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Cited by 265Substance Abuse Treatment and OutcomesDigital Mental Health InterventionsAlcohol Consumption and Health Effects

Effectiveness of Guided and Unguided Low-Intensity Internet Interventions for Adult Alcohol Misuse: A Meta-Analysis

Open access
Riper, Heleen, Blankers, Matthijs, Hadiwijaya, Hana, Cunningham, John, Clarke, Stella, Wiers, Reinout, Ebert, David, Cuijpers, Pim·2014·PLoS ONE
DOI 10.1371/journal.pone.0099912PMC PMC4061051
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Abstract

BACKGROUND: Alcohol misuse ranks within the top ten health conditions with the highest global burden of disease. Low-intensity, Internet interventions for curbing adult alcohol misuse have been shown effective. Few meta-analyses have been carried out, however, and they have involved small numbers of studies, lacked indicators of drinking within low risk guidelines, and examined the effectiveness of unguided self-help only. We therefore conducted a more thorough meta-analysis that included both guided and unguided interventions. METHODS: Systematic literature searches were performed up to September 2013. Primary outcome was the mean level of alcohol consumption and drinking within low risk guidelines for alcohol consumption at post-treatment. FINDINGS: We selected 16 randomised controlled trials (with 23 comparisons and 5,612 participants) for inclusion. Results, showed a small but significant overall effect size in favour of Internet interventions (g = 0.20, 95% CI: 0.13-0.27, p<.001). Participants in Internet interventions drunk on average 22 grams of ethanol less than controls and were significantly more likely to be adhering to low-risk drinking guidelines at post-treatment (RD 0.13, 95% CI: 0.09-0.17, p<.001). Subgroup analyses revealed no significant differences in potential moderators for the outcome of alcohol consumption, although there was a near-significant difference between comparisons with waitlist control and those with assessment-only or alcohol information control conditions (p = .056). CONCLUSIONS: Internet interventions are effective in reducing adult alcohol consumption and inducing alcohol users to adhere to guidelines for low-risk drinking. This effect is small but from a public health point of view this may warrant large scale implementation at low cost of Internet interventions for adult alcohol misuse. Moderator analyses with sufficient power are, however, needed in order to assess the robustness of these overall results and to assess whether these interventions may impact on subgroups with different levels of success.

AI snapshot

Written from the paper’s full text.

TL;DR

This meta-analysis of 16 RCTs (23 comparisons, 5,612 participants) found that low-intensity Internet interventions for adult alcohol misuse produced a small but significant reduction in alcohol consumption versus controls (g = 0.20) and increased adherence to low-risk drinking guidelines. Effects were not significant at 6–12 month follow-up for the unguided interventions with available follow-up data.

Key findings

  • Overall post-treatment effect favoured Internet interventions: g = 0.20 (95% CI: 0.13–0.27, p < .001; NNT = 8.93). Intervention participants drank on average 22 grams of ethanol less per week than controls (n = 14; 95% CI: 0.87–3.46, p = .001).
  • Intervention participants were significantly more likely to be drinking within low-risk guidelines at post-treatment: RD = 0.13 (95% CI: 0.09–0.17, p < .001; n = 6).
  • Subgroup analyses found no significant moderators for alcohol consumption. Control type was near-significant (p = .056): waitlist g = 0.48, alcohol brochure g = 0.20, assessment-only g = 0.15. Guided (g = 0.23) versus unguided (g = 0.20) did not differ significantly.
  • At 6–12 month follow-up, no significant difference remained for six unguided interventions (8 comparisons): g = 0.06 (95% CI: −0.14–0.25, p = .567). Publication bias was indicated: trim-and-fill reduced g from 0.20 to 0.14 (95% CI: 0.06–0.22; 8 trimmed studies), and Egger’s test was significant (p = .028).

Methods

  • Systematic literature searches up to September 2013 in MEDLINE, PsycINFO, Science Citation Index Expanded, Social Sciences Citation Index, Arts and Humanities Citation Index, CINAHL, PUBMED, and EMBASE. Included RCTs comparing web-based low-intensity self-help interventions (guided or unguided) with assessment-only, waitlist, or alcohol information brochure controls; adults aged 18+ exceeding low-risk drinking guidelines; primary outcome was mean alcohol consumption and drinking within low-risk guidelines at post-treatment.
  • Included 16 RCTs with 23 comparisons and 5,612 participants (3,268 experimental, 2,344 control). Random-effects meta-analysis calculated Hedges’s g; heterogeneity assessed with I²; subgroup and meta-regression analyses examined moderators; publication bias assessed with funnel plots, Egger’s test, and Duval and Tweedie trim-and-fill; risk of bias assessed with Cochrane criteria.

