Web-based Interventions for Substance Use Disorders and Mental Health: Preliminary findings from a Scoping Review

Abstract

This scoping review evaluated the efficacy and potential of web-based interventions for substance use disorders and mental health conditions. The studies comprise randomized controlled trials, pilot trials, and effectiveness trials. Web-based interventions consistently demonstrated significant reductions in substance use, improvements in mental health outcomes (e.g., PTSD, depression, anxiety), and enhancements in emotion regulation, help-seeking, and quality of life. Several studies found web-based interventions to be non-inferior or superior to traditional face-to-face treatments. Despite limitations in the current evidence base, such as methodological issues and lack of long-term follow-up, the findings highlight the promise of web-based interventions in expanding access to evidence-based care, particularly for underserved populations. Future research should focus on refining interventions, exploring novel technologies, and evaluating long-term effectiveness and cost-effectiveness. The integration of web-based interventions into healthcare systems has the potential to significantly impact public health by increasing treatment accessibility and improving outcomes for individuals with substance use disorders and mental health conditions.

Introduction

Substance use disorders (SUDs) and mental health conditions are prevalent and often co-occurring public health issues that significantly impact individuals, families, and society. SUDs, including alcohol and drug abuse or dependence, are characterized by compulsive use despite harmful consequences, while mental health conditions, such as depression, anxiety, and post-traumatic stress disorder (PTSD), involve disturbances in emotional, cognitive, and behavioral functioning. These disorders are associated with a wide range of negative outcomes, including impaired social and occupational functioning, increased healthcare utilization, and elevated risk of morbidity and mortality.

Despite the availability of evidence-based treatments for SUDs and mental health conditions, many individuals face significant barriers to accessing care. Traditional face-to-face interventions often require substantial time commitments, transportation, and financial resources, which can be particularly challenging for underserved or marginalized populations. Additionally, the stigma associated with seeking help for these conditions, as well as the limited availability of specialized services in certain geographic areas, can further impede access to treatment. As a result, a substantial proportion of individuals with SUDs and mental health conditions do not receive adequate care, highlighting the need for innovative and accessible treatment options.

Web-based interventions have emerged as a promising approach to address the challenges associated with traditional treatment for SUDs and mental health conditions. These interventions leverage the widespread availability of the internet and digital technologies to deliver evidence-based therapies, such as cognitive-behavioral therapy (CBT), motivational interviewing (MI), and relapse prevention, in a convenient and cost-effective manner. Web-based interventions can be accessed anytime, anywhere, and offer a level of anonymity that may reduce barriers related to stigma. Moreover, these interventions can be tailored to individual needs, provide automated feedback and support, and facilitate real-time monitoring of symptoms and progress. Given these advantages, web-based interventions have the potential to expand the reach of treatment and improve outcomes for individuals with SUDs and mental health conditions.

The objective of this review is to synthesize the current evidence on the efficacy, engagement, and implementation of web-based interventions for SUDs and mental health conditions. By comprehensively examining the available literature, this review aims to provide a critical analysis of the strengths, limitations, and future directions of web-based interventions in this context. The findings of this review will inform healthcare providers, policymakers, and researchers about the potential of web-based interventions to improve access to care and enhance outcomes for individuals with SUDs and mental health conditions, ultimately contributing to the development and dissemination of effective and scalable treatment options.

Methods

This scoping review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., 2009). A systematic computerized literature search was conducted across nine databases, including (EBSCOhost) Academic Search Complete®, (EBSCOhost) PsycInfo®, (EBSCOhost) CINAHL®, PubMed®, IEEE Xplore®, Web of Science®, Scopus®, Embase®, and (Ovid) Cochrane Database of Systematic Reviews®. Study eligibility was determined using inclusion criteria, the PRISMA checklist (Moher et al., 2009), and was managed using Covidence®. Two researchers independently assessed the literature based on the inclusion criteria in a first screen, followed by a second screen to evaluate the relevance of all eligible articles. Conflicts were resolved by a third researcher. The included articles were then assessed for risk of bias, and data was extracted and tabulated using Covidence®. As this review relied solely on publicly available literature, an ethics consultation was not necessary.

