Addictive Behaviors 62 (2016) 25–34

Contents lists available at ScienceDirect

Addictive Behaviors

journal homepage: www.elsevier.com/locate/addictbeh

Mobile technology-based interventions for adult users of alcohol: A

systematic review of the literature
Lauren A. Fowler ⁎, Sidney L. Holt, Deepti Joshi
George Washington University, United States

H I G H L I G H T S

• This review summarizes the current literature on mobile technology-based interventions among adult users of alcohol.
• Five relevant databases were searched for peer-reviewed articles from 2004 to 2015. Eight studies met inclusion criteria.
• The majority found positive effects of the intervention, although the interventions were primarily preliminary in nature.
• Findings highlight the promising, yet preliminary state of research in this area.
• M-tech interventions have the potential to compliment established treatment modalities for alcohol use among adults.

a r t i c l e i n f o a b s t r a c t

Article history: Background: Worldwide, 16% of people aged 15 and older engage in harmful use of alcohol. Harmful alcohol use
Received 17 January 2016 leads to a host of preventable negative social and health consequences. Mobile technology-based interventions
Received in revised form 13 May 2016 provide a particularly promising avenue for the widespread and cost-effective delivery of treatment that is acces-
Accepted 6 June 2016 sible, affordable, individualized, and destigmatized to both alcohol-dependent and nondependent individuals.
Available online 7 June 2016
Aims: The present review sought to summarize the current literature on mobile technology-based interventions
among adult users of alcohol and determine the efficacy of such interventions.
Keywords:
Alcohol
Methods: Five databases were searched in December 2015 (Jan. 2004–Dec. 2015). Inclusion criteria were: partic-
SMS ipants aged 18 or older, interventions delivered through mobile-technology, and outcome measurement of alco-
Text messaging hol reduction/cessation.
Intervention Findings: Eight studies met inclusion criteria. The majority of the studies reviewed found positive effects of the
Substance use intervention, even though the interventions themselves varied in design, length, dosage, and target population,
and were pilot or preliminary in nature.
Conclusions: Findings from this review highlight the promising, yet preliminary state of research in this area.
Studies with adequate power and valid design are necessary to evaluate the potential of mobile technology-
based interventions on long-term alcohol behavior outcomes. Furthermore, future research should elucidate
what the most effective length of time is for a mobile technology-based intervention, how often individuals
should receive messages for maximum benefit, and determine the comparative effectiveness of mobile technol-
ogy interventions with other efficacious interventions.
© 2016 Elsevier Ltd. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
1.1. Traditional treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
1.2. Mobile technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
1.3. Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
2.1. Selection of studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
2.2. Inclusion criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

⁎ Corresponding author.
E-mail address: lfowler@gwu.edu (L.A. Fowler).

http://dx.doi.org/10.1016/j.addbeh.2016.06.008
0306-4603/© 2016 Elsevier Ltd. All rights reserved.
26 L.A. Fowler et al. / Addictive Behaviors 62 (2016) 25–34

2.3. Data synthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.1. Description of studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.1.1. Participants and setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.1.2. Type of intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.1.3. Comparison and control groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.1.4. Intervention length & dosage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.1.5. Follow-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.2. Intervention effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
4.1. Summary of evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
4.2. Limitations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
4.3. Concluding remarks and future directions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Role of funding sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Conflict of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

