Digitally Delivered Cognitive Behavioral Interventions for Alcohol and Other Drug Use: Meta-Analysis Across...

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

This meta-analysis provides an overview of dCBI effects across a range of functional end points.

A literature search was conducted through October 2024. All primary and secondary reports of clinical trials of dCBI were obtained, and all available study end points were eligible for meta-analysis. Descriptive data were extracted and categorized into 1 of 13 different outcome types (eg, abstinence, quantity, cognitive, and quality of life) and into 2 broader outcome classes (ie, consumption and psychosocial). Robust variance estimation was used to conduct hypothesis tests on random effects pooled estimates with outcome class and comparison type as the primary subgroup variables of interest.

The study sample included 65 randomized trials (K=110 publications; 753 effect sizes) of dCBI for adult alcohol and other drug use. 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; k_es=134) and psychosocial (g=0.16; P=.008; I²=75.2%; k=16; k_es=60) outcomes. As an addition to usual care, efficacy was demonstrated for consumption (g=0.23; P<.001; I²=9.8%; k=20; k_es=65), but not psychosocial functioning. Efficacy compared to another digital or in-person intervention or cognitive behaviorally based intervention delivered by a therapist was not observed. Within the 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.

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 some psychosocial outcomes. This study is the first to offer a comprehensive look at dCBI intervention effects across a range of functional end points.