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Table 5 Summary results of included systematic reviews, for psychosocial interventions

From: Which interventions for alcohol use should be included in a universal healthcare benefit package? An umbrella review of targeted interventions to address harmful drinking and dependence

Intervention

Population

Comparator

Outcome

Timeframe

Effect size (method: effect (95% CI))

I2

Publication bias

Number of RCTs

RCT quality assessment

Psychotherapy (CBT, MI, BI) [107]

AUD

Control

Abstinent rate, during treatment

 ≥ 12 weeks

OR: 1.51

(1.04, 2.21)

67.3%

NR

4

NR

Psychotherapy (CBT, MI, BI) [107]

AUD

Control

Abstinent rate, after treatment

 ≥ 12 weeks

OR: 0.99

(0.57, 1.70)

67.3%

NR

2

NR

Psychotherapy (CBT, MI, BI) [107]

AUD

psychotherapy + BI

Abstinent rate, during treatment

 ≥ 12 weeks

OR: 1.20

(0.58, 2.46)

67.3%

NR

0 [NMA]

NR

Psychotherapy (CBT, MI, BI) [107]

AUD

psychotherapy + BI

Abstinent rate, after treatment

 ≥ 12 weeks

OR: 2.22

(0.89, 5.63)

67.3%

NR

0 [NMA]

NR

Psychotherapy (CBT, MI, miscellaneous) [104]

18–25 years (not in college)

Control group

Multiple (social consequences, AUDIT, ASI)

 > 6 months

Cohen’s d: 0.18

(0.07, 0.29)

NR

NR

22

NR

Cognitive behavioural therapy (CBT)

Lay health worker-led interventions (cognitive behavioural therapy) [115]

Adult patients with harmful or hazardous alcohol use

Enhanced usual care

Drinks per drinking day

up to 1 month

SMD: -0.37

(-0.52, -0.22)

0%

NR (< 4 studies)

2

1 study high risk blinding outcomes

Lay health worker-led interventions (cognitive behavioural therapy, counselling) [115]

Adult patients with harmful or hazardous alcohol use

Enhanced usual care

Amount of alcohol consumed

1 to 6 months

SMD: -0.23

(-0.56, 0.09)

61%

NR (< 4 studies)

3

1 study high risk blinding outcomes

Lay health worker-led interventions (counselling, cognitive behavioural therapy) [115]

Adult patients with harmful or hazardous alcohol use

Enhanced usual care

Amount of alcohol consumed

 > 6 months

SMD: -0.11

(-0.29, 0.06)

42%

NR (< 4 studies)

2

1 study high risk blinding outcomes

CBT [103]

Alcohol dependence or AUD

Placebo

Continuous abstinence

84–365 days

OR: 0.53

(0.23, 1.22)

NA

NR

64

Low

Short form CBT [103]

Alcohol dependence or AUD

Placebo

Continuous abstinence

84–365 days

OR: 0.05

(0, 1.16)

NA

NR

64

Very low

Placebo + CBT [103]

Alcohol dependence or AUD

Placebo

Continuous abstinence

84–365 days

OR: 0.83

(0.28, 2.42)

NA

NR

64

Very low

Contingency management (CM)

Contingency management [103]

Alcohol dependence or AUD

Placebo

Continuous abstinence

84–365 days

OR: 0.78

(0.17, 3.61)

NA

NR

64

Low

Contingency management [107]

AUD

Control

Abstinent rate, during treatment

 ≥ 12 weeks

OR: 0.30

(0.03, 2.59)

67.3%

NR

1

NR

Contingency management [107]

AUD

Control

Abstinent rate, after treatment

 ≥ 12 weeks

OR: 0.52

(0.07, 3.05)

67.3%

NR

1

NR

Contingency management [107]

AUD

CM + psychotherapy

Abstinent rate, during treatment

 ≥ 12 weeks

OR: 1.46

(0.12, 14.07)

67.3%

NR

0 [NMA]

NR

Contingency management [107]

AUD

CM + psychotherapy

Abstinent rate, after treatment

 ≥ 12 weeks

OR: 0.55

(0.07, 3.74)

67.3%

NR

0 [NMA]

NR

Contingency management [107]

AUD

Pharmacotherapy

Abstinent rate, during treatment

 ≥ 12 weeks

OR: 0.35

(0.03, 3.31)

67.3%

NR

0 [NMA]

NR

Contingency management [107]

AUD

Pharmacotherapy

Abstinent rate, after treatment

 ≥ 12 weeks

OR: 0.35

(0.05, 2.18)

67.3%

NR

0 [NMA]

NR

Contingency management [107]

AUD

Pharmacotherapy + BI

Abstinent rate, during treatment

 ≥ 12 weeks

OR: 0.68

(0.06, 5.98)

67.3%

NR

0 [NMA]

NR

Contingency management [107]

AUD

Pharmacotherapy + BI

Abstinent rate, after treatment

 ≥ 12 weeks

OR: 0.36

(0.05, 2.30)

67.3%

NR

0 [NMA]

