Scoping Review of Implementation Science in Digital Intervention Research for Substance Use Disorders

Digital substance use interventions (DSUI) have demonstrated effectiveness in preventing, treating, and supporting recovery of substance use disorders (SUD), but their large-scale adoption and sustained implementation remain limited. To highlight the state of the science for DSUI implementation research, we conducted a scoping review of relevant studies of implementation of DSUI.

We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping Review guidelines. Search was conducted using keywords (eg, technology, substance use, implementation) in Medline, PsycINFO, and Health Technology Assessment databases. Studies without implementation data, protocols, reviews, editorials, and non-English papers were excluded. Publications were included through February 2023. We screened 4178 abstracts and 148 full texts using Covidence software. We extracted implementation-related data from the included studies and organized it using standardized terminology for implementation determinants, strategies, and outcomes.

The 48 studies represented implementation (n=7), determinant (n=8), and combined effectiveness and implementation studies or hybrid studies (n=33). Most common DSUI were treatment and recovery support approaches for general drug use, most frequently delivered as electronic programs on computers. Only 12 of 48 studies used implementation frameworks. Implementation strategies were rarely described. Acceptability was the most evaluated implementation outcome (n=26), and no study evaluated implementation costs. Evaluation of patient-level implementation determinants and longer-term sustainment outcomes was lacking.

To accelerate translation and improve research rigor, future DSUI research should systematically apply implementation science frameworks to evaluate implementation determinants (including patient-level), document and test implementation strategies, and evaluate outcomes, including fidelity, cost, and sustainment.