Results

A. Overview of included studies

Number of studies and participants This systematic review included a total of 42 studies, comprising randomized controlled trials (RCTs), pilot RCTs, and effectiveness trials. The number of participants in each study varied widely, ranging from 20 (Shi et al., 2019) to 1,169 (Johansson et al., 2021). The total number of participants across all included studies was approximately 10,000, with the majority of studies having sample sizes between 100 and 300 participants. The large number of studies and participants included in this review provides a robust foundation for evaluating the efficacy and effectiveness of web-based interventions for substance use disorders and mental health conditions.

Types of interventions and target populations The included studies investigated a diverse range of web-based interventions targeting various substance use disorders and mental health conditions. The most common interventions were based on cognitive-behavioral therapy (CBT) principles, often delivered through interactive modules, exercises, and multimedia content. Examples of CBT-based interventions include CBT4CBT (Carroll et al., 2008; Kiluk et al., 2018), VetChange (Brief et al., 2013), and the Therapeutic Education System (Brooks et al., 2010; Cochran et al., 2015). Other interventions incorporated motivational interviewing (MI) techniques, such as the Take Care of Me program (Baumgartner et al., 2021a; Frohlich et al., 2021) and the Can Reduce program (Schaub et al., 2015).

Some studies focused on specific therapeutic approaches, such as dialectical behavior therapy (Wilks et al., 2018) and the Seeking Safety program (Boden et al., 2012; Zlotnick et al., 2009). Several interventions combined multiple therapeutic modalities, such as CBT with MI or relapse prevention strategies (Hyland et al., 2023; Johansson et al., 2021; Kay-Lambkin et al., 2011).

The target populations in the included studies were diverse, encompassing individuals with various substance use disorders and mental health conditions. Many studies focused on alcohol use disorders (Augsburger et al., 2022; Blankers et al., 2011; Riper et al., 2008), while others targeted drug use disorders, including cannabis (Ahlers et al., 2022; Budney et al., 2015; Schaub et al., 2015), stimulants (Cochran et al., 2015; Tait et al., 2014), and opioids (Bickel et al., 2008; Shi et al., 2019). Some studies specifically addressed substance use disorders in the context of co-occurring mental health conditions, such as depression (Baumgartner et al., 2021a; Kay-Lambkin et al., 2009) and PTSD (Acosta et al., 2017; Brief et al., 2013; Possemato et al., 2019).

The included studies also targeted specific populations, such as veterans (Acosta et al., 2017; Brief et al., 2013), college students (Ford et al., 2018), women (Kelpin et al., 2022), and individuals in primary care settings (Tetrault et al., 2020). Some studies focused on culturally adapted interventions, such as the Spanish version of CBT4CBT (Paris et al., 2018) and the Quitting is Winning program for Korean American smokers (McDonnell et al., 2011).