1. Introduction Carey, 2014; Scott-Sheldon, Demartini, Carey, & Carey, 2009;

Misuse and abuse of alcohol remains a serious public health concern.
Misuse of alcohol is the leading risk factor for premature death and dis-
ability among people between the ages of 15 and 49 (Lim et al., 2012);
nearly a quarter of all deaths among those aged 20 to 39 are attributable
to alcohol (World Health Organization [WHO], 2014a). Worldwide, 16%
of drinkers aged 15 years or older engage in harmful alcohol use (WHO,
2014b). Harmful drinking—drinking that causes damage to physical
and/or mental health—is associated with short-term risks such as inju-
ries (e.g., motor vehicle crashes, drownings, and burns), violence (e.g.,
homicide, suicide, and sexual assault) and risky sexual behaviors (e.g.,
unprotected sex and multiple sex partners) as well as long-term risks
such as mental health problems (e.g., depression and anxiety), poor
school performance, poor productivity and unemployment, family
problems, and alcohol dependence or alcoholism (Centers for Disease
Control and Prevention [CDC], 2014). Currently, only 15–25% of individ-
uals with drinking problems seek treatment (National Institute on
Alcohol Abuse and Alcoholism [NIAAA], 2014). There is an urgent
need for effective interventions that reduce or eliminate treatment
barriers.
1.1. Traditional treatments
Brief interventions (e.g. one-time brief interventions) and motiva-
tional enhancements (e.g. in-person motivational interviewing,
psychoeducational therapy) have been identified as two highly effective
forms of alcohol abuse treatment (Hester & Miller, 2002). For example, a
meta-analysis of 31 alcohol-related studies using motivational
interviewing found a combined effect size (across measures and time
points) of 0.22 (95% CI: 0.10, 0.34) for blood alcohol concentration and
0.08 (95% CI: − 0.02. 0.19) for alcohol-related problems (Hettema,
Steele, & Miller, 2005), indicating that motivational interviewing can re-
duce alcohol consumption and alcohol-related consequences. Further-
more, alcohol screenings and brief interventions have been shown to
be effective among non-treatment seeking populations and across a va-
riety of settings (Moyer, Finney, Swearingen, & Vergun, 2002). In fact, a
recent review of systematic reviews found moderate effects of brief in-
terventions among non-dependent alcohol users (Álvarez-Bueno,
Rodríguez-Martín, García-Ortiz, Gómez-Marcos, & Martínez-Vizcaíno,
2015). Cognitive-behavioral therapies are also highly effective at
treating problem drinking (Nauert, 2012). Overall, both cognitive and
behavioral changes following these traditional alcohol treatments (i.e.,
brief interventions, motivational enhancements, and cognitive behav-
ioral therapies) have been widely documented in the literature
(Samson & Tanner-Smith, 2015; Scott-Sheldon, Carey, Elliott, Garey, &
Tanner-Smith & Lipsey, 2015), and, importantly, the literature indicates
that individuals accept these treatment modalities (Hungerford,
Pollock, & Todd, 2000).
Despite the effectiveness and acceptance of these interventions, sub-
stantial barriers exist in the implementation of and access to traditional
person-delivered interventions. These interventions are resource inten-
sive, depend a great deal on the skill of the clinician (i.e., fidelity to the
intervention technique), cannot be simultaneously tailored to a large
number of individuals, lack widespread accessibility, and are potentially
stigmatizing. Barriers such as accessibility and stigma may help explain
low rates of treatment-seeking behaviors among problem drinkers.
Traditional interventions require substantial time and money as well
as trained providers. For instance, cognitive-behavioral therapies typi-
cally involve between 10 and 20 sessions (Mayo Clinic, 2015) delivered
by a therapist with a doctorate or master's degree in a mental health,
medical, or related field (Beck Institute for Cognitive Behavior
Therapy, n.d.). Furthermore, motivational enhancements involve four
carefully tailored treatment sessions that each last approximately 1 h
(Miller, Zweben, DiClemente, & Rychtarik, 1992; Miller, 2000). Existing
research has shown that tailored interventions are more effective than
group and/or untailored interventions (Ryan & Lauver, 2002), particu-
larly at promoting positive health behaviors such as quitting smoking
(Copeland, Martin, Geiselman, Rash, & Kendzor, 2006), reducing alcohol
intake (Suffoletto et al., 2015), getting vaccinated (Gowda, Schaffer,
Kopec, Markel, & Dempsey, 2013), being screened for breast cancer
(Ishikawa et al., 2012), and taking multivitamins (Milan & White,
2010). A limitation of traditional behavioral therapies is that these inter-
ventions, while effective for both individuals and groups, can be quite
resource intensive for group treatments (Center for Substance Abuse
Treatment, 1999; Velasquez, Crouch, Stephens, & DiClemente, 2015).
Due to their resource intensity, traditional behavioral interventions can-
not be easily and simultaneously tailored to large numbers of individ-
uals. Furthermore, traditional behavioral therapies depend a great deal
on the skill of the clinician/therapist. Therapeutic style forms the core
of motivational enhancement therapy (MET) and the therapist charac-
teristic of “accurate empathy” has been shown to be a powerful predic-
tor of therapeutic success with problem drinkers (Miller et al., 1992;
Miller, 2000). Brief interventions require clinicians to possess specific
knowledge, skills, and abilities in order to be effective (Barry, 1999;
U.S. Department of Health & Human Services, 2005). Most importantly,
the low rates of treatment-seeking behavior may be explained by a lack
of access to care and/or a failure to seek what is often stigmatized treat-
ment (Cunningham, Kypri, & McCambridge, 2011). For instance, in the
United States and Canada, adequate access to cognitive-behavioral ther-
apy remains a major barrier to improving clinical outcomes (Payne &
 L.A. Fowler et al. / Addictive Behaviors 62 (2016) 25–34
Myhr, 2010; Adelman, Panza, Bartley, Bontempo, & Bloch, 2014). Even if