NR

Contingency management [107]

AUD

Pharmacotherapy + psychotherapy

Abstinent rate, during treatment

 ≥ 12 weeks

OR: 0.51

(0.04, 4.78)

67.3%

NR

0 [NMA]

NR

Contingency management [107]

AUD

Pharmacotherapy + psychotherapy

Abstinent rate, after treatment

 ≥ 12 weeks

OR: 0.33

(0.04, 2.17)

67.3%

NR

0 [NMA]

NR

Contingency management [107]

AUD

Psychotherapy

Abstinent rate, during treatment

 ≥ 12 weeks

OR: 0.44

(0.04, 3.99)

67.3%

NR

0 [NMA]

NR

Contingency management [107]

AUD

Psychotherapy

Abstinent rate, after treatment

 ≥ 12 weeks

OR: 0.51

(0.07, 3.19)

67.3%

NR

0 [NMA]

NR

Contingency management [107]

AUD

Psychotherapy + BI

Abstinent rate, during treatment

 ≥ 12 weeks

OR: 0.54

(0.04, 5.09)

67.3%

NR

0 [NMA]

NR

Contingency management [107]

AUD

Psychotherapy + BI

Abstinent rate, after treatment

 ≥ 12 weeks

OR: 1.12

(0.14, 8.60)

67.3%

NR

0 [NMA]

NR

Community reinforcement

Social network support [63]

Alcohol dependents

No social network support

Abstinence in the past 90 days

 > 12 months

OR: 3.97

(2.26, 6.95)

NR

None

2

High risk of bias

Motivational interview (MI)

Motivational Enhancement Therapy (MET) [103]

Alcohol dependence or AUD

Placebo

Continuous abstinence

84–365 days

OR: 0.45

(0.19, 1.11)

NA

NR

64

Very low

MI or motivational enhancement therapy (MI plus feedback) [65]

NR

Comparison group: traditional waitlist, information only groups, ‘treatment-as-usual

Self-reported consumption

NR

OR: 2.31

(1.75, 3.06)

NR

No

9

NR

Motivational interviewing [68]

Alcohol use

NR

Biochemically confirmed measures of alcohol use

4–6 months

Cohen’s d: 0.30

(0.03, 0.57)

NR

No

5

NR

Motivational Interviewing [60]

Young people aged up to 25 years, at risk

No intervention/placebo/ treatment as usual

Quantity of alcohol consumed

Less than four months follow-up

SMD: -0.25

(-0.37, -0.14)

45%

NR

33

NR

Motivational Interviewing [60]

Young people aged up to 25 years, at risk

No intervention/placebo/ treatment as usual

Quantity of alcohol consumed

4 + months follow up

SMD: -0.12

(-0.17, -0.07)

0.0%

No

26

Low

Motivational Interviewing [60]

Young people aged up to 25 years, at risk

No intervention/placebo/ treatment as usual

Frequency of alcohol consumption

4 + months follow up

SMD: -0.15

(-0.23, -0.07)

27%

NR

14

Low

Motivational Interviewing [60]

Young people aged up to 25 years, at risk

No intervention/placebo/ treatment as usual

Binge drinking

4 + months follow up

SMD: -0.06

(-0.12, 0.01)

0%

NR

16

Low

Motivational Interviewing [60]

Young people aged up to 25 years, at risk

No intervention/placebo/ treatment as usual

Alcohol problems

4 + months follow up

SMD: -0.11

(-0.19,-0.03)

52%

NR

22

Moderate

Motivational Interviewing [60]

Young people aged up to 25 years, at risk

No intervention/placebo/ treatment as usual

Quantity of alcohol consumed

4 + months follow-up

SMD: -0.14

(-0.20, -0.08)

22%

NR

39

moderate

Motivational Interviewing [56]

Adolescents (12–20 years) with AUD or problematic alcohol use

Treatment as usual

Days of alcohol use

NR

Net mean difference:

-1.1 (-2.2, -0.3)

NA

NR

7

Moderate

Motivational interviewing [64]

Concurrent problem alcohol and illicit drug users

treatment as usual

Alcohol use as AUDIT or ASSIST scores

3 months

SMD: 0.04

(-0.29,0.37)

0%

NR

2

Low

Family-oriented approach

Family-based prevention programmes [42]

School-aged children (< = 18 years)

No intervention/ standard care

Prevalence of alcohol use

NR

SMD: -0.16

(-0.36, 0.05)

NR

No

2

NR

Family-based prevention programmes [42]

School-aged children (< = 18 years)

No intervention/ standard care

Volume of alcohol use

NR

SMD: 0.06

(-0.15, 0.27)

NR

No

2

NR

Family-based prevention programmes [42]

School-aged children (< = 18 years)

No intervention /standard care

Frequency of alcohol use

NR

SMD: -0.65

(-1.64, 0.33)

97%

NR

5

NR

Other

Coping skill training [103]

Alcohol dependence or AUD

Placebo

Continuous abstinence

84–365 days

OR: 0.35

(0.1, 1.19)

