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Practice Profile

Computerized Brief Interventions for Youth Alcohol Use

Evidence Ratings for Outcomes:

Effective - One Meta-Analysis Drugs & Substance Abuse - Alcohol

Practice Description

Practice Goals
Computerized brief interventions include preventive or therapeutic activities delivered through online or offline electronic devices such as cell phones, tablets, and computers. Compared with brief interventions that are delivered by health professionals in short therapeutic sessions lasting between 5 to 10 minutes, computerized brief interventions are delivered by an electronic device. Similar to brief interventions, computerized interventions are of short duration and aim to make the individuals think differently about their alcohol use, while also providing them with the skills to change their behavior. Overall, these interventions aim to reduce alcohol use by young people (Smedslund et al. 2016). Specifically, by intervening early, computerized brief interventions seek to reduce or eliminate alcohol use among young people before it takes control of their lives.

Target Population
Computerized brief interventions are designed to appeal to younger generations who have grown up alongside digital media (Smedslund et al. 2016). Specifically, these interventions target individuals aged 15 to 25, who are high or risky consumers of alcohol but motivated to change. Risky consumption of alcohol is defined as consuming 1) at least five beverages during any one drinking session or more than 14 alcoholic beverages a week for males, and 2) four beverages during any one drinking session or more than seven alcoholic beverages a week for females. Overall, it is believed that computerized brief interventions motivate users to think differently about their alcohol use, and–for those motivated to change–provide skills for behavioral change.

Practice Components
Typically, computerized brief interventions consist of three components: assessment, feedback, and decision-making. The assessment component classifies users as low-risk, medium-risk, high-risk, or very high-risk alcohol drinkers and provides the individuals with a recommendation on whether they would benefit from a more formalized treatment program than the computerized brief intervention.

The feedback component provides the users with information on their scores after each assessment and responds to their reactions to their assessment. Computerized interventions typically include two feedback components: targeted feedback and tailored feedback. Targeted feedback refers to providing information to users that pertains to the needs of the entire group; for example, in the case of computerized brief interventions for alcohol use, young people with risky alcohol use may receive messages to increase their awareness of the problem behavior. On the other hand, tailored feedback is feedback specific to an individual’s needs (Smedslund et al. 2016; Worden and McCrady 2013).

Finally, the decision-making component asks users to specify their motivation for behavioral change. Individuals who indicate readiness for change are provided with a list of goal options. Once users select a goal option, they are led through exercises to develop an individualized plan of change and provided with resources, including lists of self-help groups, lists of therapists, and other relevant materials. It is important to note that individuals who do not indicate a motivation to change have the option of receiving basic information on their behavioral problem; however, once this information is provided the intervention ends.

Meta-Analysis Outcomes

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Effective - One Meta-Analysis Drugs & Substance Abuse - Alcohol
Overall, the study indicated that computerized brief interventions had a small, yet statistically significant impact on the alcohol consumption of youths aged 15–25. Specifically, Smedslund and colleagues (2016) aggregated the results of 15 studies (those that included both assessment and feedback components, but no decision-making component) and found a statistically significant overall mean effect size of -0.17, suggesting that computerized brief interventions reduced short-term alcohol consumption, compared with no intervention.
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Meta-Analysis Methodology

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Meta-Analysis Snapshot
 Literature Coverage DatesNumber of StudiesNumber of Study Participants
Meta-Analysis 12008 - 2015154558

Meta-Analysis 1
Smedslund and colleagues (2016) analyzed the impact of computerized brief interventions on alcohol and cannabis use. The target population included individuals, aged 15–25, who are high or risky consumers of one or both substances. Studies that did not exclusively focus on high-risk, young adult users of alcohol or cannabis were excluded from the review. To be eligible for inclusion in the meta-analysis, studies had to be efficacy or effectiveness studies of computerized brief intervention programs targeted at youths aged 15 to 25 years old. Eligible studies had to use random assignment or quasi-random assignment to the early computerized brief intervention or comparison condition. Comparison conditions could include no intervention, wait-list control, or an alternative brief intervention. Moreover, studies had to include at least one of the primary outcomes of interest (e.g., alcohol use or cannabis use). It is important to note that this review included all types of early, computerized brief interventions regardless of the type of electronic device. However, to be considered a brief intervention, the preventive or therapeutic activity had to be provided within a maximum of four structured therapy sessions that lasted between five and ten minutes with a maximum total time in treatment time of one hour. Additionally, studies that used computerized brief interventions to target substance use in general were excluded unless alcohol and cannabis use were analyzed separately.

