Alcohol is the third leading risk factor for burden of disease in the world, causing harm to both the individual drinker and the community. Despite the existence of effective, evidence-based treatments such as motivational interviewing and cognitive behavioral therapy (CBT), alcohol misuse is greatly undertreated, with less than 15% of those with an alcohol use disorder estimated to receive treatment. Internet-delivered cognitive behavior therapy (ICBT) could potentially reduce the harms of alcohol misuse as it can overcome common barriers to treatment. For example, ICBT can provide treatment access to individuals living in rural areas without feasible travel options. Also, individuals with busy schedules can access ICBT on their own without having to make time for, or schedule, treatment. Importantly, individuals concerned about stigma related to accessing face-to-face treatment may prefer ICBT as a way to privately manage their issues. ICBT for alcohol misuse typically incorporates relapse prevention, a common approach aiming to help clients identify risk situations, develop effective coping strategies and prepare for future slips or relapses As of yet there is no review focusing specifically on ICBT for alcohol misuse. Past reviews have combined studies on ICBT and electronic screening and brief intervention (eSBI), a form of secondary prevention originally developed to identify people with alcohol problems in non-addiction health care settings and help them reflect on their alcohol consumption. With ICBT currently being implemented in mental health care settings around the world, a review could help inform policy makers and clinicians about current evidence, thus providing clinical guidelines for implementation. This review aimed to provide an overview of characteristics, program content and outcomes among published studies on ICBT for alcohol misuse. We included 14 studies. Most studies included participants from the general population, while studies conducted within clinic settings with diagnosed individuals were rare. The programs were similar content-wise, combining modules helping clients in a) preparing for change and b) learning skills training. Small effects were seen in studies on self-guided ICBT, while therapist-guided ICBT rendered moderate to large effects. In sum, the current review suggests that ICBT can help people reduce their alcohol consumption, at least in the short-term. Larger studies evaluating ICBT compared to active control groups especially within clinical settings are warranted.It is unknown whether clients with severe psychiatric comorbidity are suitable for ICBT as these clients were typically not included in the trials included in this review.
Read the full paper: Hadjistavropoulos, H. D., Mehta, S., Wilhelms, A., Keough, M. T., & Sundström, C. (in press). A systematic review of internet-delivered cognitive behavior therapy for alcohol misuse: Study characteristics, program content and outcomes. Cognitive Behaviour Therapy. doi: 10.1080/16506073.2019.1663258
Photo by: Per Carlbring
Pictured: Heather D. Hadjistavropoulos
Pictured: Christopher Sundström