access to care was not an issue, research has shown that substance use
disorders are more stigmatized than other health conditions and that
stigma is a significant barrier for accessing substance abuse treatment
services (Livingston, Milne, Fang, & Amari, 2012).
Given the nature of the barriers inherent in these effective tradition-
al treatment modalities, technology-based interventions (e.g., computer
and mobile technology) have an opportunity to complement or en-
hance the effects of these established treatments among both clinical
and subclinical users of alcohol. Specifically, mobile technology-based
interventions provide a promising avenue for the widespread and
cost-effective delivery of treatment that is accessible, affordable, de-
pendable, individualized, and destigmatized to both alcohol-dependent
and nondependent drinkers.
1.2. Mobile technologies
Mobile technology-based interventions are particularly well-suited
to address the aforementioned limitations of traditional interventions
and potentially complement or enhance established effective interven-
tions. Mobile technology-based interventions utilize text messages,
Web access, and/or mobile applications and are delivered via platforms
such as mobile phones, smart phones, personal digital assistants (PDA),
or tablets. Many of these interventions are founded on the same highly
effective psychosocial treatments (e.g., brief interventions, motivational
enhancement therapy, cue exposure therapy, cognitive-behavioral
therapy) as traditional interventions (Gustafson et al., 2014; Mason,
Benotsch, Way, Kim, & Snipes, 2014; Witkiewitz et al., 2014). However,
these interventions have been modified to fit within a portable elec-
tronic format which provides distinct advantages over human-deliv-
ered intervention approaches.
Mobile technology-based interventions can be delivered with high
fidelity—accurately and consistently, as originally specified by the de-
velopers, in order to achieve intended outcomes—through automated
systems that easily allow for message tailoring based on individual
needs and responses (Suffoletto, Callaway, Kristan, Kraemer, & Clark,
2012; Weitzel, Bernhardt, Usdan, Mays, & Glanz, 2007). The fidelity of
traditional intervention methods depends on the ability of the therapist
or clinician to deliver the intervention adequately and consistently
(Mayo Clinic, 2015; Miller et al., 1992) and in such a way as to discour-
age the premature termination of treatment by the client (Hogue et al.,
2008; Horner, Rew, & Torres, 2006). Mobile technologies offer solutions
to these challenges by standardizing treatment and assessment delivery
via pre-programmed mobile application intervention modules and au-
tomated text messages (Agyapong, Ahern, McLoughlin, & Farren,
2012; Budman, Portnoy, & Villapiano, 2003; Substance Abuse and
Mental Health Services Administration (SAMHSA), 2015b). This not
only reduces the dependence on the therapist/clinician, but eases the
burden on the client, thus encouraging the clients' continuation and/
or completion of treatment. Furthermore, the automated and adaptive
systems employed by mobile technologies have the capacity to deliver
personalized text messages to large numbers of people at low costs
(Arbanowski et al., 2004; Gibbons, 2007; SAMHSA, 2015b); this
would, for example, allow modification of future messages based on in-
dividual behavioral differences reported at baseline or other time points
in the intervention. For example, participants in a 6 month mobile tech-
nology-based alcohol use intervention who report binge drinking be-
havior at baseline might receive additional messages tailored
specifically to reduce binge drinking while those participants who do
not report binge drinking behavior would not receive these messages.
Other information collected at baseline, including demographic infor-
mation, could be used to personalize text messages. Tailoring of mes-
sages can also occur simultaneously as participants report their
behavior and cognitions at assessments during the intervention period.
For example, participants who identify a specific set of potential barriers
to reducing their alcohol consumption on an assessment during the
27
intervention period could then receive messages that address those
barriers.
Another benefit of mobile technology-based interventions is
that mobile applications can be easily and affordably downloaded
(Free et al., 2013) and mobile phones are continuously dropping in
cost (Ben-Zeev et al., 2014). In fact, underserved populations in the
US now use smartphones as their primary method for accessing re-
sources on the internet (Ben-Zeev et al., 2014). Given the stigma sur-
rounding both addiction and treatment, the anonymity afforded by
interventions that are delivered via text messaging and/or mobile
applications can be an important factor for seeking help through
this modality (Savic, Best, Rodda, & Lubman, 2013; Heron & Smyth,
2010). Most importantly, mobile technology is widely accessible to
both treatment-seeking and non-treatment-seeking populations.
Approximately 85% of the world's population owns a mobile phone
and of those 75% use text messaging (Pew Research Center, 2012).
Additionally, as of 2014, approximately 21% of the global population
owned a smartphone with an operating system capable of running
software applications (Statista, 2015), making interventions utiliz-
ing this modality increasingly convenient to access.
Notably, however, mobile technology-based interventions may
have limitations in regards to their application to vulnerable or
hard-to-reach populations, such as prison inmates, individuals with
disabilities (e.g. blindness), severe clinical populations, low-income
populations, or older populations. Such populations may not have
access to mobile phones, may not use mobile phones, or may not
have the same mobile phone number for an extended period of
time. Despite this, US government assistance programs increase ac-
cessibility of basic cell phone and functions such as text messaging
