Eric Dedert, PhD
John W. Williams, Jr., MD, MHSc
Roy Stein, MD;
J. Murray McNeil, PhD;
Jennifer McDuffie, PhD;
Isabel Ross, MD;
Caroline Feiermuth, MD;
Adam Hemminger, BA;
Andrjez Kosinski, PhD
Evidence-based Synthesis Program (ESP) Center, Durham VA Medical Center,
Washington (DC): Department of Veterans Affairs; September 2014
Alcohol misuse is the third leading cause of preventable death in the United States and the third
leading cause of morbidity and mortality worldwide. The associated costs amount to more than
1% of the gross national product in high-and middle-income countries. Substance use disorders,
including alcohol use disorder (AUD), are among the most common and most costly conditions
in Veterans presenting for treatment in the Veterans Health Administration (VHA) system.
Traditional treatment for AUD—intensive, but time-limited initial interventions, then less
intensive follow-up care—can be prohibitive because of barriers such as sufficient funding, time,
and adequately trained personnel. Even screening and brief interventions for less severe alcohol
misuse, which have been recommended by the U.S. Preventive Services Task Force (USPSTF),
require financial and clinical resource investments that can be problematic. Thus, electronic
interventions (e-interventions) may prove a useful way to extend the reach of traditional
interventions for alcohol misuse or AUD.
Eighty-seven percent of the U.S. population uses
the Internet. Thus, e-interventions have the potential
to reach those individuals with drinking problems
who wish to remain anonymous; those who live
at great distance from, cannot afford, or have little
time for traditional therapy; and shift workers who
need treatment to be available during non-standard
business hours. Given that Veterans can encounter
most, if not all, of these barriers to accessing care
for alcohol misuse, e-interventions may prove a
promising new avenue, especially for the younger,
more Internet-savvy Veterans returning from Iraq and
Although prior reviews have evaluated computerbased
interventions for alcohol misuse, our study
includes a broader array of e-interventions, evaluates
effects separately for student and non-student
populations, and focuses on studies that report longer
term, clinically important outcomes. In order to
inform policy on alcohol misuse for VHA, we offer
a systematic review of the randomized controlled
trials (RCTs) assessing CD-ROM-based, web-based,
interactive voice response (IVR), or mobile applications of e-interventions for alcohol misuse.
We assess for changes in alcohol consumption, effects on medical health, and social or legal
consequences of alcohol misuse.
Key Question #1: For e-interventions targeting adults who misuse alcohol or who have a diagnosis
of AUD, what level, type, and modality of user support is provided (eg, daily telephone
calls, weekly email correspondence), by whom (eg, professional counselor, technical
support staff), and in what clinical context (adjunct to therapy or primary intervention)?
Key Question #2: For adults who misuse alcohol but do not meet diagnostic criteria for AUD, what
are the effects of e-interventions compared with inactive controls?
Key Question #3: For adults at high risk of AUD (eg, AUDIT-C > 8), or who have a diagnosis of
AUD, what are the effects of e-interventions compared with inactive controls?
Key Question #4: For adults who misuse alcohol, are at high risk of AUD, or have a diagnosis of
AUD, what are the effects of e-interventions alone or used in combination with face-toface
therapy compared with face-to-face therapy alone?