Table 1 –

Included Studies

Author/Year	Intervention Name	Treatment Focus	Target Subjects	Sample Size
Acosta et al., 2017	Thinking Forward	PTSD and hazardous alcohol use	OEF/OIF combat veterans	162
Ahlers et al., 2022	CANreduce 2.0	Cannabis use in adults with ADHD	Adults, mean age 28 years	367
Augsburger et al., 2022	SELGE	Alcohol misuse	Adults, mean age 38 years	589
Baumgartner et al., 2021a	Take Care of Me	Alcohol misuse and depression	Adults with co-occurring disorders	689
Bickel et al., 2008	CBT4CBT	Opioid dependence	Adults with opioid dependence	135
Blankers et al., 2011	TAO and SAO	Alcohol use disorders	Adults, mean age 42 years	205
Boden et al., 2012	Seeking Safety	PTSD and substance use in veterans	Male veterans with co-occurring disorders	Not stated
Brief et al., 2013	VetChange	Alcohol use in veterans	OEF/OIF veterans	600
Brooks et al., 2010	TES	Substance use disorders	Adults with cocaine dependence	24
Budney et al., 2015	Computer-assisted CBT	Cannabis use disorder	Adults with cannabis dependence	75
Carroll et al., 2008	CBT4CBT	Substance use disorders	Adults with substance dependence	77
Carroll et al., 2009	CBT4CBT	Substance use disorders	Adults with substance dependence	73
Carroll et al., 2014	CBT4CBT	Cocaine dependence	Adults with cocaine dependence on methadone maintenance	101
Cochran et al., 2015	TES	Substance use disorders	Adults entering outpatient treatment	497
Cunningham, 2012	AHC and CYD	Alcohol use disorders	Adults, mean age 45 years	170
Farren et al., 2015	CCBT	Alcohol use disorders	Adults with alcohol disorders	35
Farren et al., 2022	UControlDrink app	Alcohol use disorder	Adults post alcohol rehab	111
Ford et al., 2018	Modular CBT combining internet and F2F	Alcohol use and PTSD in college students	College students aged 18-22 years	29
Frohlich et al., 2021	Take Care of Me	Alcohol misuse and emotional problems	Young adults, mean age 25 years	222
Hyland et al., 2023	ICBT program	Alcohol dependence	Adults, mean age 51 years	264
Johansson et al., 2021	ICBT program	Alcohol use disorder	Adults, mean age 50 years	301
Johansson et al., 2021	ICBT program	Harmful alcohol use and alcohol dependence	Adults, mean age 45 years	1169
Kay-Lambkin et al., 2011	CAC therapy (computerized CBT/MI)	Depression and comorbid addictive disorders	Adults with co-occurring disorders	274
Kay-Lambkin et al., 2012	CCBT/MI delivered via computer	Comorbid addiction and depression	Adults with co-occurring disorders	274
Kay-Lambkin et al., 2009	Integrated MI/CBT	Depression and comorbid alcohol/cannabis use	Adults with co-occurring disorders	97
Kelpin et al., 2022	CBT4CBT	Substance use disorders in women	Women in residential SUD treatment	63
Kiluk et al., 2018	CBT4CBT	Substance use disorders	Adults seeking outpatient treatment	137
Kiluk et al., 2016	CBT4CBT	Alcohol use disorders	Adults seeking substance abuse treatment	68
Kiluk et al., 2010	CBT4CBT	Substance use disorders	Adults seeking substance abuse treatment	52
McDonnell et al., 2011	Quitting is Winning	Smoking cessation	Korean American adult smokers	1112
Paris et al., 2018	Spanish CBT4CBT	Substance use disorders	Spanish-speaking adults with substance use disorders	92
Possemato et al., 2019	Thinking Forward with/without peer	PTSD and hazardous alcohol use in veterans	Primary care veterans with PTSD	30
Riper et al., 2008	Drinking Less	Problem drinking	Adult problem drinkers	261
Riper et al., 2008	Drinking Less	Problem drinking	Adult problem drinkers	261
Schaub et al., 2015	Can Reduce	Cannabis use disorders	Adults who use cannabis weekly	308
Shi et al., 2019	CBT4CBT-Buprenorphine	Opioid use disorder	Adults on buprenorphine maintenance	20
Sinadinovic et al., 2020	Cannabishjälpen	Cannabis use disorders	Adolescents and adults who use cannabis	303
Sinadinovic et al., 2014	Extended ICBT self-help	Alcohol use disorders	Adult help seekers with hazardous alcohol use	633
Sundström et al., 2016	ICBT program	Problematic alcohol use	Adults with problematic alcohol use	80
Sundström et al., 2020	High and low-intensity ICBT	Alcohol use disorders	Adults with severe alcohol use disorders	166
Tait et al., 2015	Breakingtheice	Amphetamine use disorders	Adults who use amphetamines	160
Tait et al., 2014	Breakingtheice	Amphetamine use disorders	Adults who use amphetamines	160
Takano et al., 2020	e-SMARPP	Methamphetamine use disorders	Adults diagnosed with methamphetamine dependence	48
Tetrault et al., 2020	CBT4CBT	Substance use disorders	Adults with SUD in integrated primary care	58
Tiburcio et al., 2018	PAADD	Substance use disorders	Adults seeking substance abuse treatment	74
Webb et al., 2020	Quit Genius	Smoking cessation	Adult smokers	530
Wilks et al., 2018	iDBT-ST	PTSD and alcohol use	Adults with emotion regulation difficulties	59
Zhang et al., 2022	WonderLab Harbor app	Methamphetamine use disorders	Adults diagnosed with methamphetamine dependence	100
Zlotnick et al., 2009	Seeking Safety	PTSD and substance use disorders in women	Incarcerated women with co-occurring disorders	49

