Electronic Interventions for Alcohol Misuse and Alcohol Use Disorders: A Systematic Review

Abstract

Background: The use of electronic interventions (e-interventions) may improve treatment of alcohol misuse.

Purpose: To characterize treatment intensity and systematically review the evidence for efficacy of e-interventions, relative to controls, for reducing alcohol consumption and alcohol-related impairment in adults and college students.

Data sources: MEDLINE (via PubMed) from January 2000 to March 2015 and the Cochrane Library, EMBASE, and PsycINFO from January 2000 to August 2014.

Study selection: English-language, randomized, controlled trials that involved at least 50 adults who misused alcohol; compared an e-intervention group with a control group; and reported outcomes at 6 months or longer.

Data extraction: Two reviewers abstracted data and independently rated trial quality and strength of evidence.

Data synthesis: In 28 unique trials, the modal e-intervention was brief feedback on alcohol consumption. Available data suggested a small reduction in consumption (approximately 1 drink per week) in adults and college students at 6 months but not at 12 months. There was no statistically significant effect on meeting drinking limit guidelines in adults or on binge-drinking episodes or social consequences of alcohol in college students.

Limitations: E-interventions that ranged in intensity were combined in analyses. Quantitative results do not apply to short-term outcomes or alcohol use disorders.

Conclusion: Evidence suggests that low-intensity e-inter ventions produce small reductions in alcohol consumption at 6 months, but there is little evidence for longer-term, clinically significant effects, such as meeting drinking limits. Future e-interventions could provide more intensive treatment and possibly human support to assist persons in meeting recommended drinking limits.

Primary funding source: U.S. Department of Veterans Affairs.

Appendix Figure 1

Summary of evidence search and selection. AUD = alcohol use disorder; RCT = randomized, controlled trial. * Manuscript reference list includes additional references cited for background and methods. All 28 trials and 3 trials of AUD were qualitatively described, and quantitative meta-analysis was done for 25 trials.

Appendix Figure 2

Alcohol reduction to meet drinking limit guidelines at 6 mo in studies of adults. NR = not reported. * Did not report event rates. Intervention effects are based on adjusted estimates reported from a logistic regression model.

Figure 1

Alcohol consumption at 6 and 12 mo in studies of adults. MD = mean difference; NR = not reported. * Means and SDs were not available because only MD and CI were given.

Figure 2

Alcohol consumption at 6 and 12 mo in studies of college students. DB = decisional balance; MD = mean difference; PNF = personalized normative feedback; WB = Web-based. * The intervention group had 2 options (1 screening and brief intervention session or 3 screening and brief intervention sessions), so it is labeled “both.”