like to try mindfulness meditations.
Sounds good. How often do you think you could incorporate that into your routine?	I’d say 2–3 times a week
Got it. I’ll check in next month to see how that went. I want to quickly review some other potential goals we asked you about last month. At the time, you weren’t interested in setting any goals related to your alcohol use. Would you like to set any goals for this now?	I would. I’d like to limit my drinking to just on the weekends
Great! What’s motivating you to set this goal?	I’d have more free time during the week to do schoolwork and keep up my grades.
Ok, that makes sense! I’ll make a note to ask you how this went when I check in next month. Thanks for checking in with me today. To summarize, your goals for the next month are to practice mindfulness meditation 2–3 times a week and to limit your drinking to weekends only. You can access these stress management tools by going to [link to strategies]. I’ll reach out in a month to check back in with you.	Sounds good, thanks!

Peer coaching interactions via text message were semi-structured interactions designed to be consistent with the principles of supportive accountability and motivational interviewing (see Miller & Rollnick, 2013 and Mohr et al., 2011). Peer coaching assessed current stress levels and recent stressors, progress with goals related to use of the coping strategies, and progress with substance-related goals. Peers also discussed challenges with implementing these behavioral changes and provided support and validation as needed during the exchanges. Peers re-directed participants to the coping strategies modules presented at baseline and set new goals for use of the tools and substance use for the upcoming month. If participants did not set any substance-related goals at the prior contact point, they were asked about their interest in setting goals for the upcoming month. Participants then re-completed baseline assessment measures at the 3-month follow-up in addition to completing perceptions of the peer coaching. Peer coaches, helped participants set goals and practice coping strategies to manage general trauma-related distress, such as stress, negative mood, or anxiety. Sessions reinforced skills introduced in the trauma-informed BI, including adaptive coping, emotion regulation, and planning for high-risk situations, and were designed to enhance engagement and encourage application of learned skills in daily life.

Transparency and Openness

This submission contains only a subset of information collected as part of the larger trial that pertains to feasibility and acceptability. Additional information not presented in the current study on all conditions, manipulations, and measures in the study can be found by visiting clincialtrials.gov (NCT05414344). Data will be made available upon reasonable request by emailing the corresponding author. Data were analyzed using SPSS, version 24. This study’s design was pre-registered.

Data Analytic Procedures

All analyses included only available data for their respective analyses, and no imputation methods were utilized. To examine feasibility, dropout rates from the peer coaching exchanges and follow-up were assessed through proportions. To determine the acceptability of the intervention and peer coaching, percentages of participants endorsing responses collapsed into ‘agree’, ‘disagree’, and ‘neutral’ responses for the items noted above were examined.

Results

Feasibility

All participants completed the brief intervention. Completion rates for peer coaching were high, with 80% and 81% of the sample completing the 1 and 2-month peer coaching sessions (M = 1.53 sessions attended; SD = .73), respectively. Approximately 89% completed at least one of the two peer coaching sessions. Completion rates were also good for the 3-month follow-up assessment, with 77% of the sample completing the 3-month assessment. No demographic variables were significantly associated with dropout from either the peer coaching sessions or the 3-month follow-up.

Acceptability of the Brief Intervention (TIPSBI)

Perceptions of BI and peer coaching are presented in Figure 1. Participants largely had positive perceptions of the brief intervention component (TIPSBI). Seventy-eight percent of the sample said they were satisfied with the content of the BI as opposed to 14% who were neutral and 8% that disagreed that they were satisfied with the intervention. Eighty-six percent of the sample reported finding the intervention helpful, as opposed to 10% who were neutral and 4% who disagreed. Ninety percent of the sample agreed that the intervention content was personally relevant, as opposed to 6% who were neutral and 4% who disagreed. Only 8% of the sample agreed that completing the intervention was a burden, as opposed to 82% who disagreed and 10% who were neutral. Fifty-eight percent of the sample indicated that after the intervention they felt more confident in their ability to cope with stress, compared to 26% who were neutral and 16% who disagreed.

Figure 1.

Perceptions of the Baseline Brief Intervention

Acceptability of Peer Coaching

Perceptions of peer coaching are presented in Figure 2. For the current study, 65% of respondents agreed that they found the peer coaching appointment helpful, 28% reported feeling neutral, and 8% disagreed that the intervention was helpful. Regarding satisfaction, 83% of respondents agreed that they were satisfied with the peer coaching sessions, 15% were neutral, and 3% of respondents disagreed that they were satisfied with the peer coaching sessions. Seventy-four percent of respondents felt supported by their peer coach, and 26% were neutral. Sixty-three percent of respondents agreed that their peer coaching sessions helped them make positive changes in their behavior, as compared to 28% who were neutral and 10% who disagreed. Additionally, when asked whether they found the peer coaching sessions to be burdensome, 60% of participants disagreed, 25% were neutral, and 15% agreed.

Figure 2.

Perceptions of Peer Coaching

Discussion

The purpose of the current study was to describe and report acceptability and feasibility of a trauma-informed and peer-supported digital brief intervention for heavy-drinking emerging adults with interpersonal trauma. Results showed that the adapted intervention (TIPSBI) and peer coaching were viewed favorably by the majority of participants.

These initial results are notable for a number of reasons. There is limited prior work examining brief interventions in a sample entirely composed of interpersonal trauma survivors, despite their increased risk of substance-related problems (Wilsnack et al., 1997). Additionally, as discussed above, prior work has suggested that individuals with trauma exposure and/or trauma-related distress may be less responsive to substance-focused brief interventions (Kurtz et al., 2019; Tanner-Smith et al., 2021). Thus, the current study represents one of the first examinations of the acceptability and feasibility of a brief intervention specifically for interpersonal trauma survivors. Altogether, results are encouraging in suggesting that this population has positive reactions to and could potentially benefit from low-intensity, technology-based approaches targeting mental health and substance use.