for vulnerable populations (Ben-Zeev et al., 2014).
Mobile technology-based interventions have been established as ev-
idence-based, recommended approaches towards substance use pre-
vention by the CDC (Mason, Ola, Zaharakis, & Zhang, 2014). Over the
past decade, the development of interventions for substance use disor-
ders that can be accessed and delivered via mobile technologies has in-
creased rapidly (Litvin, Abrantes & Brown, 2013). Research has found a
high willingness to use mobile technologies among both alcohol-depen-
dent (Savic et al., 2013) and non-dependent (Sankaranarayanan &
Sallach, 2014) populations and individuals perceive supportive text
messages as a useful aid in their recovery (Agyapong, Milnes,
McLoughlin, & Farren, 2013). These interventions have the potential to
be particularly pertinent as they are available on the person at all
times and provide opportunities for real-time monitoring and delivery
of substance use interventions in the contexts in which they are needed
most (Giroux, Bacon, King, Dulin, & Gonzalez, 2014).
Although there have been several recent reviews of mobile technol-
ogies used in substance use interventions, they differ from the present
study. For example, Mason, Ola, et al. (2014) conducted a meta-analysis
of 14 randomized controlled trials (RCTs) that were restricted to adoles-
cent and young adult users and focused exclusively on text messaging
interventions. The authors concluded that text messaging interventions
have a small but reliable effect on reducing substance use behaviors.
However, a majority of the studies (n = 11) tested intervention effects
on tobacco use whereas only three tested intervention effects on alcohol
use. Free et al. (2013) identified 26 trials in which various mobile tech-
nologies (e.g., mobile phone, PDA, MP3) were used to promote behavior
change. Only one trial, however, aimed to reduce alcohol consumption.
Thus there is no clear sense from the existing literature whether mobile
technologies are effective at reducing alcohol misuse.
1.3. Purpose
Given that alcohol misuse rates are so high and that only a fraction of
the individuals who misuse alcohol seek treatment via traditional ther-
apies (an estimated 7.6% of alcohol abusers; SAMHSA, 2015a), interven-
tions that are able to reach a wide number of individuals in a convenient
28 L.A. Fowler et al. / Addictive Behaviors 62 (2016) 25–34
and non-threatening (i.e., destigmatizing) way are not only useful but
necessary. Mobile technologies provide a low-cost, high fidelity, and
easily tailored method of doing this. What is unclear in the alcohol treat-
ment literature is the efficacy of mobile technology interventions at
changing harmful drinking behavior among adults. The purpose of this
systematic review is to present the current state of the literature on mo-
bile technology-based interventions for alcohol-related outcomes
among clinical and subclinical adults.
2. Methods
2.1. Selection of studies
A systematic literature search was conducted following the
guidelines established by PRISMA (Moher, Liberati, Tetzlaff,
Altman, & The PRISMA Group, 2009). During December 2015, the fol-
lowing databases were searched: PubMed, Web of Science,
MEDLINE, PsycARTICLES, and PsycINFO. The last three
databases—MEDLINE, PsycARTICLES, and PsycINFO—were searched
simultaneously. Researchers D.J. and L.F. searched MEDLINE,
PsycINFO, and PsycARTICLES; researchers S.H. and L.F. searched
PubMed; and S.H. and D.J. searched Web of Science. Each pair identi-
fied the same number of records. Databases were searched in four
steps. The first group of search terms were “mobile” OR “phone” OR
“smart phone” OR “SMS” OR “text” OR “app.” This search was com-
bined with the word AND and the next step of search terms: “inter-
vention” OR “program” OR “treatment.” Likewise, the previous
search was combined with the next grouping of terms: “substance
use” OR “substance abuse” OR “addiction” OR “dependence.” Finally,
the last step used the word AND to combine all the steps with the last
term “alcohol.” Searches were limited to articles published in the En-
glish language, in peer reviewed journals, from January 2004 to De-
cember 2015. A total of 642 records were identified using
Fig. 1. Flowchart of systematic review process.
equivalent search terms across databases. After removing duplicates,
472 records (titles and abstracts) were screened for eligibility in the
present review independently and separately by two members of the
research team before conferring. Any records that appeared relevant
were pulled for a full text review. This screening process was repeat-
ed a second time to ensure that all eligible articles were identified.
Refer to Fig. 1 for a flow chart summarizing the full inclusion process.
2.2. Inclusion criteria
Studies were eligible for inclusion in the review if they included
adults who were at least 18 years of age and reported using alcohol.
Further, to be included in the systematic review, the studies must
have: a comparison condition, an outcome measure of alcohol reduc-
tion, cessation, or abstinence maintenance, and the article had to de-
scribe a text message or mobile application intervention delivered
through mobile technology, which includes tablets, mobile phones,
smart phones, and PDAs. Excluded were studies with personal con-
tact— including telephone or in-person therapy components—in
the intervention to limit the review to mobile technology-delivered
interventions.
Nineteen full text articles were reviewed for inclusion and a total of
six studies were identified as meeting the inclusion criteria. After this,
each researcher conducted a manual search of the reference lists of
each of these six articles for relevant studies, thus providing us two
more studies that met the eligibility criteria for a total of eight studies.
Final inclusion decisions were discussed and agreed upon by all
researchers.
2.3. Data synthesis
Due to the heterogeneity among study populations, intervention
designs, and outcome measures across studies, a quantitative
 L.A. Fowler et al. / Addictive Behaviors 62 (2016) 25–34 29

