Mobile apps to reduce tobacco, alcohol, and illicit drug use: Systematic review of the first decade

Abstract

Background: Mobile apps for problematic substance use have the potential to bypass common barriers to treatment seeking. Ten years following the release ofthe first app targeting problematic tobacco, alcohol, and illicit drug use, their effectiveness, use, and acceptability remains unclear. Objective: This study aims to conduct a systematic literature review of trials evaluating mobile app interventions for problematic tobacco, alcohol, and illicit druguse. Methods: The review was conducted according to recommended guidelines. Relevant databases were searched, and articles were included if the mobile appstudy was a controlled intervention trial and reported alcohol, tobacco, or illicit drug consumption as outcomes. Results: A total of 20 studies met eligibility criteria across a range of substances: Alcohol (n=11), tobacco (n=6), alcohol and tobacco (n=1), illicit drugs (n=1),and illicit drugs and alcohol (n=1). Samples included the general community, university students, and clinical patients. The analyzed intervention sample sizesranged from 22 to 14,228, and content was considerably diverse, from simple stand-alone apps delivering self-monitoring or psychoeducation tomulticomponent apps with interactive features and audio content, or used as adjuncts alongside face-to-face treatment. Intervention duration ranged from 1 to35 weeks, with notifications ranging from none to multiple times per day. A total of 6 of the 20 app interventions reported significant reductions in substanceuse at post or follow-up compared with a comparison condition, with small to moderate effect sizes. Furthermore, two other app interventions reportedsignificant reductions during the intervention but not at post treatment, and a third reported a significant interaction of two app intervention components. Conclusions: Although most app interventions were associated with reductions in problematic substance use, less than one-third were significantly better thanthe comparison conditions at post treatment. A total of 5 out of the 6 apps that reported intervention effects targeted alcohol (of those, one targeted alcoholand illicit drugs and another alcohol and tobacco) and 1 targeted tobacco. Moreover, 3 out of 6 apps included feedback (eg, personalized) and 2 had high risk ofbias, 1 some risk, and 3 low risk. All 6 apps included interventions of 6 weeks or longer. Common study limitations were small sample sizes; risk of bias; lack ofrelevant details; and, in some cases, poorly balanced comparison conditions. Appropriately powered trials are required to understand which app interventionsare most effective, length of engagement required, and subgroups most likely to benefit. In sum, evidence to date for the effectiveness of apps targetingproblematic substance use is not compelling, although the heterogeneous comparison conditions and trial designs across studies limit the ability to compareefficacy between apps. We discuss potential approaches that can help ascertain whether the promise of mobile app interventions for problematic substanceuse can be fulfilled.