Comparative effectiveness of digital versus face-to-face cognitive behavioral therapy for alcohol use disorder: a systematic review and meta-analysis

Abstract

Alcohol use disorder (AUD) is a chronic condition that impairs health and function. Cognitive behavioral therapy (CBT) is an evidence-based treatment traditionally delivered face-to-face. Recently, digital CBT delivered online has gained prominence because of access barriers and user preferences. Although many digital CBT studies have emerged, few systematic reviews have directly compared digital and face-to-face CBT in adults with AUD. This systematic review and meta-analysis aimed to evaluate their comparative effectiveness. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a comprehensive search identified 25 randomized controlled trials (n = 2,065) comparing these formats. A random-effects meta-analysis evaluated pre- and post-effectiveness by calculating the standardized mean change using raw score standardization (SMCR). For drinking quantity, digital CBT showed a significant pre-post effect (SMCR = 1.21, 95% confidence interval [CI]: 0.38 to 2.04; p = 0.004). Face-to-face CBT showed no overall significant effect (SMCR = 0.69, 95% CI: -0.16 to 1.53; p = 0.110). However, subgroup analysis of face-to-face trials showed significance for active treatment (SMCR = 1.09), but a nonsignificant negative effect for relapse prevention (SMCR = -0.72). For drinking frequency, both interventions yielded statistically significant effects; however, face-to-face CBT demonstrated a stronger effect (SMCR = 1.02, 95% CI: 0.30 to 1.74; p = 0.006) than digital CBT (SMCR = 0.54, 95% CI: 0.29 to 0.79; p < 0.001). Forest plots were generated, and Begg's test was used to assess publication bias.