Cognitive-behavioral therapy (CBT) focuses on challenging and changing unhelpful thoughts and behaviors, and is a proven treatment for alcohol use disorder. However, the training and expert supervision needed to deliver consistent, high-quality face-to-face sessions is costly, limiting the widespread implementation of CBT in clinical practice. Delivering CBT through technology-based platforms, such as web-based programs and mobile apps, has potential to provide widespread and low-cost access to this evidence-based intervention ─but it's important to establish that tech-based CBT is as effective for alcohol treatment as the in-person format. A new report published in the journal Alcoholism: Clinical & Experimental Research systematically examines the evidence for tech-based delivery of CBT for alcohol use by combining data from multiple published studies, using a statistical technique known as meta-analysis.
The researchers (from Yale University, University of California, Brown University, and the Unversity of New Mexico) identified fifteen clinical trials of tech-delivered CBT-based interventions for alcohol use, which together involved almost ten thousand participants. Most of the studies were conducted among at-risk or heavy drinkers, and assessed whether CBT reduced participants' alcohol consumption compared to an assessment-only or usual care approach. The tech-delivered programs varied in length, from 4 to 62 sessions/exercises, and often incorporated elements of other approaches that target patient motivation.
Overall, the results of the meta-analysis showed a benefit for tech-delivered CBT-based interventions when used either as a standalone therapy for heavy drinking or in addition to usual care in specialty substance use settings. Although the effect sizes were modest, there is emerging evidence that even a small reduction in drinking – eg from 4 to 3 drinks a day – is associated with improvements in markers of health and quality of life.
The opportunity for patients to access a tech-based intervention for alcohol use, without the need to attend in-person sessions, greatly enhances the reach of the intervention. However, the researchers caution that because of the varied characteristics of the included CBT interventions and trials, it is too early to draw firm conclusions on the efficacy of individual formats ─and there is currently no suggestion that tech-based CBT should replace in-person or established services for alcohol use treatment.