Internet-based interventions may be effective in curbing various patterns of adult problem drinking in both community and health care settings, according to an article in the open-access journal PLOS Medicine by Heleen Riper of VU University in Amsterdam, the Netherlands, and colleagues.
As noted by the authors in the study published on 18 December 2018, their large-scale meta-analysis of trial data suggests that internet-based interventions for adult problem drinking (iAIs) could serve as a first step toward changing problem-drinking behaviours and seeking more intensive treatment if needed.
Global estimations continue to show increasing morbidity, mortality and social harm caused by all types of problem drinking. Although brief face-to-face interventions are effective, they are rarely used. Internet-based interventions could overcome this treatment gap because they are more accessible and scalable, and they are more acceptable to problem drinkers.
In the new study, Riper and colleagues investigated the effectiveness and moderators of treatment outcomes in internet-based interventions for adult problem drinking. The researchers performed systematic searches in medical and psychological databases to find trials quantifying the effect of iAIs on problem drinking.
They analyzed individual patient data for 14,198 adults who participated in 19 randomized controlled trials and exhibited various profiles of problem drinking when the studies began. They also obtained post-treatment data for 8,095 participants.
The results show that Internet-based alcohol interventions in both community and health care populations are effective in reducing mean weekly alcohol consumption (from 381 to 329 grams of ethanol) and patients receiving iAIs were more likely than controls to achieve adherence to low-risk drinking limits (odds ratio [OR] of treatment response = 2.20, 95% confidence interval [CI] 1.63 to 2.95, p<0.001).
Treatment outcomes do not differ significantly for regular, heavy or binge drinkers. However, people above age 55 showed a greater likelihood of post-intervention adherence to low-risk drinking recommendations than younger people (OR of treatment response = 1.66, 95% CI 1.21 to 2.27, p = 0.002).
Moreover, mean weekly consumption dropped by roughly 20 grams of ethanol more for men than for women, and for less educated participants than for more highly educated ones. In addition, human-guided interventions showed a stronger impact on treatmentoutcome than fully automated ones.
According to the authors, the health gains of Internet-based alcohol interventions could be substantial because they can benefit both men and women from different age groups and with different drinking profiles.
Effectiveness and treatment moderators of internet interventions for adult problem drinking: An individual patient data meta-analysis of 19 randomised controlled trials
Face-to-face brief interventions for problem drinking are effective, but they have found limited implementation in routine care and the community. Internet-based interventions could overcome this treatment gap. We investigated effectiveness and moderators of treatment outcomes in internet-based interventions for adult problem drinking (iAIs).
Methods and findings
Systematic searches were performed in medical and psychological databases to 31 December 2016. A one-stage individual patient data meta-analysis (IPDMA) was conducted with a linear mixed model complete-case approach, using baseline and first follow-up data.
The primary outcome measure was mean weekly alcohol consumption in standard units (SUs, 10 grams of ethanol). Secondary outcome was treatment response (TR), defined as less than 14/21 SUs for women/men weekly. Putative participant, intervention and study moderators were included. Robustness was verified in three sensitivity analyses: a two-stage IPDMA, a one-stage IPDMA using multiple imputation, and a missing-not-at-random (MNAR) analysis.
We obtained baseline data for 14,198 adult participants (19 randomised controlled trials [RCTs], mean age 40.7 [SD = 13.2], 47.6% women). Their baseline mean weekly alcohol consumption was 38.1 SUs (SD = 26.9). Most were regular problem drinkers (80.1%, SUs 44.7, SD = 26.4) and 19.9% (SUs 11.9, SD = 4.1) were binge-only drinkers. About one third were heavy drinkers, meaning that women/men consumed, respectively, more than 35/50 SUs of alcohol at baseline (34.2%, SUs 65.9, SD = 27.1). Post-intervention data were available for 8,095 participants.
Compared with controls, iAI participants showed a greater mean weekly decrease at follow-up of 5.02 SUs (95% CI −7.57 to −2.48, p < 0.001) and a higher rate of TR (odds ratio [OR] 2.20, 95% CI 1.63–2.95, p < 0.001, number needed to treat [NNT] = 4.15, 95% CI 3.06–6.62). Persons above age 55 showed higher TR than their younger counterparts (OR = 1.66, 95% CI 1.21–2.27, p = 0.002).
Drinking profiles were not significantly associated with treatment outcomes. Human-supported interventions were superior to fully automated ones on both outcome measures (comparative reduction: −6.78 SUs, 95% CI −12.11 to −1.45, p = 0.013; TR: OR = 2.23, 95% CI 1.22–4.08, p = 0.009). Participants treated in iAIs based on personalised normative feedback (PNF) alone were significantly less likely to sustain low-risk drinking at follow-up than those in iAIs based on integrated therapeutic principles (OR = 0.52, 95% CI 0.29–0.93, p = 0.029).
The use of waitlist control in RCTs was associated with significantly better treatment outcomes than the use of other types of control (comparative reduction: −9.27 SUs, 95% CI −13.97 to −4.57, p< 0.001; TR: OR = 3.74, 95% CI 2.13–6.53, p < 0.001). The overall quality of the RCTs was high; a major limitation included high study dropout (43%). Sensitivity analyses confirmed the robustness of our primary analyses.
To our knowledge, this is the first IPDMA on internet-based interventions that has shown them to be effective in curbing various patterns of adult problem drinking in both community and healthcare settings. Waitlist control may be conducive to inflation of treatment outcomes.
Heleen Riper, Adriaan Hoogendoorn, Pim Cuijpers, Eirini Karyotaki, Nikolaos Boumparis, Adriana Mira, Gerhard Andersson, Anne H. Berman, Nicolas Bertholet, Gallus Bischof, Matthijs Blankers, Brigitte Boon, Leif Boß, Håvar Brendryen, John Cunningham, David Ebert, Anders Hansen, Reid Hester, Zarnie Khadjesari, Jeannet Kramer, Elizabeth Murray, Marloes Postel, Daniela Schulz, Kristina Sinadinovic, Brian Suffoletto, Christopher Sundström, Hein de Vries, Paul Wallace, Reinout W Wiers and Johannes H Smit
Internet-based interventions can help reduce problem drinking Effectiveness and treatment moderators of internet interventions for adult problem drinking: An individual patient data meta-analysis of 19 randomised controlled trials