Internet-based interventions for young people with problematic substance use: a systematic review

Robert J Tait and Helen Christensen
Med J Aust 2010; 192 (11): 15.


Objective: To conduct a systematic review of randomised trials of web-based interventions for problematic substance use by adolescents and young adults.

Data sources: An extensive search conducted in February 2009 of computer databases (MEDLINE, PsycINFO, Current Contents) and manual searches of key references.

Study selection: Randomised comparisons of fully automated web-based interventions specifically targeting adolescents and young adults (ie, typically school or tertiary students, ≤ 25 years old) versus other interventions.

Data synthesis: 16 relevant studies were identified, and data were extracted from 13  of the 14 reporting on alcohol use by young adults. The alcohol interventions had a small effect overall (d =  0.22) and for specific outcomes (level of alcohol consumption, d =  0.12; binge or heavy drinking frequency, d =  0.35; alcohol-related social problems, d =  0.57). The interventions were not effective (d = 0.001) in preventing subsequent development of alcohol-related problems among people who were non-drinkers at baseline. Due to methodological differences, data from the two studies reporting on tobacco interventions among adolescents were not combined.

Conclusions: Based on findings largely from tertiary students, web interventions targeting alcohol-related problems have an effect about equivalent to brief in-person interventions, but with the advantage that they can be delivered to a far larger proportion of the target population. Web-based interventions to prevent the development of alcohol-related problems in those who do not currently drink appear to have minimal impact. There are currently insufficient data to assess the effectiveness of web-based interventions for tobacco use by adolescents.

  • Robert J Tait1
  • Helen Christensen2

  • Centre for Mental Health Research, Australian National University, Canberra, ACT.



This research was supported by the Centre for Mental Health Research at the Australian National University.

Competing interests:

None identified.

