There is moderate-quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants. Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower. Low-quality evidence from fewer studies suggested there may be little or no difference in impact on alcohol consumption between digital and face-to-face interventions.The BCTs of behaviour substitution, problem solving and credible source were associated with the effectiveness of digital interventions to reduce alcohol consumption and warrant further investigation in an experimental context.Reporting of theory use was very limited and often unclear when present. Over half of the interventions made no reference to any theories. Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness.

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Aim: To assess what factors were associated with reported changes to usual alcohol drinking behaviour during the start of lockdown in the UK. Design: Online cross-sectional survey from 21st March to 4th April 2020. Setting: UK. Participants: 30,375 adults aged ≥18y. Measurements: Changes in drinking over the past week, sociodemographic characteristics, diagnosed or suspected COVID-19, adherence to COVID-19 protective behaviours, stress about COVID-19, finances or boredom, recent drop in household income, key worker status, and health conditions. Findings: Of 22,113 drinkers (65.7% of analytic sample), 48.1% (95% CI=47.0-49.1%) reported drinking about the same as usual, 25.7% (24.8-26.6%) reported drinking less than usual, and 26.2% (25.4-27.1%) reported drinking more than usual over the past week. Drinking less than usual was independently associated with being younger (OR=0.88 [95% CI=0.83-0.93]), male (OR=0.76 [0.68-0.84]), of an ethnic minority (OR=0.76 [0.61-0.97]), low annual household income (OR=0.74 [0.66-0.83]), having diagnosed or suspected COVID-19 (OR=2.04 [1.72-2.41]), adhering to COVID-19 protective behaviours (OR=1.58 [1.08-2.32]), being significantly stressed about becoming seriously ill from COVID-19 (OR=1.26 [1.08-1.48]) and not being a key worker (OR=0.87 [0.76-0.99]). Drinking more than usual was independently associated with being younger (OR=0.73 [0.69-0.78]), female (OR=1.36 [1.22-1.51]), post-16 qualifications (OR=1.21 [1.04-1.40]), high annual household income (OR=1.43 [1.27-1.61]), being significantly stressed about catching (OR=1.22 [1.03-1.45]) or becoming seriously ill from COVID-19 (OR=1.28 [1.10-1.48]), being significantly stressed about finances (OR=1.43 [1.24-1.66]), and having a diagnosed anxiety disorder (OR=1.24 [1.05-1.46]). Conclusions: In a representative sample of adults in the UK, about half of drinkers reported drinking the same amount of alcohol as usual during the start of the COVID-19 related lockdown, with a quarter drinking more and a quarter drinking less than usual. Drinking more than usual was associated with being younger, female, high socioeconomic position, having an anxiety disorder, and being stressed about finances or COVID-19. These groups may benefit targeted alcohol reduction support if there are further periods of lockdown.

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