A systematic review of internet-delivered cognitive behavior therapy for alcohol misuse: study characteristics, program content and outcomes

Figures & data

Figure 1. Flow chart.

Figure 2. Risk of bias.

Table 1. Characteristics of included studies.

Author	Mean age (SD)	Gender	Name of intervention	N	Control	Number of modules	Follow-up	Attrition	Alcohol-related outcomes
Blankers et al. (2011)	Overal = 42.2 (9.7)	F = 51% M = 49%	Therapy Alcohol Online/ Self-Help Alcohol Online	205	Self-guided Waitlist	Therapy Alcohol Online = 7 Self-help Alcohol Online = 4	3 months 6 months	3 months = 30% 6 months = 40%	Drinks preceding week
Brendryen et al. (2014)	Exp. = 39 (14) Control = 37 (13)	F = 33% M = 67%	Balance	244	E-booklet on Alcohol Education	62	2 months 6 months	2 months Exp. = 52% Con. = 24% 6 months Exp. = 42% Con. = 21%	Drinks preceding week
Brendryen et al. (2017)	Overall = 43 (11)	F = 52% M = 48%	Balance	85	E-booklet on Alcohol Education	62	2 months 6 months	2 months Exp. = 40% Con. = 29% 6 months Exp. = 35% Con. = 17%	Drinks preceding week
Brief et al. (2013)	Exp. = 32 (7.8) Control = 32.1 (7.7)	F = 14% M = 86%	VetChange	600	Waitlist	8	8 weeks 3 months	8 weeks Exp. = 52% Con. = 60% 3 months Exp. = 55% Con. = 60%	Median drinks per drinking day Median drinks per week Median percent heavy drinking days
Cunningham (2012)	Overall = 45 (12.2)	F = 41% M = 59%	Alcohol Help Center	170	eSBI (Check Your Drinking)	20	6 months	6 months Exp. = 8% Con. = 11%	Drinks in a typical week AUDIT-C Highest number of drinks on one occasion
Cunningham et al. (2017)	Exp. = 37.6 (13.9) Control = 37.5 (13.6)	F = 50% M = 50%	Alcohol Help Center	490	eSBI (Check Your Drinking)	20	6 months 12 months 24 months	6 months Exp. = 21.9% Con. = 13.4% 12 months Exp. = 19.1% Con. = 14.2% 24 months Exp. = 20.7% Con. = 17.6%	Drinks in a typical week AUDIT-C Highest number of drinks on one occasion
Farren et al. (2015)	Exp = 45 (14.2) Control = 45 (14.7)	F = 29% M = 71%	(no name provided)	55	Placebo (Cognitive stimulation computer exercises)	5	1 month 2 months 3 months	3 months Exp. = 35.5% Con. = 37.5%	Continuous abstinence 30-day abstinence Units per drinking day
Hester et al. (2013)	Overall = 44.3 (10.9)	F = 60.6% M = 39.4%	Overcoming Addictions	188	Group meetings (SMART Recovery)	4	3 months	3 months Exp. = 19% Con. = 21%	Percent days abstinent Drinks per drinking day
Kiluk et al. (2016)	Overall = 42.7 (11.9)	F = 35.3% M = 64.7%	CBT4CBT	68	Treatment as usual (weekly group or individual psychotherapy)	7	8 weeks 1 month 3 months 6 months	Total = 54.5%	Percent days abstinent Percent heavy drinking days
Postel et al. (2010)	Overall = 45.3 (9.8)	F = 54% M = 46%	Alcohol Debaas	156	Waitlist	9	3 months	Total = 34.6%	Drinks preceding week
Riper et al. (2007)	Exp. = 45.9 (8.9) Con. = 46.2 (9.2)	F = 49% M = 51%	Mindern Drinken	261	E-booklet on Alcohol Education	4	6 months	Total = 42.1%	Percentage drinking within normative limits Drinks per week
Sinadinovic et al. (2014)	Exp. = 43.8 (11.9) Comp. = 44 (13.6) Con. = 44.1 (12.1)	F = 55% M = 45%	Alkoholhjälpen	633	eSBI (eScreen) Control	18	3 months 6 months 12 months	Total = 45.3%	AUDIT-C AUDIT
Sundström et al. (2016)	Exp 1 = 40.6 (11.8) Exp 2 = 43.2 (9.8) Control = 42.7 (13.4)	F = 60% M = 40%	eChange	80	Self-guided	8	10 weeks	10 weeks Exp. 1 = 15% Exp. 2 = 25% Control = 52.5%	Drinks preceding week AUDIT AUDIT-C
Wallace et al. (2011)	Overall = 38 (-)	F = 57% M = 43%	Down Your Drink	7935	E-booklet on Alcohol Education	6	1 month 3 months 12 months	3 months Exp. = 56% Con. = 48% 12 months Exp. = 69% Con. = 66%	Drinks preceding week Highest number of drinks on one occasion

Table 2. Categories of modules identified in the programs. “X” indicates presence of the subcategory.

