Internet-based cognitive behavioral therapy for alcohol use disorder: A systematic review of evidence and future potential

Abstract

Introduction

While cognitive behavioral therapy (CBT) remains a highly effective psychotherapy approach for managing Alcohol Use Disorder (AUD), its potential is hindered by workforce shortages and access barriers. In response to these challenges, Internet-Based Cognitive Behavioral Therapy (iCBT) has emerged as an innovative solution that integrates the core CBT structure with technology. In iCBT, educational materials, therapist communication and progress dashboards can be centralized in a digital format, and delivered in a self-guided, therapist-guided or blended approach.

Methods

In this systematic review we aimed to summarize the current evidence of iCBT for AUD. The study performed a comprehensive literature search on PubMed, Embase, Cochrane, Web of Science, and Scopus in August 2023.

Results

Out of 497 studies that met our search criteria, five high-quality studies met our inclusion criteria. The studies presented a wide variation in the choice of outcomes and in the definition of controls or treatment as usual. When compared to treatment as usual, studies reported non-inferior to superior abstinence results of iCBT for AUD. Overall, most studies favor iCBT use as an adjunct to AUD treatment due to feasibility and access advantages. However, there were limitations identified in recruitment and implementation processes that warrant further studies. The review also showcases how studies on iCBT for AUD often neglect crucial variables such as insurance coverage, digital literacy and health equity. Clinical trials' investigators need to account for economic feasibility and external validity since the method design phase.

Conclusion

iCBT may be an effective adjunct treatment for AUD. However, further research is required. Research in the field should entail larger trials with standard controls and outcome measures. It is also important to actively recruit participants from diverse ethnic and cultural backgrounds and adapt iCBT materials to different languages. This will allow a wider population to benefit from the treatment and address existing health disparities.