Considerations for Ecological Momentary Assessments in Alcohol Use: A Narrative Review

Background: Ecological Momentary Assessments (EMAs), a newer method assessing alcohol use, present advantages over Timeline Follow Back (TLFB). EMAs have progressed from telephone calls to smartphone applications, providing opportunities for growth in a naturalistic assessment. This narrative review provides an overview of smartphone-based EMAs in alcohol clinical trials showing strengths/weaknesses, implications of designs, assessment durations, validity, and compliance. Methods: A literature review was conducted from March 2020 to April 2025, with no limitations on article time frame as EMAs are newer. PubMed, PsycINFO, EMBASE, and Web of Science were searched for English peer-reviewed articles. Results: 100 final articles were included. EMAs can collect real-time data, resulting in nuanced alcohol use data, often revealing that TLFB underreports alcohol consumption due to recall bias. EMA validity is influenced by design, intoxication while reporting, and increased awareness of drinking patterns. EMA compliance increases if the study design avoids participant burden, provides incentives, and accounts for participants who react to EMAs by changing their alcohol use patterns. However, this narrative review is limited to focusing on breadth due to research on a high number of different EMAs with few being investigated repeatedly. Conclusions: Additional clinical trials with the same EMAs are needed to continue to establish their validity and refine existing protocols for researchers and clinical trial specialists. EMAs offer advantages including fine-grained/real-time data on alcohol use, avoiding recall bias, and a higher external validity. EMA recommendations include providing drink options, training participants on platform usage, and designing studies based on specific aims.