Limitations

  • Stated by the paper: the number of studies in subgroup analyses was low, limiting statistical power; some included studies had substantial dropout rates above 30%; control group drinking assessment may have motivated controls to reduce consumption, possibly underestimating intervention effects; negative side-effects could not be evaluated because studies lacked reports on them.
  • Evident from the text: publication bias was detected, with trim-and-fill reducing the pooled effect size; follow-up effects were non-significant for unguided interventions; only 5 guided comparisons were available, limiting conclusions about guided versus unguided interventions.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1371/journal.pone.0099912

Cites

85 of 85 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 61 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    There was evidence of publication bias by Duval and Tweedie's trim-and-fill method.

    “There was evidence of publication bias in terms of Duval and Tweedie’s trim-and-fill method.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Egger's test indicated an asymmetric funnel plot (p = .028, two-tailed).

    “Egger’s test indicated an asymmetric funnel plot (p = .028, two-tailed).”
    Quote in the paperSubstantial claim
  • Findingown data

    Participants in Internet interventions drank on average 22 grams of ethanol less than controls.

    “Participants in Internet interventions drunk on average 22 grams of ethanol less than controls”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control conditions used in the included trials (assessment-only, waitlist, alcohol information brochure) function as no-intervention controls.
    • Rests on an assumption: Self-reported alcohol consumption is a valid measure of actual drinking.
  • Findingown data

    No significant difference in effect remained at follow-up (6 to 12 months after baseline) between the six unguided interventions (8 comparisons) and control groups (g = 0.06, 95% CI −0.14-0.25, p = .567).

    “No significant differences in effect remained at follow-up (6 to 12 months after baseline) between the six unguided interventions (8 comparisons) and control groups (g = 0.06, 95% CI: −0.14–0.25, p = .567, random effects model) for which such follow-up assessments were available.”
    Quote in the paperSubstantial claim
  • Findingown data

    Participants in Internet interventions were significantly more likely to be adhering to low-risk drinking guidelines at post-treatment (RD 0.13, 95% CI: 0.09-0.17, p<.001).

    “and were significantly more likely to be adhering to low-risk drinking guidelines at post-treatment (RD 0.13, 95% CI: 0.09–0.17, p<.001).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control conditions used in the included trials (assessment-only, waitlist, alcohol information brochure) function as no-intervention controls.
    • Rests on an assumption: Self-reported alcohol consumption is a valid measure of actual drinking.
  • Classified as probably not a substantial claim. 32
  • May combine two claims. 11

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Six studies used personalised normative feedback as a single-focus therapeutic strategy.

    “Seven studies applied a single-focus therapeutic strategy, which in six cases was personalised normative feedback (PNF) and in one case a generic health education approach.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One study selected on the basis of GGT testing.

    “Two studies applied both AUDIT and alcohol consumption cut-off points; one selected on the basis of GGT (gamma-glutamyl transpeptidase) testing.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Seven studies applied a single-focus therapeutic strategy.

    “Seven studies applied a single-focus therapeutic strategy, which in six cases was personalised normative feedback (PNF) and in one case a generic health education approach.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Five other studies applied the Alcohol Use Identification Test (AUDIT) or the Fast Alcohol Screening Test (FAST).

    “Five other studies applied the Alcohol Use Identification Test (AUDIT [55]) or the Fast Alcohol Screening Test (FAST [56]).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [55] JB Saunders, 1993, Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption II, Addiction source

      Not checked in the free run.

    • cites [56] R Hodgson, 2002, The FAST Alcohol Screening Test, Alcohol Alcohol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The other nine studies used combined treatment approaches consisting of motivational interviewing, personalised normative feedback, cognitive-behavioural therapy and/or behavioural self-control and change principles.

    “The other nine studies used combined treatment approaches consisting of motivational interviewing (MI), personalised normative feedback (PNF), cognitive-behavioural therapy (CBT) and/or behavioural self-control and change principles.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The outcome assessments to indicate alcohol consumption were expressed in terms of mean standard drinks per drinking day, total numbers of standard drinks in the previous week, mean standard drinks per drinking occasion or amounts of alcohol in grams.

