Efficacy of Electronic Interventions for Unhealthy Alcohol Use

Electronic delivery of brief interventions for unhealthy alcohol use can potentially overcome some of the barriers in clinical settings and reach a broader population. To assess their efficacy, researchers conducted a systematic review of English-language trials of at least 50 adult participants who screened positive for unhealthy alcohol use randomized to an electronic intervention (e-intervention), or control. The majority (68%) of the 28 trials that met eligibility criteria consisted of single-session e-interventions.

• In college students, e-interventions were associated with a mean consumption difference of -11.7 g alcohol in a week at 6 months and -4.7 g alcohol in a week at 12 months.
• In non-college student adults, e-interventions were associated with a mean difference of -25.0 g alcohol in a week at 6 months and -8.6 g in a week at 12 months.
• Two of the 3 trials focused on adults with alcohol use disorder did not find an effect, but one trial found increased odds of abstinence (odds ratio, 1.94) among patients who, after completing residential alcohol treatment, received a smartphone with a data plan, alcohol-focused application, and GPS-triggered alerts.

Comments:

This well-done systematic review found a small effect of e-interventions at 6 months but no clinically significant effect at 12 months. One of the promising features of e-interventions is the capability to deliver multiple very brief intervention “moments” over time. These may produce a cumulative effect, but would need to be thoughtfully balanced against the risk of overwhelming and potentially turning off the patient. Future studies should take advantage of this capability and, as the authors note, link the e-intervention with human support when needed.

Kevin L. Kraemer, MD, MSc

Reference:

Dedert EA, McDuffie JR, Stein R, et al. Electronic interventions for alcohol misuse and alcohol use disorders: a systematic review. Ann Intern Med. 2015;163:205–214.