			Blankers et al., 2011: Therapy Alcohol Online/Self-help Alcohol Online	Brendryen et al., 2014: Balance	Brief et al., 2013: VetChange	Cunningham, 2012: Alcohol Help Center	Farren et al., 2015: No name provided	Hester et al., 2013: Overcoming Addictions	Kiluk et al., 2016: CBT4CBT	Postel et al., 2010: Alcohol Debaas	Sinadinovic et al., 2014: Alkoholhjälpen	Sundström et al., 2016: eChange	Wallace et al., 2011: Down your drink
Category 1 Alcohol information	(a) Alcohol education	3		X		X							X
	(b) Personalized feedback	6	X	X	X	X	X						X
Category 2 Preparing for change	(a) Stages of change	3			X			X					X
	(b) Decisional balance	8	X		X	X		X		X	X	X	X
	(c) Goal setting	9	X	X	X	X		X		X	X	X	X
Category 3 Skills training	(a) Risk situations and triggers	9	X		X	X	X	X		X	X	X	X
	(b) Self-control skills	5	X	X		X						X	X
	(c) Coping skills to deal with craving, emotions and thoughts	11	X	X	X	X	X	X	X	X	X	X	X
	(d) Refusal skills	5	X			X			X		X	X
	(e) Problem solving	3						X	X		X
	(f) Social training skills	4			X	X					X		X
	(g) Relapse prevention	9	X	X		X	X	X		X	X	X	X
Category 4 Well-being	(a) Relaxation and mindfulness	4		X		X		X			X
	(b) Exercise and nutrition	4		X		X		X					X
	(c) Sleep	5		X	X			X			X		X
Category 5 Program components	(a) Drinking diary	7	X	X		X				X	X	X	X
	(b) Online Discussion Forum	3	X			X					X
	(c) Automated text or email prompts	6		X	X	X		X				X	X
	(d) BAC calculator	2				X							X

Figure 3. Forest plot with 95% confidence interval.

Blankers, M., Koeter, M. W. J., & Schippers, G. M. (2011). Internet therapy versus internet self-help versus no treatment for problematic alcohol use: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 79(3), 330–341. doi:10.1037/a0023498

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Cunningham, J. A. (2012). Comparison of two internet-based interventions for problem drinkers: Randomized controlled trial. Journal of Medical Internet Research, 14(4), e107. doi:10.2196/jmir.2090

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Farren, C. K., Milnes, J., Lambe, K., & Ahern, S. (2015). Computerised cognitive behavioural therapy for alcohol use disorder: A pilot randomised control trial. Irish Journal of Psychological Medicine, 32(3), 237–246. doi:10.1017/ipm.2014.64

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Kiluk, B. D., Devore, K. A., Buck, M. B., Nich, C., Frankforter, T. L., LaPaglia, D. M., … Carroll, K. M. (2016). Randomized trial of computerized cognitive behavioral therapy for alcohol use disorders: efficacy as a virtual stand-alone and treatment add-on compared with standard outpatient treatment. Alcoholism, Clinical and Experimental Research, 40(9), 1991–2000. doi:10.1111/acer.13162

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Postel, M., de Haan, H., Ter Huurne, E., Becker, E., & de Jong, C. (2010). Effectiveness of a Web-based intervention for problem drinkers and reasons for dropout: Randomized controlled trial. Journal of Internet Medical Research, 12(4), e68. doi:10.2196/jmir.1642

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Sinadinovic, K., Wennberg, P., Johansson, M., & Berman, A. H. (2014). Targeting individuals with problematic alcohol use via Internet-based cognitive-behavioral self-help modules, personalized screening feedback or assessment only: A randomized controlled trial. European Addiction Research, 20, 305–318. doi:10.1159/000362406

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