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

The DOI matches its Crossref record; 85 of the 85 references it cites were found in a registry or an index; none of the 61 sources its claims cite is checked for support yet.

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

Open access

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.

Overview

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.

Figures

Figure 1 Study inclusion meta-analysis: flow chart.
Figure 1 Study inclusion meta-analysis: flow chart.CC BY · PubMed Central
Figure 2 Results of meta-analysis: forest plot.
Figure 2 Results of meta-analysis: forest plot.CC BY · PubMed Central

Verification

Claims the paper makes

37 Not checked yet · 31 Own result · 16 Own method · 5 Own interpretation · 2 No basis given

Verify all 61 references — free account

Show all 51 claims

  • Probably not a substantial claim. 32
  • It may state two separate claims as one. 11
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

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Citations

Cites

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

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Metadata

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
Venue
PLoS ONE
Published
2014-06-17
Volume
9
Issue
6
Pages
e99912
ISSN
1932-6203 (ISSN-L)
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
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

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