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Alcohol – Excessive Consumption: Electronic Screening and Brief Interventions (e-SBI)


What the Task Force Found

About The Systematic Review

The Task Force finding is based on evidence from a systematic review of 31 studies with 36 study arms (search period 1970–October 2011). The review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to preventing excessive alcohol consumption.


  • e-SBI can be readily integrated into standard organizational practices in various settings.
  • e-SBI can be used to reach populations who would not otherwise be offered traditional SBI, by:
    • Expanding the settings within which SBI can be feasibly delivered
    • Ensuring consistent delivery to intended recipients

Summary of Results

The systematic review included 31 studies with 36 study arms.

  • The studies assessed changes in excessive alcohol consumption and related harms after use of e-SBI; participants were categorized into two groups.
    • Excessive drinkers (i.e., those who reported drinking above an established threshold)
    • All participants (i.e., the entire sample of people exposed to the brief intervention, including those above and below threshold for excessive drinking)

Alcohol Consumption

Included studies showed decreases in alcohol consumption following the use of e-SBI.

  • Binge drinking* frequency (i.e., number of binge drinking occasions per month)
    • Excessive drinkers: 16.5% median reduction (interquartile interval [IQI]: -35.6 to -11.8; 8 studies with 9 study arms)
    • All participants: 1.8% median reduction (2 studies)
  • Mean drinking intensity (i.e., average number of drinks per occasion or estimated blood alcohol concentration [BAC])
    • Excessive drinkers: 5.5% median reduction (IQI: -14.5 to 1.1; 11 studies with 14 study arms)
    • All participants: 13.5% median reduction (2 studies)
  • Peak consumption per occasion (i.e., maximum number of drinks per occasion or estimated peak BAC)
    • Excessive drinkers: 23.9% median reduction (IQI: -51.3 to -2.1; 8 studies with 9 study arms)
    • All participants: 19.1% median reduction (IQI: -42.1 to -17.7; 5 studies)
  • Frequency of alcohol consumption per month (i.e., number of days per month when any amount of alcohol was consumed)
    • Excessive drinkers: 11.5% median reduction (IQI: -17.3 to -4.9; 7 studies with 8 study arms)
    • All participants: 14.4% median reduction (1 study)
  • Mean number of drinks consumed per month
    • Excessive drinkers: 13.8% median reduction (IQI: -31.7 to -10.8; 13 studies with 16 study arms)
    • All participants: 16.2% median reduction (IQI: -33.4 to -8.2; 5 studies with 7 study arms)
  • Proportion of participants who changed their drinking patterns
    • Proportion of participants who exceeded guidelines for binge drinking*: 3.2% median reduction (IQI: -9.5 to 3.0; 5 studies)
    • Proportion of participants who exceeded guidelines for heavy drinking*: 15.0% median reduction (IQI: -26.2 to -11.8; 4 studies)

*The definition of binge and heavy drinking varied slightly across studies. Binge drinking is typically defined as 5 or more drinks for a man, and 4 or more drinks for a woman, per occasion; heavy drinking is typically defined as more than 14 drinks for a man, and more than 7 drinks for a woman, per week.

Alcohol-Related Harms (scores from scales assessing multiple problems)

  • Alcohol Use Disorders Identification Test this link is to an external website (AUDIT) score
    • Excessive drinkers: 1.1 point decrease in AUDIT score in the favorable direction (IQI: -2.1 to 0.2; 3 studies with 4 study arms)
    • All participants: 0.9 point decrease in AUDIT score (1 study)
  • Other scores were reported using various scales, such as the Rutgers Alcohol Problem Index, and could not be combined to calculate the magnitude of the effect.
    • 12 of the 17 study arms showed favorable intervention effects, 7 of which were statistically significant.
    • The remaining five study arms showed an increase in alcohol-related problems or no effect; all of these results were not statistically significant.


Summary of Economic Evidence

Three studies were included in the review. Two studies from the Netherlands reported costs and benefits, and one study from the U.S. reported benefits only in terms of annual costs averted. All values are reported in 2011 U.S. dollars.

  • One study estimated the average cost per user per year to be $57, a benefit-to-cost ratio of 12:1, and a net savings of $468 per capita (95% CI: -$334, $1,275).
  • Another study estimated the cost per user would vary from $12 to $258, depending on intervention intensity and found that partially substituting face-to-face interventions with e-Health interventions would result in similar disability adjusted life years (DALY) averted while decreasing costs of alcohol interventions by $84.8 million per year.
  • A third study estimated e-SBI would save the U.S. military $136 million annually through healthcare costs averted, increased productivity, decreased non-deployability, and decreased early separation.

Although available evidence indicates e-SBI has the potential to be cost-saving, additional studies in a broader range of contexts are necessary to adequately assess the economic merits of this intervention.


  • Based on the settings and populations from included studies, results are applicable to the following.
    • Interventions implemented in a universities, healthcare settings, and communities
    • Adults of all ages
    • Men and women
  • Included studies reported limited data on effectiveness by race/ethnicity, and only one study provided information about program effectiveness among adolescents.

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

  • Research should be conducted to assess the effectiveness of e-SBI in settings other than colleges and healthcare organizations (e.g., military, worksites, public health organizations) and among specific populations (e.g., adolescents, racial and ethnic groups).
  • Additional studies comparing e-SBI with traditional alcohol screening and brief intervention would help improve understanding of relative benefits.
  • Evaluations of long-term effectiveness of e-SBI (i.e., beyond 12 months) are needed to assess whether reported reductions in alcohol consumption among excessive drinkers are sustained.
  • Research is needed to determine the optimal level of intervention intensity and assess the relative effectiveness of different types of feedback.
  • Studies should evaluate the potential usefulness of “booster sessions” to improve the long-term effectiveness of e-SBI.
  • More information is needed about the costs of developing and implementing e-SBI in the U.S.
  • Future research should also evaluate the cost-effectiveness of e-SBI in communities that have widely implemented this intervention.


Study Characteristics

  • All included studies were randomized control trials, and most had follow-up periods of 6 –12 months.
  • Twenty-four studies (28 study arms) provided results for excessive drinkers only, and seven studies (eight study arms) reported results for all drinkers.
  • Nearly two-thirds of the studies used probability sampling designs or attempted to recruit everyone willing to participate.
  • In approximately 60% of the studies, participants were screened for excessive consumption through automated methods—most often via the Internet.
  • Over 80% of the brief interventions were delivered solely through automated methods.
  • Evaluated interventions were conducted in universities (17 studies), healthcare settings (11 studies), and communities (8 studies).
  • Studies were conducted in the U.S. (17 studies) and other countries (19 studies).