Table 12 Summary of findings table
Intervention category | Summary of findings | Certainty in findings (GRADE) |
|---|---|---|
Research question 1: interventions for individuals at risk of, or with, hazardous/harmful drinking | ||
Screening, brief intervention and referral to treatment | Brief interventions show a small effect in the mid to long term (6 to 12Â months). More than one session should be provided, although further research is required on the optimal duration and frequency of sessions. There does not seem to be a significant difference of effect among different sub-groups, but further research is required Brief counselling interventions show high effectiveness in the mid-long term (up to 12Â months). Brief motivational interviewing effect is highly variable and likely to depend on context and delivery. There is insufficient evidence to support social norms interventions | Low |
No evidence identified for referral mechanisms | NA | |
Psychosocial interventions | Cognitive behavioural therapy delivered by lay health workers may be effective in the mid-term (up to 6Â months). No evidence for other settings | Very low |
No evidence identified for contingency management | NA | |
No evidence identified for community reinforcement approach | NA | |
Motivational interviewing shows a small reduction in consumption in the mid-term (up to 6Â months) | Low | |
Family-oriented approaches has no evidence of effect in school-aged children. No evidence identified for other groups | Very low | |
Mentoring may significantly reduce alcohol use among children and adolescents over the long-term (over 1Â year) | Moderate | |
Forming implementation intentions may have a large short-term effect | Moderate | |
Digital interventions | Digital interventions (web, computer, mobile-based) show non-inferiority to face-to-face interventions | Very low |
Pre-operative alcohol cessation programme | Intensive pre-operative cessation programmes (including psychosocial interventions and disulfiram) show a significant improvement in abstinence | Low |
Research question 2: interventions for individuals with alcohol dependence or alcohol use disorder | ||
Screening, brief intervention and referral to treatment | No effect has been shown for brief interventions | Very low |
No evidence identified for referral to treatment | NA | |
Psychosocial interventions | Cognitive behavioural therapy shows no evidence of effect | Very low |
For contingency management, imprecision in the evidence is too great to draw any conclusion. Further research is required | Very low | |
Community reinforcement approach shows a large, long-term effect | Low | |
No evidence identified for motivational interview | NA | |
No evidence identified for family-oriented approaches | NA | |
No effect shown for coping skills training | Very low | |
No effect shown for cue exposure therapy | Very low | |
Abstinence-based strategies are likely to be more effective than moderation based strategies (controlled drinking) | Low | |
Naltrexone combined with psychosocial interventions show an improved effect as compared with psychosocial interventions alone | Very low | |
Digital interventions | Insufficient evidence to draw meaningful conclusions | Very low |
Pharmacological interventions | Anticonvulsants show no evidence of effectiveness, with the exception of topiramate for which there may be an effect and further research is required | Very low |
Antidepressants show no evidence of effectiveness, with the exception of SSRI for which the evidence is inconclusive | Very low | |
Antipsychotics show no evidence of effectiveness, with the exception of quetiapine for which there may be an effect and further research is required | Very low | |
The evidence for disulfiram is inconclusive | Very low | |
The evidence for baclofen is inconclusive | Very low | |
No evidence identified for benzodiazepines | NA | |
Acamprosate shows good evidence of effectiveness up to 12Â months | Low | |
Nalmefene may be effective in reducing alcohol consumption | Low | |
Evidence for naltrexone is inconclusive | Very low | |
GHB may significantly improve abstinence, but further research is warranted | Very low | |
No effect has been shown for atenolol, bromocriptine, buspirone, galantamine, lisuride, lithium, memantine, modafinil, or paroxetine | Very low | |
Evidence is inconclusive for alpha blockers, antiepileptics, and varenicline | Very low | |
Combinations of pharmacological interventions | No effect has been shown for naltrexone + SSRI, naltrexone + disulfiram, naltrexone + escitalopram, or GHB + escitalopram | Very low |
There is evidence of an effect for naltrexone + acamprosate, but it is unclear whether the effect is superior to acamprosate alone | Very low | |
There is evidence of an effect for naltrexone + GHB and naltrexone + GHB + escitalopram, but it is unclear whether the effect is superior to GHB alone | Very low | |
Miscellaneous interventions | Physical activity has not shown any significant effect when delivered alone | Very low |