Using this eligibility criteria, a search of bibliographic databases, websites, and grey literature was conducted. Studies were not limited to the English language and could be international in scope. The literature search resulted in 7,553 hits of which 7,111 resulted from the search of the electronic databases and 442 from our search for grey literature. After excluding duplicates and screening titles and abstracts for relevant references, 60 studies met the eligibility criteria for review. Of these, 53 focused on alcohol use, 3 focused on cannabis use, and 4 focused on both alcohol and cannabis use.

The included studies were published between 2004 and 2016, and 59 of the 60 studies were randomized controlled trials (RCTs). The one study that did not use random assignment used a cluster-RCT instead. The majority of the studies were conducted at colleges or universities (N = 51), while the remaining studies were conducted in the general population (N = 5) and emergency departments (N = 4). Additionally, studies were predominately conducted in the United States (N = 44), while the others were conducted in New Zealand (N = 4), Sweden (N = 4), the Netherlands (N = 2), Australia (N = 2), Germany (N = 1), Switzerland (N = 1), and Brazil (N = 1). The mean age across the 60 studies varied, with a range between 16.3 and 25.4 years. Similarly, the proportion of whites in the included studies ranged from between 13.3 percent and 99.6 percent. Finally, the duration of the intervention ranged from 0–10 minutes in 7 studies, 11–20 minutes in 13 studies, and 21–60 minutes in 11 studies. Although 29 studies did not report the length of the intervention, it was determined that the description of the intervention met the criteria for a brief intervention.

RevMan 5 software was used to perform meta-analysis using the generic inverse variance method when similar treatments were compared to similar comparators and similar outcomes were used at similar follow-up times. Given the expected heterogeneity across the included studies, random effects models were used to determine the effectiveness of computerized brief interventions on alcohol and cannabis use.

However, although Smedslund and colleagues (2016) analyzed the impact of computerized brief interventions on alcohol and cannabis use, this CrimeSolutions.gov practice review only focused on the impact of computerized brief interventions on alcohol use. Outcomes related to cannabis use did not meet the requirements for review due to the limited number of studies. In addition, the meta-analysis examined nine subgroups, including (but not limited to) assessment and feedback versus no intervention, computer feedback versus counsellor feedback, and feedback plus moderation skills versus feedback only. However, the CrimeSolutions.gov practice review only focused on the assessment and feedback versus no intervention analysis.
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Cost

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There is no cost information available for this practice.
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Evidence-Base (Meta-Analyses Reviewed)

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These sources were used in the development of the practice profile:

Meta-Analysis 1
Smedslund, Geir, Sabine Wollscheid, Lin Fang, Wendy Nilsen, Asbjorn Steiro, and Lillebeth Larun. 2017. “Effects of Early, Computerized Brief Interventions on Risky Alcohol Use and Risky Cannabis Use Among Young People.” Campbell Collaboration 6.
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Additional References

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These sources were used in the development of the practice profile:

Worden, B.L., and B.S. McCrady. 2013. “Effectiveness of a Feedback-Based Brief Intervention to Reduce Alcohol Use in Community Substance Use Disorders.” Alcoholism Treatment Quarterly 31(186):186–205.
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Practice Snapshot

Age: 15 - 25

Gender: Both

Race/Ethnicity: Other, White

Targeted Population: Alcohol and Other Drug (AOD) Offenders

Settings: Campus, Inpatient/Outpatient, Other Community Setting

Practice Type: Alcohol and Drug Prevention, Alcohol and Drug Therapy/Treatment, Individual Therapy

Unit of Analysis: Persons