    “The outcome assessments to indicate alcohol consumption were expressed in terms of mean standard drinks per drinking day, total numbers of standard drinks in the previous week, mean standard drinks per drinking occasion or amounts of alcohol in grams.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In five studies, sample inclusion was based on self-reported alcohol consumption using cut-off points indicative of alcohol use exceeding low-risk guidelines, with differing levels for men and women.

    “In five studies, sample inclusion was based on self-reported alcohol consumption, using cut-off points indicative of alcohol use exceeding low-risk guidelines, with differing levels for men and women.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The meta-analysis included 16 randomised controlled trials with 23 comparisons and 5,612 participants (3,268 in experimental and 2,344 in control conditions).

    “We selected 16 randomised controlled trials (with 23 comparisons and 5,612 participants) for inclusion.”
    • Also stated in: § Characteristics of Included Studies · plain
      “Table 1 summarises the selected characteristics of the 16 studies (containing 23 comparisons) included in the meta-analysis.”
    • Also stated in: § Characteristics of Included Studies · plain
      “The studies assessed a total of 5,612 participants (3,268 in experimental and 2,344 in control conditions)”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The control groups represented assessment-only (n = 6), waitlisted (n = 3) or alcohol information brochure conditions (n = 7).

    “The control groups represented assessment-only (n = 6), waitlisted (n = 3) or alcohol information brochure conditions (n = 7).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One study used a generic health education approach as a single-focus therapeutic strategy.

    “Seven studies applied a single-focus therapeutic strategy, which in six cases was personalised normative feedback (PNF) and in one case a generic health education approach.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Sensitivity analyses including only one effect size per study showed that removal of the comparisons with the highest effect sizes and removal of the comparisons with the lowest effect sizes had almost no influence on the pooled effect size.

    “As table 2 shows, removal of the comparisons with the highest effect sizes had almost no influence on the pooled effect size nor did removing the comparisons with the lowest effect sizes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Meta-regression uncovered no significant associations between effect size and either the number of alcohol intervention sessions or the risk of bias.

    “Meta-regression analyses with Hedges’s g as the dependent variable uncovered no significant associations between effect size and either the number of alcohol intervention sessions (β = −0.0001, 95% CI: −0.004–0.003, p = .938) or the risk of bias (β = 0.068, 95% CI: −0.15–0.01, p = .089) in the studies assessed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Two of the sixteen studies included anyone interested in participating.

    “Two of the sixteen studies [57], [58] included anyone interested in participating; for these studies, we confined our analysis to subgroups belonging to the at-risk drinking population.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [57] DM Doumas, 2008, Preventing high-risk drinking in youth in the workplace: a web-based normative feedback program, J Subst Abuse Treat source

      Not checked in the free run.

    • cites [58] MR Pemberton, 2011, Evaluation of two web-based alcohol interventions in the U.S. military, J Stud Alcohol Drugs source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Two studies applied both AUDIT and alcohol consumption cut-off points.

    “Two studies applied both AUDIT and alcohol consumption cut-off points; one selected on the basis of GGT (gamma-glutamyl transpeptidase) testing.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    AUDIT scores among studies using stricter measurements were high (averaging around 20), indicating a potentially high risk of alcohol dependence amongst participants.

    “AUDIT scores among the latter were high (averaging around 20, indicating a potentially high risk of alcohol dependence amongst participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Guided Internet interventions are as effective as face-to-face interventions for depression or anxiety.

    “and that guided Internet interventions are as effective as face to face interventions [36].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Cuijpers P, Donker T, van Straten A, Li J, Andersson G (2010) Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychol Med 1–15. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Ten studies used intention-to-treat analyses.

    “The risk of bias varied among the studies (table 1), with 14 studies reporting adequate sequence generation, 6 reporting allocation to conditions by an independent party, 15 reporting blinding of outcome assessors or using self-report outcomes only, and 10 using intention-to-treat analyses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The same raters assessed the effect sizes and moderator variables in the included studies.

    “The same raters assessed the effect sizes and moderator variables in the included studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Fourteen studies reported adequate sequence generation.

    “The risk of bias varied among the studies (table 1), with 14 studies reporting adequate sequence generation, 6 reporting allocation to conditions by an independent party, 15 reporting blinding of outcome assessors or using self-report outcomes only, and 10 using intention-to-treat analyses.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The validity of included studies was assessed on the basis of four criteria from the Cochrane Collaboration risk-of-bias assessment tool.

