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Systematic Review
KQ 1: For e-interventions targeting adults who misuse alcohol or who have a diagnosis of AUD, what level, type, and modality of user support is provided, by whom, and in what clinical context?
• KQ 2: For adults who misuse alcohol but do not meet diagnostic criteria for AUD, what are the effects of e-interventions compared with inactive controls?
• KQ 3: For adults at high risk of AUD (eg, AUDIT-C ≥8), or who have a diagnosis of AUD, what are the effects of e-interventions compared with inactive controls?
• KQ 4: For adults who misuse alcohol, are at high risk of AUD, or have a diagnosis of AUD, what are the effects of e-interventions alone or used in combination with face-toface therapy compared with face-to-face therapy alone?
We identified 26 RCTs involving over 14,000 participants with alcohol misuse, at risk of AUD, or with AUD. Participants were selected for these trials based on one or more alcohol consumption criteria, but only 3 studies based inclusion on an assessment of AUD. Studies were divided roughly equally between college students and other groups of adults. Adult participants were typically midlife (median age=41.4 years), and the majority had at least some college education, with baseline alcohol consumption in excess of 14 drinks per week. Most trials compared e-interventions with inactive controls. E-interventions were typically accessed online, consisted of one session lasting 30 minutes or less, and were completed without supplementary human support; PNF was the predominant strategy. A single trial used a mobile device as the delivery platform
We found limited evidence for small or no effects of e-interventions compared with controls on long-term (≥6 months) alcohol outcomes in participants who screened positive for alcohol misuse. Findings were even more limited for participants with AUD or comparisons of e-interventions to face-to-face treatment. Further research is needed to determine with higher confidence whether e-interventions can produce long-term benefits for alcohol-related outcomes. In particular, given the limited number and duration of intervention episodes in the studies reviewed, it is possible that these e-interventions were not designed to be robust enough to produce significant, enduring effects on alcohol misuse. As reported in previous reviews, brief in-person interventions produce sustained reductions in alcohol consumption in participants with alcohol misuse. Current evidence does not support substitution of e-interventions for brief, in-person treatment. Future research on e-interventions should include evaluations of more intensive or longer duration e-interventions for alcohol misuse.