Effectiveness of E-Self-help Interventions for Curbing Adult Problem Drinking: A Meta-analysis

Abstract

BackgroundSelf-help interventions without professional contact to curb adult problem drinking in the community are increasingly being delivered via the Internet.ObjectiveThe objective of this meta-analysis was to assess the overall effectiveness of these eHealth interventions.MethodsIn all, 9 randomized controlled trials (RCTs), all from high-income countries, with 9 comparison conditions and a total of 1553 participants, were identified, and their combined effectiveness in reducing alcohol consumption was evaluated by means of a meta-analysis.ResultsAn overall medium effect size (g = 0.44, 95% CI 0.17-0.71, random effect model) was found for the 9 studies, all of which compared no-contact interventions to control conditions. The medium effect was maintained (g = 0.39; 95% CI 0.23-0.57, random effect model) after exclusion of two outliers. Type of control group, treatment location, type of analysis, and sample size did not have differential impacts on treatment outcome. A significant difference (P = .04) emerged between single-session personalized normative feedback interventions (g = 0.27, 95% CI 0.11-0.43) and more extended e- self-help (g = 0.61, 95% CI 0.33-0.90).ConclusionE-self-help interventions without professional contact are effective in curbing adult problem drinking in high-income countries. In view of the easy scalability and low dissemination costs of such interventions, we recommend exploration of whether these could broaden the scope of effective public health interventions in low- and middle-income countries as well.

Electronic Interventions for Alcohol Misuse and Alcohol Use Disorders

“…Previous systematic reviews that evaluated e-interventions for alcohol misuse have generally found short-term benefits (13)(14)(15)(16)(17), but examination of maintenance of intervention effects is needed. Two recent systematic reviews have reported follow-up outcomes at 6 months or longer.…”

“…However, they did not analyze college student and noncollege adult trials separately (13,17), despite distinctions between these groups in patterns of alcohol consumption and associated impairment (18,19). In addition, previous systematic reviews have generally not reported on the efficacy of e-interventions for AUDs (13)(14)(15)(16)(17) or provided detailed descriptions of treatment intensity, including amount and type of human support (13)(14)17).…”

“…The search strategies are shown in Appendix Table 2 (available at www.annals.org). We reviewed bibliographies of included trials and applicable systematic reviews for missed publications (14)(15)(21)(22)(23)(24)(25). To assess for publication bias, we searched ClinicalTrials.gov for trials that met our eligibility criteria (26) and found 2 trials that were completed at least 1 year before our literature search but were unpublished.…”

Guided Internet-delivered cognitive behavioural treatment for insomnia: a randomized trial

“…During the past decade eHealth has been introduced in mental health care in general. Many Internet-delivered programmes have been developed for different disorders such as depression, alcohol and anxiety disorders (Andrews et al 2010;Griffiths et al 2010;Riper et al 2011) and meta-analyses have demonstrated that these programmes are effective . However, they seem to be much more effective when delivered with some form of guidance and coaching (Spek et al 2007).…”

“…However, of the 10 included studies, only one provided the self-help through the Internet (Ström et al 2004). Other studies on Internet-delivered CBT (Suzuki et al 2008;Ritterband et al 2009;Vincent & Lewycky, 2009;Espie et al 2012;Lancee et al 2012) have concluded that this treatment has positive effects, although the interventions in these studies were provided without personal guidance or coaching and some studies had small sample sizes.…”