analysis was not feasible since combined effect sizes for intervention 3. Results
efficacy were not provided. Therefore the results are presented as a
qualitative integration of the systematic review. Study and design 3.1. Description of studies
characteristics were extracted from all studies and summarized in
Table 1. Synthesis of the outcome measures, major findings, and no- 3.1.1. Participants and setting
table strengths and limitations of each intervention can be found in All studies targeted adult alcohol users aged 18 and over, per inclu-
Table 2. sion criteria, with five of the studies focusing specifically on problematic

Table 1
Design of included studies.

Citation Sample/eligibility criteria Study design Intervention Intervention description Model/theoretical Intervention
type basis dose/duration

Agyapong 54 patients 18 or older with DSM-IV Pilot; single blind Text Intervention: Half of TMs targeted N/A 2× per day for 12 weeks
et al. diagnosis of MDD & AUD; Ireland RCT; messaging improvement in mood and (180 unique texts)
(2012) intervention: (n (TM) medication adherence; half targeted
= 26); control: abstinence from alcohol and help
(n = 28) with cravings. Control received TM
every 2 weeks thanking them.
Gonzalez 54 adults 18 or older with DSM-V Pilot; RCT; Smartphone App (LBMI-A): 7 psychoeducational Existing App: Daily assessments
and diagnosis of AUD; minimal smartphone application steps and 8 tools (e.g. brief Cognitive-Behavioral & access to LBMI-A app
Dulin motivation to change drinking; not intervention: (n (app) interventions) with weekly Treatments for 6 weeks; DCU + Bib:
(2015) seeking treatment; no existing = 28); feedback & daily assessments; DCU log-in information to
psychiatric or medical condition; US Web-based + bibliotherapy: Internet-based revisit site during 6 week
intervention: (n brief motivational intervention trial
= 26) completed in 1 h, assessment and
results similar to LBMI-A
introduction assessment. All
received Rethinking Drinking
booklet.
Gustafson 349 AUD patients 18 or older with Unblinded RCT; App Intervention (A-CHESS): improve Self-Determination TAU plus access to
et al. no existing psychiatric or medical intervention: (n continuing care for AUDs by Theory A-CHESS app for 8
(2014) condition; US = 170); control: providing monitoring, information, months; weekly
(n = 179) communication, and support assessments
services in an app. Control group
received treatment as usual (TAU).
Mason, 18 college students (ages 18–23); Unblinded RCT; TM Tailored TMs from baseline data. Motivational 4 days; 4–6 text
Ola, et al. problem drinkers; US intervention: (n Intervention group could request Interviewing (MI); messages daily
(2014) = 8); control: (n booster TMs for additional support. Social Network
= 10) Control did not receive TMs. Counseling
Suffoletto 45 ED patients (ages 18–24); Pilot; unblinded TM Assessment and intervention groups N/A Once a week for 12
et al. hazardous drinkers; not seeking RCT; received standard automated weeks; at 12 pm of peak
(2012) treatment; no previous or current intervention: (n assessment TMs with immediate drinking day as
treatment for any psychiatric = 15); tailored responses. Intervention identified by assessment
disorders; US assessment: (n = group TMs assessed willingness to
15); control: (n set a goal to reduce drinking and
provided strategies for cutting down
= 15)
drinking. Control group did not
receive TMs.
Suffoletto 765 ED patients (ages 18–25); Single blind RCT; TM Assessment: Respond to weekly Health Belief Model; TMs each Thursday and
et al. hazardous drinkers; not seeking intervention: (n alcohol consumption queries; Information Sunday for 12 weeks
(2015) treatment; no past treatment for = 384); Intervention: Aims to increase Motivation Behavior
drug use or psychiatric disorders; assessment: (n = awareness of drinking intentions Model; Theory of
US 196); control: (n and behavior and increase goal Reasoned Action; MI
striving and goal attainment
= 185)
towards reduced alcohol
consumption. Control did not
receive TMs.
Weitzel et 40 college students 18 or older; RCT; Tailored Both groups completed daily N/A Daily assessment for 2
al. reported drinking at least once per intervention: (n messages on surveys about alcohol consumption weeks
(2007) week; US = 20); control handheld and, if applicable, their drinking
(assessment): (n computers experience. Only intervention group
= 20) received tailored feedback.
Witkiewitz 94 college students; not seeking RCT; BASICS-M TM BASICS-Mobile & DM groups: Cognitive-Behavioral Web modules or TM
et al. treatment; engaged in 1+ (intervention): (n (assessment); Random TM prompts for brief Treatment assessments 3× per day
(2014) episode(s) of heavy drinking in the = 32); DM mobile assessments. BASICS-Mobile group: for 2 weeks
past 2 weeks; reported concurrent (assessment): (n website tailored web module after
smoking and drinking at least once = 33); control: (intervention assessments (protective behavioral
a week; US (n = 29) module) or alternative strategies for
drinking). User-initiated
assessments at beginning and end of
each drinking occasion. Control did
not receive TMs.