    “We assessed the validity of the included studies on the basis of four criteria from the risk-of-bias assessment tool developed by the Cochrane Collaboration [39].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] Higgins JPT, Green S (2008 February) Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0. The Cochrane Collaboration. Available. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All papers included or excluded at all stages were assessed by two independent raters (authors HR and HH).

    “All papers included or excluded at all stages were assessed by two independent raters (authors HR and HH) (see figure 1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Richards and Richardson were able to include 19 RCTs on depression in their 2012 meta-analysis.

    “For example, Richards and Richardson [34] were able to include 19 RCTs on depression in their 2012 meta-analysis.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] D Richards, 2012, Computer-based psychological treatments for depression: a systematic review and meta-analysis, Clin Psychol Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Authors HH and MB assessed risk of bias as Yes, No or Unclear using the Cochrane Collaboration tool.

    “Authors HH and MB assessed risk of bias as Yes, No or Unclear using the Cochrane Collaboration tool (see 2.3).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    For depression and anxiety disorders, overall evidence is accumulating that guided interventions generally lead to a greater reduction of symptoms than unguided interventions.

    “For these disorders, overall evidence is accumulating that guided interventions generally lead to a greater reduction of depressive or anxiety symptoms than unguided interventions [34], [35]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [34] D Richards, 2012, Computer-based psychological treatments for depression: a systematic review and meta-analysis, Clin Psychol Rev source

      Not checked in the free run.

    • cites [35] P Cuijpers, 2009, Computer-aided psychotherapy for anxiety disorders: a meta-analytic review, Cogn Behav Ther source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Six studies reported allocation to conditions by an independent party.

    “The risk of bias varied among the studies (table 1), with 14 studies reporting adequate sequence generation, 6 reporting allocation to conditions by an independent party, 15 reporting blinding of outcome assessors or using self-report outcomes only, and 10 using intention-to-treat analyses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    This is the first meta-analysis that includes both guided and unguided Internet interventions to address problematic alcohol consumption among adults.

    “To the best of our knowledge, this is the first meta-analysis that includes both guided and unguided Internet interventions to address problematic alcohol consumption among adults.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Riper meta-analysis identified only 7 eligible randomised controlled trials.

    “The Riper meta-analysis [26], for example, identified only 7 eligible randomised controlled trials.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] H Riper, 2011, Effectiveness of E-self-help interventions for curbing adult problem drinking: a meta-analysis, J Med Internet Res source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Dropout rates varied from 0% to 42%.

    “Dropout rates varied from 0% to 42%.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Fifteen studies reported blinding of outcome assessors or using self-report outcomes only.

    “The risk of bias varied among the studies (table 1), with 14 studies reporting adequate sequence generation, 6 reporting allocation to conditions by an independent party, 15 reporting blinding of outcome assessors or using self-report outcomes only, and 10 using intention-to-treat analyses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    In reporting the results, the authors followed the guidelines of the PRISMA statement.

    “In reporting the results we followed the guidelines of the PRISMA statement (see Checklist S1) [54].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] D Moher, 2010, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, Int J Surg source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Any disagreement between raters was resolved by discussion.

    “Any disagreement was resolved by discussion.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Decreasing alcohol consumption as well as abstinence and adherence to low-risk guidelines are health benefits in their own right and potential predictors of longer-term maintenance of decreased alcohol consumption.

    “Decreasing alcohol consumption as well as abstinence and adherence to low-risk guidelines are health benefits in their own right and potential predictors of longer-term maintenance of decreased alcohol consumption [85].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [85] M Roerecke, 2013, Reduction of alcohol consumption and subsequent mortality in alcohol use disorders: systematic review and meta-analyses, J Clin Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Jonas and colleagues showed that those receiving primary care alcohol interventions were 11% more likely to stay within guidelines compared with controls.

    “This is in line with the study of Jonas and colleagues [15] who showed that those receiving primary care alcohol interventions were 11% more likely to do so when compared with controls.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] DE Jonas, 2012, Behavioral counseling after screening for alcohol misuse in primary care: a systematic review and meta-analysis for the U.S. Preventive Services Task Force, Ann Intern Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    High study and treatment dropout rates are a common phenomenon in both online and offline self-help interventions for alcohol misuse and in Internet interventions in general.

