Internet-based interventions can help reduce problem drinking

Internet-based interventions may be effective in curbing various patterns of adult problem drinking in both community and health care settings, according to a study published December 18 in the open-access journal PLOS Medicine by Heleen Riper of VU University in Amsterdam, the Netherlands, and colleagues. As noted by the authors, 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 behaviors 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 trails 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 treatment outcome 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.

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The authors did not receive specific funding for this work.

I have read the journal's policy and the authors of this manuscript have the following competing interests: DE has served as a consultant to/on the scientific advisory boards of Sanofi, Novartis, Minddistrict, Lantern, Schoen Kliniken, and German health insurance companies (BARMER, Techniker Krankenkasse). He is also a stakeholder of the Institute for health training online (GET.ON), which aims to implement scientific findings related to digital health interventions into routine care. RH's company owns the IP of the web applications that their data came from, as a basis for their contribution to the overall data set. HDV is the scientific director of Vision2Health, a company with the goal to implement evidence-based eHealth interventions. HR received a fee for participating in a brainstorm session on ehealth and bipolar disorders/PTSD organized by Sandoz. The remaining authors declare no competing interests.

Riper H, Hoogendoorn A, Cuijpers P, Karyotaki E, Boumparis N, Mira A, et al. (2018) Effectiveness and treatment moderators of internet interventions for adult problem drinking: An individual patient data meta-analysis of 19 randomised controlled trials. PLoS Med 15(12): e1002714. https://doi.org/10.1371/journal.pmed.1002714

Department of Clinical, Neuro- and Developmental Psychology, VU University, Amsterdam, the Netherlands

Department of Psychiatry, VU University Medical Centre, Amsterdam, the Netherlands

APH Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands

Department of Psychology and Technology, Universitat Jaume I, Castellon, Spain

Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain

Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden

Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden

Alcohol Treatment Centre, Department of Community Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland

Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany

Arkin Mental Health Care, Department of Research, Amsterdam, the Netherlands

Academic Medical Centre, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands

Trimbos Institute--Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands

Academy Het Dorp, Arnhem, the Netherlands

Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University of Lüneburg, Lüneburg, Germany

Norwegian Centre for Addiction Research, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada Department of Psychiatry and Department of Psychology, University of Toronto, Toronto, Ontario, Canada

Centre for Addiction and Mental Health, Toronto, Ontario, Canada

Research School of Population Health, Australian National University, Canberra, Australia

Department of Clinical Psychology and Psychotherapy, FriedrichAlexander-Universität Erlangen-Nürnberg, Erlangen, Germany

Strategic Research and Development Support, Metropolitan University College, Copenhagen, Denmark

Research Division, Behavior Therapy Associates, Albuquerque, New Mexico, United States of America

School of Health Sciences, University of East Anglia, Norwich, United Kingdom

Health Service and Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom

eHealth Unit, Research Department of Primary Care and Population Health,

University College London, Royal Free Hospital, London, United Kingdom

Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands

Department of Development and Advice, Tactus Addiction Treatment, Deventer, the Netherlands

CAPHRI School for Public Health and Primary Care, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands

Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America

Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

Addiction Development and Psychopathology (ADAPT) Laboratory, Department of Psychology, University of Amsterdam, the Netherlands

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002714