Technology-Delivered Cognitive Behavioral Therapy for Alcohol Use Shows Benefit

Cognitive behavioral therapy (CBT) is an evidence-based treatment for alcohol use disorder, and recent efforts to increase access to CBT have involved web-based and mobile technologies. This meta-analysis was the first to synthesize the evidence for technology-delivered CBT (CBT-Tech) for reduction in unhealthy alcohol use. CBT-Tech interventions were fully computerized web-based or mobile apps that included no clinician-delivered components.

• Randomized controlled trials (15 trials, 9838 total participants) in which the majority of participants had unhealthy alcohol use* were identified and analyzed by type of control group. Content varied in length, and many incorporated elements of motivational interviewing.
• CBT-Tech compared with minimal treatment (6 trials, 8663 participants) showed a positive and significant reduction in drinking, but with a small effect size (Hedges’ g, 0.2).**
• When tested as an additional intervention combined with treatment as usual (8 trials, 1125 participants), CBT-Tech demonstrated a slightly larger effect size and longer duration of benefit (Hedges’ g = 0.3), compared with treatment as usual alone.
• Comparing CBT-Tech directly with treatment as usual (3 trials, 385 participants) or to clinician-delivered CBT (2 trials, 234 participants) did not show a significant difference in drinking.

* Defined here as meeting DSM criteria for alcohol use disorder, or scoring ≥8 on the Alcohol Use Disorders Identification Test (AUDIT).

** When assessing effect size with Hedges g, a rule of thumb is: small effect = 0.2; medium effect = 0.5; large effect = 0.8.

Comments: Technology-delivered CBT demonstrated potential benefits for people with unhealthy alcohol use as a stand-alone intervention, and potentially a stronger benefit when added to treatment as usual, although no significant benefit was seen when tested against other treatments. CBT-Tech requires patient motivation and time to complete, but offers potential advantages over other treatments, including privacy, low cost, and easy access, as well as avoiding potential deficiencies in provider training, treatment fidelity, and competency.

Joseph Merrill, MD, MPH

Reference: Kiluk BD, Ray LA, Walthers J, et al. Technology-delivered cognitive-behavioral interventions for alcohol use: a meta-analysis. Alcohol Clin Exp Res. 2019;43:2285–2295.