  • 1. Australian Bureau of Statistics. National Survey of Mental Health and Wellbeing: summary of results, 2007. Canberra: ABS, 2008. (ABS Cat. No. 4326.0.)
  • 2. Australian Bureau of Statistics. Australian social trends, 2008. Canberra: ABS, 2008. (ABS Cat. No. 4102.0.)
  • 3. Atkinson NL, Saperstein SL, Pleis J. Using the internet for health-related activities: findings from a national probability sample. J Med Internet Res 2009; 11 (1): e4.
  • 4. Fox S. The engaged e-patient population. Washington, DC: Pew Internet & American Life Project, 2008. (accessed Mar 2009).
  • 5. Lenhart A, Rainie L, Lewis O. Teenage life online: the rise of the instant-message generation and the Internet’s impact on friendships and family relationships. Washington, DC: Pew Internet & American Life Project, 2001. (accessed Apr 2009).
  • 6. Borzekowski DL, Rickert VI. Adolescent cybersurfing for health information: a new resource that crosses barriers. Arch Pediatr Adolesc Med 2001; 155: 813-817.
  • 7. Bien TH, Miller WR, Tonigan JS. Brief interventions for alcohol problems: a review. Addiction 1993; 88: 315-335.
  • 8. Moyer A, Finney JW, Swearingen CE, Vergun P. Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction 2002; 97: 279-292.
  • 9. Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev 2008; (2): CD000165.
  • 10. Russell MA, Wilson C, Taylor C, Baker CD. Effect of general practitioners’ advice against smoking. Br Med J 1979; 2: 231-235.
  • 11. Walters ST, Neighbors C. Feedback interventions for college alcohol misuse: what, why and for whom? Addict Behav 2005; 30: 1168-1182.
  • 12. Fiore MC, Bailey WC, Cohen SJ, et al. Treating tobacco use and dependence: clinical practice guideline. Rockville, Md: US Department of Health and Human Services, 2000.
  • 13. Evers KE, Cummins CO, Prochaska JO, Prochaska JM. Online health behavior and disease management programs: are we ready for them? Are they ready for us? J Med Internet Res 2005; 7 (3): e27.
  • 14. Copeland J, Martin G. Web-based interventions for substance use disorders: a qualitative review. J Subst Abuse Treat 2004; 26: 109-116.
  • 15. Kypri K, Sitharthan T, Cunningham JA, et al. Innovative approaches to intervention for problem drinking. Curr Opin Psychiatry 2005; 18: 229-234.
  • 16. Bewick BM, Trusler K, Barkham M, et al. The effectiveness of web-based interventions designed to decrease alcohol consumption — a systematic review. Prev Med 2008; 47: 17-26.
  • 17. Kypri K, McAnally HM. Randomized controlled trial of a web-based primary care intervention for multiple health risk behaviors. Prev Med 2005; 41: 761-766.
  • 18. Flay BR, Biglan A, Boruch RF, et al. Standards of evidence: criteria for efficacy, effectiveness and dissemination. Prev Sci 2005; 6: 151-175.
  • 19. Dunlap WP, Cortina JM, Vaslow JB, Burke MJ. Meta-analysis of experiments with matched groups or repeated measures designs. Psychol Methods 1996; 1: 170-177.
  • 20. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005; 5: 13. doi: 10.1186/1471-2288-5-13.
  • 21. Bersamin M, Paschall MJ, Fearnow-Kenney M, Wyrick D. Effectiveness of a Web-based alcohol-misuse and harm-prevention course among high- and low-risk students. J Am Coll Health 2007; 55: 247-254.
  • 22. Bewick BM, Trusler K, Mulhern B, et al. The feasibility and effectiveness of a web-based personalised feedback and social norms alcohol intervention in UK university students: a randomised control trial. Addict Behav 2008; 33: 1192-1198.
  • 23. Chiauzzi E, Green TC, Lord S, et al. My student body: a high-risk drinking prevention web site for college students. J Am Coll Health 2005; 53: 263-274.
  • 24. Croom K, Lewis D, Marchell T, et al. Impact of an online alcohol education course on behavior and harm for incoming first-year college students: short-term evaluation of a randomized trial. J Am Coll Health 2009; 57: 445-454.
  • 25. Doumas DM, McKinley LL, Book P. Evaluation of two Web-based alcohol interventions for mandated college students. J Subst Abuse Treat 2009; 36: 65-74.
  • 26. Doumas DM, Hannah E. Preventing high-risk drinking in youth in the workplace: a web-based normative feedback program. J Subst Abuse Treat 2008; 34: 263-271.
  • 27. Kypri K, Langley JD, Saunders JB, et al. Randomized controlled trial of web-based alcohol screening and brief intervention in primary care. Arch Intern Med 2008; 168: 530-536.
  • 28. Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption — II. Addiction 1993; 88: 791-804.
  • 29. Kypri K, Saunders JB, Williams SM, et al. Web-based screening and brief intervention for hazardous drinking: a double-blind randomized controlled trial. Addiction 2004; 99: 1410-1417.
  • 30. Moore MJ, Soderquist J, Werch C. Feasibility and efficacy of a binge drinking prevention intervention for college students delivered via the Internet versus postal mail. J Am Coll Health 2005; 54: 38-44.
  • 31. Neighbors C, Lee CM, Lewis MA, et al. Internet-based personalized feedback to reduce 21st-birthday drinking: a randomized controlled trial of an event-specific prevention intervention. J Consult Clin Psychol 2009; 77: 51-63.
  • 32. Saitz R, Palfai TP, Freedner N, et al. Screening and brief intervention online for college students: the ihealth study. Alcohol Alcohol 2007; 42: 28-36.
  • 33. Walters ST, Vader AM, Harris TR, et al. Dismantling motivational interviewing and feedback for college drinkers: a randomized clinical trial. J Consult Clin Psychol 2009; 77: 64-73.
  • 34. Walters ST, Vader AM, Harris TR. A controlled trial of web-based feedback for heavy drinking college students. Prev Sci 2007; 8: 83-88.
  • 35. Wechsler H, Lee JE, Kuo M, et al. Trends in college binge drinking during a period of increased prevention efforts. Findings from 4 Harvard School of Public Health College Alcohol Study surveys: 1993–2001. J Am Coll Health 2002; 50: 203-217.
  • 36. White HR, Labouvie EW. Towards the assessment of adolescent problem drinking. J Stud Alcohol 1989; 50: 30-37.
  • 37. McGee R, Kypri K. Alcohol-related problems experienced by university students in New Zealand. Aust N Z J Public Health 2004; 28: 321-323.
  • 38. Buller DB, Borland R, Woodall WG, et al. Randomized trials on Consider This, a tailored, internet-delivered smoking prevention program for adolescents. Health Educ Behav 2008; 35: 260-281.
  • 39. Patten CA, Croghan IT, Meis TM, et al. Randomized clinical trial of an Internet-based versus brief office intervention for adolescent smoking cessation. Patient Educ Couns 2006; 64: 249-258.
  • 40. Tait RJ, Hulse GK. A systematic review of the effectiveness of brief interventions with substance using adolescents by type of drug. Drug Alcohol Rev 2003; 22: 337-346.
  • 41. McCrone P, Knapp M, Proudfoot J, et al. Cost-effectiveness of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial. Br J Psychiatry 2004; 185: 55-62.
  • 42. Christensen H, Griffiths K. Reaching standards for dissemination: a case study. Stud Health Technol Inform 2007; 129: 459-463.
  • 43. Kentala J, Utriainen P, Pahkala K, Mattila K. Can brief intervention through community dental care have an effect on adolescent smoking? Prev Med 1999; 29: 107-111.
  • 44. Colby SM, Monti PM, Barnett NP, et al. Brief motivational interviewing in a hospital setting for adolescent smoking: a preliminary study. J Consult Clin Psychol 1998; 66: 574-578.
  • 45. Sussman S. Effects of sixty six adolescent tobacco use cessation trials and seventeen prospective studies of self-initiated quitting. Tob Induc Dis 2002; 1: 35-81.
  • 46. Aveyard P, Cheng KK, Almond J, et al. Cluster randomised controlled trial of expert system based on the transtheoretical (“stages of change”) model for smoking prevention and cessation in schools. BMJ 1999; 319: 948-953.
  • 47. Pallonen UE, Velicer WF, Prochaska JO, et al. Computer-based smoking cessation interventions in adolescents: description, feasibility, and six-month follow-up findings. Subst Use Misuse 1998; 33: 935-965.
  • 48. Riley W, Jerome A, Behar A, Zack S. Feasibility of computerized scheduled gradual reduction for adolescent smoking cessation. Subst Use Misuse 2002; 37: 255-263.
  • 49. Eysenck HJ. An exercise in mega-silliness. Am Psychol 1978; 33: 517.
  • 50. Oakes M. The logic and role of meta-analysis in clinical research. Stat Methods Med Res 1993; 2: 147-160.
  • 51. Bangert-Drowns RL. Review of developments in meta-analytic method. Psychol Bull 1986; 99: 388-399.
  • 52. Rosenthal R, Rosnow RL. Essentials of behavioral research: methods and data analysis. New York: McGraw-Hill, 1984.
  • 53. White V, Hayman J. Australian secondary school students’ use of alcohol in 2005. Canberra: Drug Strategy Branch, Australian Government Department of Health and Ageing, 2006.
  • 54. Degenhardt L, Lynskey M, Hall W. Cohort trends in the age of initiation of drug use in Australia. Aust N Z J Public Health 2000; 24: 421-426.
  • 55. Anthony JC, Petronis KR. Early-onset drug use and risk of later drug problems. Drug Alcohol Depend 1995; 40: 9-15.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.