Table 2 –

substance use outcomes:

Outcome	Key Findings
Reductions in alcohol consumption	- Significant reductions in alcohol use and heavy drinking days with web-based interventions (Acosta et al., 2017; Augsburger et al., 2022; Baumgartner et al., 2021a; Blankers et al., 2011; Brief et al., 2013; Sundström et al., 2016)
Reductions in drug use	- Significant reductions in cannabis use and dependence severity with web-based interventions (Ahlers et al., 2022; Schaub et al., 2015; Wilks et al., 2018) - Reductions in stimulant and opioid use with computer-assisted CBT (Bickel et al., 2008; Cochran et al., 2015)
Abstinence rates and relapse prevention	- Higher rates of abstinence from alcohol and drugs with web-based CBT interventions (Carroll et al., 2008; Carroll et al., 2014; Kiluk et al., 2018) - Sustained reductions in substance use and relapse prevention at follow-up (Carroll et al., 2009; Zlotnick et al., 2009)

Web-based interventions have demonstrated significant reductions in alcohol consumption across various studies. Acosta et al. (2017) found that a web-based CBT intervention led to significant reductions in heavy drinking days among veterans with PTSD and hazardous alcohol use. Similarly, Augsburger et al. (2022) and Baumgartner et al. (2021a) reported significant reductions in alcohol use and hazardous drinking with web-based interventions incorporating CBT and motivational interviewing techniques. Blankers et al. (2011) and Brief et al. (2013) also found significant reductions in alcohol consumption with web-based interventions compared to control conditions. Furthermore, Sundström et al. (2016) demonstrated that a counselor-guided web-based CBT program significantly reduced past-week alcohol use compared to a self-help program.

Web-based interventions have also shown promise in reducing drug use, particularly for cannabis, stimulants, and opioids. Ahlers et al. (2022) and Schaub et al. (2015) reported significant reductions in cannabis use days and dependence severity with web-based interventions that included motivational interviewing and CBT components. Wilks et al. (2018) found improvements in alcohol and drug use outcomes with a web-based dialectical behavior therapy skills training program. Regarding stimulant and opioid use, Bickel et al. (2008) demonstrated higher rates of abstinence from opioids and cocaine with computer-assisted CBT compared to standard treatment, while Cochran et al. (2015) found that a web-based therapeutic education system was more effective for reducing stimulant use than opioid use.

Several studies have highlighted the efficacy of web-based interventions in promoting abstinence and preventing relapse. Carroll et al. (2008) and Carroll et al. (2014) found that a computer-based CBT program (CBT4CBT) led to higher rates of abstinence from drugs and increased the likelihood of achieving three or more weeks of continuous abstinence compared to standard treatment. Kiluk et al. (2018) also reported improved substance use outcomes and higher retention rates with CBT4CBT compared to standard outpatient treatment. Moreover, Carroll et al. (2009) demonstrated sustained reductions in drug use over a 6-month follow-up period with CBT4CBT, indicating its potential for long-term relapse prevention. Similarly, Zlotnick et al. (2009) found significant improvements in substance use outcomes over time with a web-based version of the Seeking Safety intervention for individuals with PTSD and substance use disorders.

Table 3 –

mental health outcomes:

Outcome	Key Findings
Improvements in PTSD symptoms	- Significant reductions in PTSD symptoms with web-based CBT interventions (Acosta et al., 2017; Brief et al., 2013; Possemato et al., 2019) - Sustained improvements in PTSD symptoms at follow-up (Wilks et al., 2018; Zlotnick et al., 2009)
Reductions in depression and anxiety symptoms	- Significant reductions in depression and anxiety symptoms with web-based interventions (Baumgartner et al., 2021a; Ford et al., 2018; Frohlich et al., 2021) - Improvements in depression and anxiety symptoms maintained at follow-up (Kay-Lambkin et al., 2009; Kay-Lambkin et al., 2011)
Enhancements in emotion regulation and coping skills	- Improvements in emotion regulation and coping skills with web-based CBT and DBT interventions (Ford et al., 2018; Wilks et al., 2018) - Increased use of cognitive and behavioral strategies for managing substance use and mental health symptoms (Carroll et al., 2008; Kiluk et al., 2010)

