Kwan Irene, Burchett Helen Elizabeth Denise, Macdowall Wendy, D'Souza Preethy, Stansfield Claire, Kneale Dylan, Sutcliffe Katy
Evidence for Policy & Practice information (EPPI) Centre, Social Research Institute, University College London, London, UK.
Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Addiction. 2025 Aug;120(8):1531-1550. doi: 10.1111/add.70021. Epub 2025 Mar 24.
Although remote drug/alcohol interventions have been widely reviewed, their effectiveness specifically for people in treatment remains unclear. We aimed to systematically review the effectiveness of remote interventions (delivered by telephone or computer) in alcohol/drug treatment and recovery support.
We searched 29 databases including Medline and PsycINFO for randomised controlled trials (RCTs) of remote interventions for adults diagnosed with alcohol/drug use disorder conducted in Organization for Economic Co-operation and Development (OECD) countries published 2004-2023. We grouped interventions according to whether they supplemented or replaced/partially replaced in-person care. We used random effects meta-analyses to estimate pooled odds ratios (OR) for relapse, and standardised mean differences (SMD) for days of alcohol/drug use. We appraised outcomes using Cochrane Risk of Bias 2.
We identified 34 RCTs (6461 participants) evaluating 42 remote interventions, with diverse therapeutic approaches. Over 70% of outcomes were judged to be at high risk-of-bias. When remote interventions supplemented in-person care, there was a 39% lower odds of relapse [17 interventions; OR 0.61; 95% confidence interval (CI) = 0.46, 0.81; P = 0.001; I = 40.3%) and a reduction in the mean days of use (17 interventions; SMD -0.18; 95% CI = -0.28 to -0.08; P = 0.001; I = 27.3%) compared with in-person care alone. When remote interventions replaced/partially replaced in-person care, there was a 49% lower odds of relapse (7 interventions; OR 0.51; 95% CI = 0.34, 0.76; P = 0.001; I = 39.7%) and a very slight and uncertain reduction in mean days of use (8 interventions; SMD -0.08; 95% CI = -0.24 to 0.07; P = 0.301; I = 48.4%) compared with in-person care. Subgroup analyses by type of substance and therapeutic approach were mixed and inconclusive.
Remote interventions which supplement in-person alcohol/drug treatment appear to reduce relapse and days of use. The evidence is less conclusive regarding remote interventions that replace/partially replace in-person care due to a smaller body of evidence and uncertainty (days of use). High risk-of-bias means findings should be interpreted with caution.
尽管远程药物/酒精干预措施已得到广泛综述，但其对正在接受治疗的人群的有效性仍不明确。我们旨在系统综述远程干预措施（通过电话或计算机实施）在酒精/药物治疗及康复支持方面的有效性。
我们检索了包括Medline和PsycINFO在内的29个数据库，以查找2004年至2023年在经济合作与发展组织（OECD）国家开展的、针对被诊断为酒精/药物使用障碍的成年人的远程干预随机对照试验（RCT）。我们根据干预措施是补充还是替代/部分替代面对面护理对干预措施进行分组。我们使用随机效应荟萃分析来估计复发的合并优势比（OR）以及酒精/药物使用天数的标准化均数差（SMD）。我们使用Cochrane偏倚风险2对结果进行评估。
我们确定了34项RCT（6461名参与者），评估了42种远程干预措施，这些措施具有多种治疗方法。超过70%的结果被判定为高偏倚风险。当远程干预措施补充面对面护理时，与仅采用面对面护理相比，复发几率降低了39%[17项干预措施；OR 0.61；95%置信区间（CI）=0.46，0.81；P = 0.001；I² = 40.3%]，且使用天数均值有所减少（17项干预措施；SMD -0.18；95% CI = -0.28至-0.08；P = 0.001；I² = 27.3%）。当远程干预措施替代/部分替代面对面护理时，与面对面护理相比，复发几率降低了49%（7项干预措施；OR 0.51；95% CI = 0.34，0.76；P = 0.001；I² = 39.7%），且使用天数均值有非常轻微且不确定的减少（8项干预措施；SMD -0.08；95% CI = -0.24至0.07；P = 0.301；I² = 48.4%）。按物质类型和治疗方法进行的亚组分析结果不一，尚无定论。
补充面对面酒精/药物治疗的远程干预措施似乎可降低复发率和使用天数。对于替代/部分替代面对面护理的远程干预措施，由于证据较少且存在不确定性（使用天数），证据的结论性较差。高偏倚风险意味着对研究结果的解释应谨慎。
