Intense, Combinatorial Psychosocial Therapy Best Reduces Harmful Alcohol Behavior

More intensive, combined psychosocial interventions may be more effective at reducing harmful alcohol consumption behaviors, according to results of a systematic review and network meta-analysis published in the journal Addiction.

Investigators from the University of Utah searched publication databases from inception through January 2022 for randomized controlled trials evaluating psychosocial interventions for addressing harmful alcohol consumption behaviors. The primary outcome was a change in the Alcohol Use Disorder Identification Test (AUDIT) score. Harmful alcohol consumption was generally defined as a score of 8 or greater, however, different thresholds were defined for women (AUDIT ≥6) and the Chinese version (AUDIT ≥7).

This analysis considered a total of 19 trials evaluating 13 psychosocial interventions which included combinations of brief intervention (BI), motivational interview (MI), cognitive behavioral therapy (CBT), and feedback (FB) components delivered face-to-face (F2F) or by telemedicine (Tele) in 1 (Once) or multiple (Multi) sessions. The most common intervention was BI/Once/F2F (n=6), followed by MI-CBT/Multi/F2F (n=4).

The pooled study population comprised 7149 individuals; mean age 35.68 (range, 18.99 to 62.83) years; and 67% were men.

The MI-CBT/Multi/F2F intervention associated with significant AUDIT reductions compared with usual care (mean difference [MD], -4.98; 95% CI, -7.04 to -2.91), BI/Once/F2F (MD, -4.90; 95% CI, -2.53 to -7.27), BI/Multi/F2F (MD, -4.73; 95% CI, -1.81 to -7.64), BI-FB/Multi/Tele (MD, -4.38; 95% CI, -1.32 to -7.44), FB/Multi/Tele (MD, -4.18; 95% CI, -0.50 to -7.86), and BI-FB/Once/F2F (MD, -3.64; 95% CI, -0.98 to -6.29).

In addition, compared with usual care, MI/Multi/F2F (MD, -4.52; 95% CI, -8.10 to -0.95), MI/Multi/Tele (MD, -4.16; 95% CI, -7.66 to – 0.66), and MI-CBT/Multi/Tele (MD, -3.76; 95% CI, -5.78 to -1.74) were associated with significant AUDIT score improvements.

In the network meta-analysis, MI-CBT/Multi/F2F was the overall favored intervention (surface under the cumulative ranking curve [SUCRA], 91.3%), followed by MI/Multi/F2F (SUCRA, 82.8%), MI/Multi/Tele (SUCRA, 80.6%), and MI-CBT/Multi/Tele (SUCRA, 76.6%).

In subgroup analyses, more intense interventions had greater effects on AUDIT scores compared with less-intense interventions.

The major limitation of this analysis was the use of AUDIT scores which can be difficult to interpret due to the lack of psychometrically established minimally clinical important differences.

Analysis authors concluded, “[O]ur findings suggest that the provision of combined motivational interviewing and cognitive behavioral therapy more than once via face-to-face sessions is more effective in reducing alcohol consumption in individuals with harmful use of alcohol compared to usual care and most of the other comparators.”