Several studies in this review demonstrated significant improvements in PTSD symptoms following web-based interventions. Acosta et al. (2017) found that a web-based CBT program called Thinking Forward led to significant reductions in PTSD symptoms among veterans with co-occurring hazardous alcohol use. Similarly, Brief et al. (2013) reported significant reductions in PTSD symptoms with the VetChange web-based intervention for veterans with alcohol misuse. Possemato et al. (2019) also found improvements in PTSD symptoms with the Thinking Forward program, both with and without peer support. Furthermore, sustained improvements in PTSD symptoms were observed at follow-up assessments in studies by Wilks et al. (2018) and Zlotnick et al. (2009), suggesting the long-term benefits of web-based interventions for PTSD.

Web-based interventions also demonstrated efficacy in reducing depression and anxiety symptoms. Baumgartner et al. (2021a) found that the Take Care of Me program, which combines CBT and motivational interviewing, led to significant reductions in depression symptoms among adults with co-occurring alcohol misuse and depression. Similarly, Ford et al. (2018) reported reductions in depression and anxiety symptoms with a modular CBT intervention combining internet and face-to-face counseling for college students with alcohol use and PTSD. Frohlich et al. (2021) also found improvements in depression and anxiety symptoms with the Take Care of Me program among young adults with alcohol misuse and emotional problems. Notably, improvements in depression and anxiety symptoms were maintained at follow-up assessments in studies by Kay-Lambkin et al. (2009) and Kay-Lambkin et al. (2011), indicating the potential for long-term benefits of web-based interventions for these mental health outcomes.

Web-based interventions also demonstrated enhancements in emotion regulation and coping skills. Ford et al. (2018) found that a modular CBT intervention combining Internet and face-to-face counseling led to improvements in emotion regulation among college students with alcohol use and PTSD. Similarly, Wilks et al. (2018) reported improvements in emotion regulation and coping skills with a web-based dialectical behavior therapy (DBT) skills training program for adults with PTSD and alcohol use. Carroll et al. (2008) and Kiluk et al. (2010) also found that the CBT4CBT web-based intervention led to increased use of cognitive and behavioral strategies for managing substance use and related problems, indicating enhancements in coping skills. These findings suggest that web-based interventions can effectively promote the development and application of emotion regulation and coping strategies, which are critical for managing both substance use disorders and mental health conditions.

Discussion

Increased help-seeking intentions and behaviors

In addition to the primary substance use and mental health outcomes, several studies in this review reported increased help-seeking intentions and behaviors following web-based interventions. Tait et al. (2015) found that the Breakingtheice program, which incorporates motivational interviewing and CBT techniques, led to significant increases in help-seeking intentions and actual help-seeking behaviors among adults with amphetamine use disorders. Similarly, Cunningham (2012) reported that the Alcohol Help Center (AHC) website, which provides personalized feedback and self-help resources, resulted in greater increases in help-seeking intentions compared to a brief screening intervention. These findings suggest that web-based interventions can serve as a valuable gateway to engage individuals in further treatment and support services, potentially increasing access to care for those who may not otherwise seek help.

Improvements in quality of life and functional outcomes

Several studies also demonstrated improvements in quality of life and functional outcomes following web-based interventions. Frohlich et al. (2021) found that the Take Care of Me program, which addresses alcohol misuse and emotional problems, led to significant improvements in psychological, social, and environmental quality of life domains among young adults. Similarly, Tait et al. (2015) reported significant reductions in days out of role (i.e., days unable to perform usual activities) with the Breakingtheice program for amphetamine use disorders. Kay-Lambkin et al. (2011) also found that a computerized CBT and motivational interviewing intervention (CAC therapy) led to improvements in quality of life and functional outcomes among adults with depression and comorbid addictive disorders. These findings highlight the potential for web-based interventions to not only address substance use and mental health symptoms but also to promote broader improvements in overall well-being and functioning.

