Comparative effectiveness of psychosocial interventions in adults with harmful use of alcohol: a systematic review and network meta-analysis.

Aims: Psychosocial approaches are the hallmark of treatment for harmful alcohol use. However, the most effective psychosocial intervention has not been identified. We aimed to compare the effectiveness of psychosocial therapy for harmful alcohol use using a network meta-analysis approach.

Methods: We searched PubMed, Embase, CENTRAL, CINAHL and ProQuest Dissertations and Theses from inception to January 2022. Randomized controlled trials in adults aged > 18 years with harmful alcohol use were included. Psychosocial interventions were classified using the theme, intensity, and provider/platform (TIP) framework. The mean differences (MD) of the alcohol use disorder identification test (AUDIT) score were estimated in the primary analysis using a random-effects model. Surface under the cumulative ranking curve (SUCRA) methods were used to rank different interventions. The certainty of evidence was evaluated using the confidence in network meta-analysis (CINeMA) approach. This review was registered with PROSPERO (CRD42022328972).

Results: A total of 4225 records were retrieved from searches; 19 trials (n = 7149) met the inclusion criteria. The most common TIP combination was brief interventions delivered once via face-to-face sessions (six studies) and 11 TIP features were included in the network meta-analysis. A significant difference in AUDIT score was evident among 16 of 55 treatment comparisons, with the highest effect size observed when motivational interviewing plus cognitive behavioral therapy in multiple sessions via face-to-face (MI-CBT/Mult/F2F) was compared with usual care [MD = -4.98; 95% confidence interval (CI) = -7.04, -2.91]. This finding was consistent with SUCRA, which suggested that MI-CBT/Mult/F2F is most likely to be better than other interventions (SUCRA = 91.3). MI-CBT/Mult/F2F remained the highest-ranking intervention in our sensitivity analyses (SUCRA = 64.9, 80.8). However, the certainty of evidence for most treatment comparisons was low.

Conclusions: Combined psychosocial intervention with a more intensive approach may provide greater effect in reducing harmful alcohol consumption behavior.