Although digital interventions offer some advantages over in-person modalities, such as increased reach, reduced stigma, and greater dissemination, digital interventions can suffer from lower engagement and higher attrition (Eysenbach, 2005; Mohr et al., 2011; Torous et al., 2024). Initial results from the current study reflect relatively high levels of engagement and generally positive perceptions of peer coaching, supporting the use of peer coaches via text message follow-up. This modality may be especially palatable to emerging adults given texting has been shown to be their preferred form of digital communication (Mason et al., 2018; Rideout & Robb, 2018). However, a small subset of the sample did not complete the peer coaching sessions and/or had neutral to negative perceptions of the peer coaching. Additional work is needed to identify how to improve the engagement and experience of these individuals.

Results are also notable given that prior substance-focused brief interventions utilizing peer coaching via synchronous text message are limited. Of note, standard BIs typically do not provide additional follow-up post intervention receipt, which may partially explain the limited duration of their effects. This is understandable when considering that BIs are intended as time-limited and lower-resource preventative approaches. Incorporating additional contact may be unfeasible or impractical in many settings. However, prior studies indicate that additional follow-up may help promote and prolong intervention gains (Mason et al., 2018). Due to their feasibility, some interventions have incorporated use of automated text messages, which have demonstrated effectiveness (Chung et al., 2023, Mason et al., 2015). Although promising, one limitation of this approach is that technology-based interventions augmented with human support have been shown to encourage greater treatment adherence more so than automated systems (Mohr et al., 2011; Tate et al., 2006; Torous et al., 2024). Studies of brief interventions within substance use literature have yet to compare automated to human-supported text interventions, which may be a useful area of future research.

Findings suggest there may be utility of incorporating laypersons and peers into substance-focused treatment such as BIs (Bassuk et al., 2016; Kelly et al., 2020). Incorporation of peers into BIs specifically has also been found to improve outcomes, with one study finding that inclusion of a supportive friend in an in-person BI resulted in a three times greater decrease relative to a standard BI in alcohol use and alcohol problems (Tevyaw et al., 2007). However, comparisons to alternative conditions are needed before it can be concluded that the peer coaching component enhances existing BIs. It is also important to note that while these results suggest that human support via laypersons can be successfully incorporated into digital BIs without requiring significant additional time investments from recipients of the intervention, there was substantial time commitment from peer coaches for training to ensure fidelity and quality. This may serve as an additional barrier to implementation at a larger scale.

In sum, this study provides preliminary evidence that a digitally delivered trauma-informed, peer-support brief intervention (TIPSBI) shows high levels of acceptability and feasibility in a sample of young adult interpersonal trauma survivors. However, implementation in more real-world settings in which participants do not receive compensation for participation are needed. Though additional work in larger samples and additional contexts are needed, this approach has potential for promoting and maintaining improvements in alcohol use and mental health symptoms in this population. Future work is also needed to determine whether the included components may also be beneficial to the broader population of substance users, including those without interpersonal trauma.

Despite the merits of the current study, a number of limitations should be acknowledged. The current study presented preliminary feasibility and acceptability results of an ongoing clinical trial and thus the current submission does not include comparisons to other controls and conditions. As such, more rigorous comparisons to other conditions are needed. At present, the mechanisms underlying the perceived benefits of the intervention are unclear, including whether benefit is related to the improvement of coping strategies, peer coach influence, or alternative mechanisms. Relatedly, comparisons to traditional interventions such as standardized BIs are needed to determine whether the adapted intervention implemented in the current study yields superior outcomes. The sample was fairly homogenous and included university students who were predominantly white and female, which limits the generalizability of the results. Although peer coaching was delivered by university students who did not have formal clinical training, these individuals were affiliated with a research laboratory and may differ from peers in non-research or community settings. Thus, findings related to feasibility and acceptability may not generalize to other contexts or intervention recipients, such as non-college emerging adult samples. Additional investigations are needed in more diverse samples, including community samples and older individuals. The sample size was also relatively modest and follow-up was limited to the three-month assessment. A more intensive and protracted period of follow-up with a larger sample would bolster demonstrations of effectiveness and provide input on the duration of the effects. Finally, although dropout rates at three-month follow-up were similar to dropout rates in prior studies (e.g., Gex et al., 2023), incomplete follow-up data indicate that additional strategies to improve retention are warranted.

Despite these limitations, these results add important information to the literature on digital alcohol interventions and show that these interventions may benefit from incorporating trauma-informed and peer-coaching elements. Though preliminary, these results are promising regarding adapting brief interventions to an important subsample of individuals at high-risk for problematic alcohol-related outcomes. These results help establish an overview and the practicality of study procedures prior to launching a larger, fully powered trial with additional follow-ups.

Digital BIs hold significant potential to reduce the harms of alcohol and other substance use and prevent substance use disorders. However, they may benefit from augmentation via inclusion of adaptive coping strategies and peer coaches in order to improve outcomes in interpersonal trauma survivors. The current study found positive preliminary results that suggest a text-message-based alcohol BI augmented with personal feedback and peer support is feasible and acceptable to participants. Although more work is needed to determine the utility of the current intervention relative to existing alternatives, this study offers potential avenues for prevention and intervention efforts aimed at improving substance use outcomes among trauma-exposed young adults.

Public Significance Statement.

Emerging adults with interpersonal trauma are at heightened risk for problematic alcohol use and other negative outcomes that traditional brief interventions may fail to address. This study provides promising evidence that a trauma-informed, peer-supported digital brief intervention is both feasible and acceptable, offering an additional strategy to potentially support mental health and reduce alcohol-related harms in at-risk young adults.