Comparison of web-based interventions to traditional treatments

Non-inferiority or superiority of web-based interventions Several studies in this review directly compared web-based interventions to traditional face-to-face treatments, providing insights into their relative efficacy. Johansson et al. (2021) conducted a non-inferiority trial comparing a web-based CBT program to face-to-face CBT for alcohol use disorder and found that the web-based intervention was non-inferior in reducing alcohol consumption at follow-up. Similarly, Kay-Lambkin et al. (2011) found that a computerized CBT and motivational interviewing intervention (CAC therapy) was as effective as therapist-delivered CBT in reducing alcohol consumption and depression symptoms among adults with comorbid disorders. In some cases, web-based interventions demonstrated superiority over traditional treatments. Blankers et al. (2011) found that a therapist-guided web-based self-help intervention (TAO) was more effective than a self-help-only intervention (SAO) in reducing alcohol consumption among adults with alcohol use disorders. Similarly, Carroll et al. (2014) reported that the CBT4CBT web-based intervention led to significantly higher rates of abstinence from cocaine compared to standard methadone maintenance treatment. These findings suggest that web-based interventions can be as effective as, and in some cases, superior to, traditional face-to-face treatments for substance use disorders and mental health conditions. This has important implications for increasing access to evidence-based care, particularly for individuals who may face barriers to traditional treatment settings.

Implications for healthcare delivery and access

The potential of web-based interventions to reach underserved populations The findings of this review have important implications for healthcare delivery and access. Web-based interventions offer a promising approach to reach underserved populations who may face barriers to traditional treatment, such as geographic distance, limited transportation, stigma, or time constraints. The accessibility and convenience of web-based interventions can help bridge the treatment gap and provide evidence-based care to individuals who might otherwise go untreated. Moreover, web-based interventions can be particularly valuable for reaching specific populations, such as veterans, college students, or individuals with co-occurring disorders, who may have unique needs or preferences for treatment delivery.

Integration of web-based interventions into existing healthcare systems

The integration of web-based interventions into existing healthcare systems can enhance the continuum of care and provide a stepped-care approach to treatment. Web-based interventions can serve as a first-line intervention for individuals with mild to moderate substance use or mental health concerns, reserving more intensive face-to-face treatments for those with severe or complex conditions. This stepped-care model can optimize resource allocation and improve the efficiency of healthcare delivery. Furthermore, web-based interventions can be used to supplement or augment traditional treatments, providing additional support and skill-building opportunities between face-to-face sessions.

Limitations and gaps in the current evidence base

The current evidence base for web-based interventions in substance use disorders and mental health conditions has several limitations and gaps. Many of the included studies had methodological shortcomings, such as small sample sizes, brief follow-up periods, and lack of blinding, which may limit the generalizability and long-term effectiveness of the findings. Moreover, the substantial heterogeneity in interventions, populations, and outcome measures across studies makes direct comparisons and meta-analyses challenging. Another significant gap in the literature is the scarcity of long-term follow-up data and cost-effectiveness analyses. Although some studies demonstrated sustained effects at 6- or 12-month follow-ups, further research is necessary to evaluate the durability of treatment outcomes over extended periods. Additionally, the limited number of cost-effectiveness analyses hinders informed policy and resource allocation decisions. Future research should prioritize long-term follow-up assessments and economic evaluations to better understand the real-world impact and value of web-based interventions.

Future directions for research and implementation

Future research and implementation efforts should focus on refining and optimizing web-based interventions by identifying the most effective components, tailoring interventions to specific populations, and developing strategies to enhance engagement and adherence. This may involve investigating the use of prompts, reminders, incentives, or social support features, as well as conducting qualitative research to gain insights into user experiences and preferences. Additionally, exploring the potential of novel technologies and delivery platforms, such as mobile apps, wearable devices, virtual reality, and artificial intelligence, can further expand the reach and impact of web-based interventions. Collaboration between researchers, clinicians, technology experts, and end-users will be crucial for driving the development of more sophisticated, adaptive, and effective interventions that can respond to individual needs and preferences in real time.

Conclusion

In conclusion, this review provides compelling evidence for the efficacy and potential of web-based interventions in addressing substance use disorders and mental health conditions. The included studies consistently demonstrated significant reductions in substance use, improvements in mental health outcomes, and enhancements in related domains. While limitations and gaps exist in the current evidence base, the findings highlight the promise of web-based interventions as a valuable treatment approach that can expand access to evidence-based care, particularly for underserved populations. Continued research and implementation efforts are necessary to refine and optimize interventions, explore novel technologies and delivery platforms, and fully realize the potential impact of web-based interventions on public health and healthcare delivery.