    “High study (and treatment) dropout rates are a common phenomenon in both online and offline self-help interventions for alcohol misuse and in Internet interventions in general [81], [82].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [81] G Eysenbach, 2005, The law of attrition, J Med Internet Res source

      Not checked in the free run.

    • cites [82] MG Postel, 2011, Attrition in web-based treatment for problem drinkers, J Med Internet Res source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A decay of intervention effects is not uncommon; larger effect sizes are generally found at the earliest follow-ups.

    “Such a decay of intervention effects is not uncommon; larger effect sizes are generally found at the earliest follow-ups [15], [68].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [15] DE Jonas, 2012, Behavioral counseling after screening for alcohol misuse in primary care: a systematic review and meta-analysis for the U.S. Preventive Services Task Force, Ann Intern Med source

      Not checked in the free run.

    • cites [68] A Moyer, 2002, Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations, Addiction source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Meta-analyses of face-to-face primary care samples and of non-clinical samples performing postal self-help interventions based on bibliotherapy have shown significant small to moderate effect sizes for curbing alcohol misuse.

    “The current overall effect also compares with meta-analyses of face-to-face primary care samples [3], [30], [67], [68] and of non-clinical samples performing postal self-help interventions based on bibliotherapy [69]–[71]. These studies all showed significant small to moderate effect sizes for curbing alcohol misuse.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [3] VA Moyer, 2013, Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. preventive services task force recommendation statement, Ann Intern Med source

      Not checked in the free run.

    • cites [30] Kaner EF, Beyer F, Dickinson HO, Pienaar E, Campbell F, et al. (2007) Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev CD004148. source

      Not checked in the free run.

    • cites [67]–[71]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Internet-based interventions for alcohol misuse, female uptake appears equally as high as male uptake and they have been seen to have similar impacts on female and male drinking, or possibly even greater influence on females.

    “In the case of Internet-based interventions for alcohol misuse, however, female uptake appears equally as high as male uptake [28], [77] and have been seen to have similar impacts on female and on male drinking, or possibly even greater influence on females, as suggested by Riper and colleagues (2008, [78]).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [28] H Riper, 2009, Translating effective web-based self-help for problem drinking into the real world, Alcohol Clin Exp Res source

      Not checked in the free run.

    • cites [77] JA Cunningham, 2010, Internet-based interventions for problem drinkers: From efficacy trials to implementation, Drug Alcohol Rev source

      Not checked in the free run.

    • cites [78] H Riper, 2008, Predicting successful treatment outcome of web-based self-help for problem drinkers: secondary analysis from a randomized controlled trial, J Med Internet Res source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A modelling study by Smit and colleagues suggested that if online interventions were to partially replace conventional face-to-face brief alcohol interventions, that could sustain comparable levels of population health at lower costs.

    “A modelling study by Smit and colleagues [86] has suggested that if online interventions were to partially replace conventional face-to-face brief alcohol interventions, that could sustain comparable levels of population health at lower costs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [86] F Smit, 2011, Modeling the cost-effectiveness of health care systems for alcohol use disorders: how implementation of eHealth interventions improves cost-effectiveness, J Med Internet Res source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The literature is somewhat inconclusive but provides some confirmation for the current findings on single-session versus extended interventions.

    “Although the literature is somewhat inconclusive [75], it provides some confirmation for our current findings [30], [68], [76].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [75] VA Moyer, 2013, Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. preventive services task force recommendation statement, Ann Intern Med source

      Not checked in the free run.

    • cites [30] Kaner EF, Beyer F, Dickinson HO, Pienaar E, Campbell F, et al. (2007) Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev CD004148. source

      Not checked in the free run.

    • cites [68] A Moyer, 2002, Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations, Addiction source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Some studies of brief interventions for problem drinking have reported positive influences on alcohol reduction up to four years later and on mortality.

    “Some studies of brief interventions for problem drinking have nonetheless reported positive influences on alcohol reduction up to four years later [67] and on mortality [72].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [67] A O’Donnell, 2014, The impact of brief alcohol interventions in primary healthcare: a systematic review of reviews, Alcohol Alcohol source

      Not checked in the free run.

    • cites [72] P Cuijpers, 2004, The effects on mortality of brief interventions for problem drinking: a meta-analysis, Addiction source

      Not checked in the free run.

40 of 40

  • The paper relies on this without support.

    The control conditions used in the included trials (assessment-only, waitlist, alcohol information brochure) function as no-intervention controls.