NR

NR

64

Very low

Cue Exposure Therapy; OR Cue Exposure Therapy and Coping Skills Training [67]

Adult participants (≥ 18) diagnosed with sub-clinical or clinical AUD

Active target conditions like cognitive behavioral therapy, relaxation or meditation and daily contact with assessment

Self-reported drinking days

3 months

SMD: -0.07

(-0.34, 0.49)

0%

Yes

2

Very low

Cue Exposure Therapy; OR Cue Exposure Therapy and Coping Skills Training [67]

Adult participants (≥ 18) diagnosed with sub-clinical or clinical AUD

Active target conditions like cognitive behavioral therapy, relaxation or meditation and daily contact with assessment

Self-reported drinking days

6 months

SMD: -0.21

(-0.48, 0.06)

24%

Yes

5

Very low

Cue Exposure Therapy; OR Cue Exposure Therapy and Coping Skills Training [67]

Adult participants (≥ 18) diagnosed with sub-clinical or clinical AUD

Active target conditions like cognitive behavioral therapy, relaxation or meditation and daily contact with assessment

Drinks per day

3 months

SMD: -0.07

(-0.48, 0.34)

0%

Yes

2

Very low

Cue Exposure Therapy; OR Cue Exposure Therapy and Coping Skills Training [67]

Adult participants (≥ 18) diagnosed with sub-clinical or clinical AUD

Active target conditions like cognitive behavioral therapy, relaxation or meditation and daily contact with assessment

Drinks per day

6 months

SMD: -0.16

(-0.52, 0.19)

64%

Yes

6

Very low

Cue Exposure Therapy; OR Cue Exposure Therapy and Coping Skills Training [67]

Adult participants (≥ 18) diagnosed with sub-clinical or clinical AUD

Active target conditions like cognitive behavioral therapy, relaxation or meditation and daily contact with assessment

Days with heavy drinking

6 months

SMD: -0.02

(-0.38, 0.41)

37%

Yes

2

Very low

Forming implementation intentions [66]

General population (no restrictions)

Passive and active control groups

Self-reported alcohol consumption

2 weeks to 3 months

OR: 0.31

(0.21, 0.42)

18%

No

16

Good

Home visit [101]

Pregnant women with alcohol problem

Usual care

Continued alcohol use

NR

RR: 1.18 (0.96, 1.46)

0%

NR

3

Low

Home visit [103]

Alcohol dependence or AUD

Placebo

Continuous abstinence

84–365 days

OR: 0.95

(0.32, 2.85)

NA

NR

64

Low

Mentoring interventions [69]

Alcohol use; children or adolescents

No intervention or wait list

Alcohol use

9–15 months

OR: 0.72

(0.58, 0.90)

0%

NR

2

Low risk of bias

Non-abstinent treatment strategies [62]

Alcohol dependent: adult

Abstinent-based treatment strategies

Controlled drinking goal

6–42 month

OR: 1.32

(0.51–3.39)

0%

No

2

High

Combination

Psychotherapy + BI [107]

AUD

Control

Abstinent rate, during treatment

 ≥ 12 weeks

OR: 1.82

(0.90, 3.71)

67.3%

NR

2

NR

Psychotherapy + BI [107]

AUD

Control

Abstinent rate, after treatment

 ≥ 12 weeks

OR: 2.18

(0.84, 6.01)

67.3%

NR

0

NR

CM + psychotherapy [107]

AUD

Control

Abstinent rate, during treatment

 ≥ 12 weeks

OR: 0.20

(0.10, 0.40)

67.3%

NR

0

NR

CM + psychotherapy [107]

AUD

Control

Abstinent rate, after treatment

 ≥ 12 weeks

OR: 0.93

(0.44, 2.05)

67.3%

NR

0

NR

CM + psychotherapy [107]

AUD

Psychotherapy

Abstinent rate, during treatment

 ≥ 12 weeks

OR: 0.30

(0.17, 0.54)

67.3%

NR

10

NR

CM + psychotherapy [107]

AUD

Psychotherapy

Abstinent rate, after treatment

 ≥ 12 weeks

OR: 0.93

(0.51, 1.68)

67.3%

NR

3

NR

CM + psychotherapy [107]

AUD

Psychotherapy + BI

Abstinent rate, during treatment

 ≥ 12 weeks

OR: 0.37

(0.14, 0.90)

67.3%

NR

0

NR

CM + psychotherapy [107]

AUD

Psychotherapy + BI

Abstinent rate, after treatment

 ≥ 12 weeks

OR: 2.04

(0.71, 6.05)

67.3%

NR

0

NR

  1. ASSIST Alcohol, Smoking and Substance Involvement Screening Test, AUD Alcohol use disorder, AUDIT AUD identification test, BI Brief intervention, CBT Cognitive behavioural therapy, CI Confidence interval, CM Contingency management, MD Mean difference, MI Motivational interviewing, NMA Network meta-analysis, NR Not reported, OR Odds ratio, RCT Randomized controlled trial, RR Relative risk, SMD Standard mean difference