Digital Mental Health for Alcohol and Substance Use Disorders

Abstract

Purpose Only about 20% of people suffering from substance use disorders access available treatments due to various obstacles; digital interventions could potentially overcome some of these. Meta-analyses suggest the strongest evidence for interventions targeting alcohol use reduction, followed by cannabis and illicit substances. However, most randomized controlled trials (RCTs) used unguided standalone interventions compared to non-active controls, with limited follow-up periods and disregarded comorbidity. This review examines the literature published over the last three years (2016-2019), with a focus on recent RCTs and whether they addressed some of these gaps. Recent findings Except for digital interventions targeting alcohol use, the number of RCTs in the last three years is limited. Although there is considerable heterogeneity between the studies, most of them applied unguided add-on interventions compared to active control groups, and a limited number investigated guided interventions. In addition, there is a need for longer follow-up periods, active rather than non-active control groups, outcome standardization, and increased focus on comorbidity. Summary Although the number of studies using guided add-on or blended interventions compared to active controls has increased, future studies should consider our identified gaps and suggestions to further strengthen the evidence of digital interventions for reducing the use of alcohol and other substances.

A Therapeutic Relational Agent for Reducing Problematic Substance Use (Woebot): Development and Usability Study

“…Electronic screening and brief intervention programs, which use mobile tools to screen for excessive alcohol use and deliver personalized feedback, have been found to effectively reduce alcohol consumption and alcohol-related problems [ 58 ]. However, rigorous evaluation trials of digital interventions targeting nonalcohol substance use are limited [ 7 ]. Furthermore, although a systematic review concluded that conversational agents showed preliminary efficacy in reducing psychological distress among adults with mental health concerns compared with inactive control conditions [ 27 ], this is the first published study of a conversational agent adapted for substance use.…”

“…Web-based interventions and digital health apps may reduce or eliminate common, significant barriers to traditional SUD treatment (eg, stigma; financial, time, and transportation constraints; lack of access to qualified providers; challenges navigating complex treatment systems; and low perceived utility) [ 6 ]. Preliminary evidence suggests that digital SUD interventions affect substance use behavior [ 6 , 7 ] and have the potential to reduce the population burden of SUDs. To date, most digital SUD interventions have been delivered on a web platform, rather than via mobile apps.…”

Connected Mental Health: Systematic Mapping Study

“…The identified lack of empirical evaluation of the proposed solutions was reflected in the findings of a meta-analysis on digital interventions for alcohol and substance use disorders, reporting limitations in the number of randomized control trials (RCTs) in that area [ 117 ]. Another review on RCTs on the effectiveness of occupational e-mental health concluded the need for more detailed and specific effectiveness research [ 246 ].…”

A randomized controlled trial of a therapeutic relational agent for reducing substance misuse during the COVID-19 pandemic

“…Digital health applications (apps) can reduce barriers to traditional SUD treatment including stigma, costs and inadequate insurance coverage, time demands, transportation needs, lack of access to qualified providers, and challenges navigating complex treatment systems ( Giroux et al, 2017 ). Preliminary evidence suggests that digital SUD interventions can reduce substance misuse ( Boumparis et al, 2019 ; Giroux et al, 2017 ). Scalable digital SUD interventions could lessen the population-level burden of SUDs.…”