Footnote: A-CHESS = Addiction-Comprehensive Health Enhancement Support System; AUD = alcohol use disorder; BASICS-M = Brief Alcohol and Smoking Intervention for College Stu-
dents via Mobile; DCU = Drinker's Check-Up; DM = Daily Monitoring; ED = emergency department; LBMI-A = Location-Based Monitoring and Intervention for Alcohol Use Disorders;
MDD = major depressive disorder; RCT = randomized controlled trial.
30 L.A. Fowler et al. / Addictive Behaviors 62 (2016) 25–34

Table 2
Results of included studies.

Citation Outcome measures Follow-up Results Strengths Limitations/comments

Agyapong CAD; Obsessive Compulsive
et al. Drinking Scale; Alcohol
(2012) Abstinence Self Efficacy Scale;
days to first drink; units of
alcohol per DD
Gonzalez Percent days abstinent (PDA);
and PHDD; drinks per week (DPW);
Dulin alcohol-related problems;
(2015) motivation to change
Gustafson Risky DD: # of days drinking
et al. exceeded 4 (men) or 3 (women)
(2014) drinks in 2 hour period;
abstinence and NC of drinking
Mason, Drinks in past week; drinks on
Ola, et al. last occasion; average DPDP last
(2014) month; maximum drinks past
month; readiness to change;
confidence in ability to change;
intentions to reduce use
Suffoletto HDD; risky DD; drinks in past
et al. month
(2012)
Suffoletto Binge DD; DPDD in the past 30
et al. days; proportion of Ps with
(2015) weekend binge episodes and
most DPDD during weekends
Weitzel et DPDP; DD; DPDD; NC; NC per
al. day; ACES; ACSES
(2007)
3 months (end of CAD scores were marginally
intervention) higher for intervention compared
to control, with medium effect
size [88.3 (6.2) vs. 79.3 (24.1), t
= 1.78, df = 48, p = 0.08, η2p =
0.06, d = 0.51]. Controlling for
baseline, there was a trend
towards participants (Ps) in
intervention consuming lower
units of alcohol PDD compared to
control [F(1, 49) = 2.52, p = 0.1,
η2p = 0.05].
6 weeks (end of Effect sizes reveal a moderate
intervention) increase in PDA among DCU +
bib group (d = 0.76) & a large
increase in PDA for LBMI-A group
(d = 0.93). Both interventions
resulted in significant decreases
in DPW & PHDD, with LBMI-A
producing larger reductions in
first weeks of trial, and plateauing
after. Effect sizes suggest large
reductions in DPW and PHDD
compared with baseline for
LBMI-A group (e.g., d = 1.09).
8 months (end of Ps who received treatment as
intervention) and usual (TAU) plus A-CHESS
4 month reported lower average number
post-intervention of risky DD (1.39 vs. 2.75; p =
0.003, d = 0.23) and higher
likelihood of consistent
abstinence (51.9% vs. 39.6%; p =
0.032, odds ratio = 1.65) than Ps
who received only TAU. No
differences in NC of drinking.
1 month The intervention increased
post-intervention readiness to change from baseline sustained effects 1 month
to F/U [F(1, 16) = 13.69, p b 0.01, post-treatment.
d = 1.86]. Trends included an
increase in the intervention
relative to control in confidence
in ability to change drinking
behavior [F(1, 16) = 3.58, p b
0.10] and an increase in
intentions to reduce alcohol use
[F(1, 16) = 3.19, p b 0.10]. No
differences in behavioral
outcomes.
3 month Exposure to TM-based feedback
post-intervention was associated with a 3.4
decrease in number of HDD (SD
= 5.4) and a 2.1 decrease in
maximum DPDD (SD = 1.5)
compared to baseline. Ps willing
to set goals were less likely to
report a HDD (36%) compared to
those who were not willing to set
a goal (63%).
3 months (end of Significant intervention by time
intervention), 3 interaction at 3, 6 and 9 months
months was found. When compared with
post-intervention, controls, intervention Ps reported
and 6 months lower binge DD, DPDD, and binge
post-intervention drinking prevalence. There were
no significant reductions in
alcohol-related outcomes when
comparing assessment Ps to
controls.
2 weeks (end of Ps in intervention reported
intervention) significantly fewer DPDD than
control Ps during the intervention
Addiction counselors aided
research team with creating TMs;
Low attrition (less than 8% loss).
Compared two technology-based
interventions; system usage of
app was recorded & majority of
LMBI-A Ps launched all 7 steps
(71.4%) & all 8 tools (67.9%) at
least once.
More than 90% of Ps in A-CHESS
group used system at least once;
F/U examined sustained effects 4
months post-treatment.
Tailored TMs; F/U examined
Tailored TMs; Low attrition (86%
completed F/U); F/U examined
sustained effects 3 months
post-treatment; 77% of Ps
responded to all 12 weeks.
Tailored TMs; F/U examined
sustained effects 6 months
post-treatment; roughly 1/3 of Ps
in intervention and assessments
completed all text queries.
Tailored TMs; high participant
preference: majority (65%)
preferred TMs delivered to a
Potential bias from single-blind
design; small sample size (power
limitations); F/U done at end of
treatment therefore no test for
sustained treatment effects;
active participation with the TMs
was not confirmed; targeted
multiple behaviors.
Ps had to indicate at least
minimal motivation to change
drinking behavior to be included,
creating a potentially biased
sample. No control group; all Ps
received either app or web
intervention. F/U done at end of
treatment; small sample size
(power limitations).
Possibility of assessment effect
(A-CHESS group received
assessments in addition to
intervention and control group
received neither); past 30 day
timeframe at each F/U gives
incomplete picture; sample
mostly white males; AUD severity
not collected.
Small sample size (power
limitations); small recruitment
rate (8%) could be a cause for
concern regarding self-selection
bias; Ps in the control group were
more moderate drinkers at
baseline making interpretation
difficult; short intervention (4
days).
Ps could learn to underreport
alcohol consumption to avoid
TMs. Bias in selecting Ps since
number & characteristics of
eligible Ps were not
predetermined. TM based system
was triggered by only high
drinking thresholds; could have
underidentified Ps below that
threshold but still who drank
heavily; targeted specific
population (ED patients); small
sample size (power limitations).
Participation rate decreased
significantly during 12 weeks
(93% to 71%). F-U retention was
54.9% (n = 420) at 9-months; Ps
lost to 9-month F/U were more
likely to have higher baseline
AUDIT-C scores (p b 0.001).
Small sample size (power
limitations); short intervention
(2 weeks); no control group; F/U
 L.A. Fowler et al. / Addictive Behaviors 62 (2016) 25–34 31