    “compared a web-based intervention with a control group (in an assessment-only, waitlisted or alcohol information brochure control condition)”
    “in comparison with no-intervention controls”

  • The paper relies on this without support.

    Self-reported alcohol consumption is a valid measure of actual drinking.

    “blinding of outcome assessors or using self-report outcomes only”
    “The outcome assessments to indicate alcohol consumption were expressed in terms of mean standard drinks per drinking day, total numbers of standard drinks in the previous week, mean standard drinks per drinking occasion or amounts of alcohol in grams.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • On a population level, gains from unguided e-mental health interventions could be considerable because they can be scaled up at relatively low financial expense (no costs for therapists or coaches).

    “On a population level, the gains could then be considerable, given that such unguided interventions can be scaled up at relatively low financial expense as there are no costs for therapists or coaches involved (Donker et al., 2009; Riper et al., 2014).”

    From The effect of e-mental health interventions on academic performance in university and college students: A meta-analysis of randomized controlled trials (2020) · cites this paper as Riper et al., 2014

    The Discussion (Clinical Implications; page unavailable) says the public-health impact of internet interventions for alcohol misuse could be substantial with broad uptake, and the Conclusion supports scaling them up. The Introduction notes potential economic gains, but the paper does not establish that unguided interventions can be scaled at relatively low cost specifically because they incur no therapist or coach costs. Its findings also concern alcohol misuse, rather than e-mental health interventions generally. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Guided digital treatments for alcohol and substance abuse show significant but more modest benefits.

    “Several RCTs of guided digital treatments for alcohol and substance abuse have shown significant but more modest benefits of DMHTs (31, 32).”

    From Banbury forum consensus statement on the path forward for digital mental health treatment (2021) · cites this paper as [31]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Meta-regression estimate lies outside its confidence interval

    Minor

    The reported coefficient of 0.068 is greater than the upper bound of its reported 95% confidence interval, 0.01.

  • Reported dropout range excludes a 45% study

    Minor

    The stated maximum dropout rate is 42%, but Table 1 reports 45% for Wallace (2011).

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. Latimer N, Guillaume L (2009) Prevention and early identification of alcohol use disorders in adults and young people: screening and brief interventions: cost effectiveness review. Sheffield: ScHARR Public Health Collaborating Centre.
  2. Cohen J (1997) Statistical power analyses for the behavioral sciences (revised ed.). New York: Academic Press.
  3. VA Moyer, 2013, Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. preventive services task force recommendation statement, Ann Intern Med, 159, 210, 10.7326/0003-4819-159-3-201308060-00652 · DOI · Paper page
  4. J McCambridge, 2014, Regression to the mean and alcohol consumption: a cohort study exploring implications for the interpretation of change in control groups in brief intervention trials, Drug Alcohol Depend, 135, 156, 10.1016/j.drugalcdep.2013.11.017 · DOI · Paper page

Cited by

Sorted by citations

Related

Authors
Riper, H., Blankers, M., Hadiwijaya, H., Cunningham, J., Clarke, S., Wiers, R., Ebert, D., & Cuijpers, P.
Affiliations
  • Leuphana University of Lüneburg (DE)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • Tilburg University (NL)
  • Australian National University (AU)
  • NHS Fife (GB)
  • University of Amsterdam (NL)
Corresponding author
Riper, Heleen
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2014-06-17
Volume
9
Issue
6
Pages
e99912
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0099912
PMC
PMC4061051
OpenAlex
W2102290516
Cited by
265
References
85
Citations by year
2026: 4 · 2025: 7 · 2024: 9 · 2023: 11 · 2022: 11 · 2021: 36 · 2020: 25 · 2019: 24 · 2018: 34 · 2017: 38 · 2016: 35 · 2015: 24 · 2014: 6
FWCI
4.58
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UvA-DARE (University of Amsterdam) (publishedVersion, other-oa)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
  • Multilingual Matters (Channel View Publications) (publishedVersion, cc-by)
  • VU Research Portal (publishedVersion, other-oa)
  • Research portal (Tilburg University) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • ANU Open Research (Australian National University) (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
Keywords
alcohol abuse, online intervention, low-intensity intervention, guided self-help, alcohol consumption, low-risk drinking guidelines, alcohol consumption reduction
MeSH terms
Alcohol Drinking, Alcoholism, Humans, Patient Compliance, Health Behavior, Randomized Controlled Trials as Topic, Treatment Outcome, Internet

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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