JMIR Publications

ABSTRACT

Background:

Cognitive-behaviorally-based interventions (CBI) have broad appeal and potential for impact when treating adult alcohol and other drug use (AOD). CBIs delivered through digital platforms (dCBIs) may offer this impact with the benefit of increased accessibility. Although prior reviews have indicated benefits of dCBIs on substance use outcomes, the extension to psychosocial functioning outcomes is unknown.

Objective:

The current meta-analysis provides an overview of dCBI efficacy and effectiveness across range of functional endpoints.

Methods:

A literature search was conducted through October of 2024. All primary and secondary reports of clinical trials of dCBI were obtained and all available study endpoints were eligible for meta-analysis. Descriptive data were extracted and categorized into one of thirteen different outcome types (eg, abstinence, quantity, cognitive, quality of life), and into two broader outcome classes (ie, consumption; psychosocial). Robust variance estimation was used to conduct hypothesis tests on random effects pooled estimates with outcome class and comparison type as the primary sub-group variables of interest.

Results:

The study sample included 65 randomized trials (K = 110 publications; 770 effect sizes) of dCBI for adult AOD. With respect to efficacy, dCBI as a stand-alone treatment in contrast to a minimal treatment control showed positive and statistically significant effects for consumption (g = 0.27, p < .001; I2 = 85.1%; k = 31, kes = 134) and psychosocial (g = 0.16, p = .008; I2 = 75.2%; k = 16, kes = 60) outcomes. As an addition to usual care, efficacy was demonstrated for consumption (g = 0.23, p < .001; I2 = 9.8%; k = 20, kes = 65), but not psychosocial functioning. Efficacy compared to another digital or in person intervention or CBI delivered by a therapist was not observed. Within dCBI condition, large effect sizes were observed for both outcome classes (ie, 60%-80% of participants showed improvement relative to baseline), and effect size magnitude and statistical heterogeneity varied by the type of outcome examined.

Conclusions:

These results show a benefit for dCBI as a stand-alone therapy and an addition to usual care. Importantly, stand-alone effects were observed for both consumption and psychosocial outcomes. This study is the first to offer a comprehensive look at dCBI intervention effects across a range of functional endpoints.