Table 2 (continued)

Citation Outcome measures Follow-up Results Strengths Limitations/comments

Witkiewitz DPDD; HDD; Adult Alcohol
et al. Problem Screening Test; days of
(2014) drinking and smoking per week
when responding on the
handheld computer (p = 0.02)
but not on the F/U surveys (p =
0.44). Intervention group Ps had
lower expectancies that they
would get into trouble as a result
of alcohol use than did control Ps.
1 month Ps in both DM and BASICS-Mobile
post-intervention conditions reported that they
“developed a goal to change
[their] drinking habits” (24.1% in
DM and 23.3% in BASICS-Mobile,
p = 0.94). Ps in the
BASICS-Mobile condition
indicated that the tips they
received “motivated me to
change my alcohol use” (20.1%).
DPDD, HDD, and drinking-related
problems at 1-month F/U did not
differ across conditions.
handheld device versus another
delivery method (e.g. e-mail).
Tailored TMs; N65% of Ps across
conditions reported that the
study helped increase awareness
of their drinking and N90% stated
they would recommend
participation in the study to a
friend; F/U examined sustained
effects 1 month post-treatment.
done at end of treatment
therefore no test for sustained
treatment effects; intervention
reported less drinking on F/U
paper survey than on handheld
computers.
Small sample size (power
limitations); short intervention
(2 weeks); no objective measure
of degree of engagement with
intervention content; individuals
not seeking treatment and might
have lacked motivation; F/U done
at end of treatment therefore no
test for sustained treatment
effects; targeted multiple
behaviors (could also be seen as
strength).

Footnote: ACES = Alcohol Consequences Expectancy Scale; ACSES = Alcohol Consequences Self-Efficacy Scale; AUDIT-C = Alcohol Use Disorders Identification Test for Consumption;
CAD = cumulative abstinence duration; DCU + Bib = Drinker's Check-Up + bibliotherapy; DD = drinking day; DPDP = drinks per drinking period; DPDD = drinks per drinking
day; F/U = follow-up; NC = negative consequences; HDD = heavy drinking days; IRR = incident rate ratio LBMI-A = Location-Based Monitoring and Intervention for Alcohol Use Dis-
orders; PHDD = percent HDD.

