‘E-interventions' not effective over the long term for problem drinking
Although e-interventions may reduce alcohol consumption over the short term, the effects are usually small and are not maintained long term.
Low-intensity electronic interventions yield small short-term reductions in alcohol consumption but do not appear to have clinically significant long-term effects, according to a new study.
E-interventions for alcohol misuse can potentially be made available to more patients and decrease demands on clinicians' time compared to in-person counseling. To examine the efficacy of e-interventions versus inactive or minimal-intervention controls for decreasing alcohol consumption and alcohol-related impairment in adults and college students, researchers performed a systematic review of studies published from January 2000 to March 2015. Included studies were English-language, randomized, controlled trials that involved at least 50 adults who misused alcohol and that compared an e-intervention group and a control group, with outcomes reported at 6 months or longer. The study results were published in the Aug. 4 Annals of Internal Medicine.
A total of 28 trials that tested an e-intervention providing brief feedback on alcohol consumption were included in the study. Fourteen trials included college students, and 14 included noncollege adults. Three trials recruited patients who had or were at high risk for an alcohol use disorder, defined as continuing a pattern of alcohol use despite more than 2 clinically significant alcohol-related problems in impaired control over use, social impairment, health consequences, and physiologic dependence, while the remaining 25 trials included patients who misused alcohol. (The term “alcohol misuse” defines a spectrum ranging from hazardous use above guideline limits to alcohol use disorder.) Seventeen of the trials used minimal interventions with no human support, 8 used interventions with low noncounseling support, and 3 used interventions with moderate or high counseling support.
The researchers found that at 6 months, alcohol consumption appeared to decrease by about 1 drink per week in adults and college students. However, this effect was not seen at 12 months. E-interventions appeared to have no statistically significant effect on meeting drinking limits in adults or in reducing binge-drinking episodes or the social consequences of alcohol misuse in college students. None of the trials reported on whether patients were meeting drinking limits at 12 months or included enough data to analyze the effects of the interventions on health-related quality of life, alcohol-related health problems, medical utilization, or adverse effects.
When adults with a likely diagnosis of an alcohol use disorder were considered separately, no difference in alcohol consumption (P=0.62) or binge drinking (P=0.69) was seen between intervention and control groups at 12 months in 3 trials. One trial of an intervention that included an interactive voice-response system, online modules, and calls from the study coordinator about missed participation found that self-reported abstinence rates were 5.6 percentage points higher in the control group than in the intervention group (66.7% vs. 72.2%, respectively). However, another trial that incorporated a smartphone app as well as counselor support via telephone calls when risk was elevated found increased odds of abstinence and lower frequency of risky drinking at 12 months in the intervention group.
The study authors noted that analyses combined e-interventions of varying intensity and that participants were not blinded, among other limitations. However, they concluded that although e-interventions may reduce alcohol consumption over the short term, the effects are usually small and are not maintained long term. “More clinically significant measures, such as meeting drinking limit guidelines, need to be measured in clinical trials and targeted by e-interventions,” the authors wrote. “More intensive interventions with extended interaction between the person and the e-intervention and possibly human support could produce more robust, enduring benefits with the possibility of improved health and decreased alcohol-related impairment.”