alcohol users—two of which were young adults in the emergency de-
partment (Suffoletto et al., 2012; Suffoletto et al., 2015)—and three
using clinical populations (Agyapong et al., 2012; Gonzalez & Dulin,
2015; Gustafson et al., 2014). The remaining three studies recruited col-
lege students who either reported weekly drinking (Weitzel et al.,
2007) or risky drinking (Mason, Ola, et al., 2014; Witkiewitz et al.,
2014). In one of the aforementioned studies, individuals were only eligi-
ble to participate if they reported concurrent smoking and drinking at
least once per week (Witkiewitz et al., 2014). Additionally, one study
was limited to individuals who indicated minimal motivation to change
their drinking behavior on a change assessment scale (Gonzalez &
Dulin, 2015). Seven of the studies were conducted in the US and one
study (Agyapong et al., 2012) was conducted in Ireland.
3.1.2. Type of intervention
The type of intervention varied: the majority of interventions (n =
5) were primarily delivered through text messages sent via a Short Mes-
sage Service (SMS), two studies used a smartphone application
(Gonzalez & Dulin, 2015; Gustafson et al., 2014), and another study
had a mobile website component in addition to SMS assessments
(Witkiewitz et al., 2014). Great variability exists in the delivery of infor-
mation through these different types of mobile technology-based inter-
ventions, such that applications and mobile websites involve user-
initiated usage and seeking of information, whereas text messages can
be delivered with or without the request of the participant. Further-
more, use of applications and mobile websites as a delivery method
has the benefit of allowing researchers to track application usage, and
two of the trials measured usage of the intervention app (Gonzalez &
Dulin, 2015; Gustafson et al., 2014).
Five of the eight interventions identified at least one theoretical
framework around which the intervention was designed. These includ-
ed Self-Determination Theory (Gustafson et al., 2014), Motivational
Interviewing (Mason, Ola, et al., 2014; Suffoletto et al., 2015), Cogni-
tive-Behavioral Treatment (Gonzalez & Dulin, 2015; Witkiewitz et al.,
2014), the Health Belief Model, Theory of Reasoned Action, and Infor-
mation Motivation Behavior Model (Suffoletto et al., 2015).
3.1.3. Comparison and control groups
To be included in the review, all trials were required to include a
control or comparison condition in their study design. Six of the
studies (Agyapong et al., 2012; Gustafson et al., 2014; Mason, Ola,
et al., 2014; Suffoletto et al., 2012; Suffoletto et al., 2015;
Witkiewitz et al., 2014) included control conditions in which partic-
ipants only completed baseline and follow-up assessments and did
not receive daily or weekly text message assessments or any inter-
vention components. Three of the studies included a control condi-
tion and a second comparison condition (Suffoletto et al., 2012;
Suffoletto et al., 2015; Witkiewitz et al., 2014). This second compar-
ison condition acted as an “assessment-only” condition in which par-
ticipants received daily or weekly text messages requesting an
assessment; however, participants in the assessment-only condition
did not receive intervention text messages. One trial (Weitzel et al.,
2007) included an assessment-only comparison condition but no
control condition. Finally, in one study, participants were randomly
allocated to one of two technology-based interventions: either a mo-
bile technology-based smartphone application intervention or an in-
ternet-based intervention supplemented with bibliotherapy as a
comparison condition (Gonzalez & Dulin, 2015). The internet-
based comparison condition that was implemented by Gonzalez
and Dulin (2015) has previously been established as an effective in-
tervention for reducing alcohol use among problem drinkers
(Hester, Delaney, & Campbell, 2012; Hester, Squires, & Delaney,
2005).
3.1.4. Intervention length & dosage
Particularly noteworthy in the interventions reviewed is the vari-
ability in intervention length, dosage, and follow-up periods. The lon-
gest intervention was 32 weeks (Gustafson et al., 2014), three
interventions lasted 12 weeks (Agyapong et al., 2012; Suffoletto et al.,
2012; Suffoletto et al., 2015), one trial was 6 weeks long (Gonzalez &
Dulin, 2015), two interventions were 2 weeks long (Weitzel et al.,
2007; Witkiewitz et al., 2014), and one intervention was delivered
over 4 days (Mason, Ola, et al., 2014). Dosage ranged from weekly text
messages (Suffoletto et al., 2012) to text messages received 4–6 times
daily (Mason, Ola, et al., 2014), and many of the interventions used per-
sonalized or tailored text messages (n = 5). Participation in the mobile
application modules varied, given that it was user-initiated. For exam-
ple, participants could engage with the application or website often
throughout the entire intervention period, or launch the application
rarely, if at all. Studies that measured application usage reported high
engagement with the application, with 90% of participants in the inter-
vention condition using the application as least once during the study
32 L.A. Fowler et al. / Addictive Behaviors 62 (2016) 25–34
period in one trial (Gustafson et al., 2014) and 71.4% of participants in
the smartphone application condition completing all psychoeducational
modules in another trial (Gonzalez & Dulin, 2015). Two of the studies
reported on participant opinion regarding the treatment modality
(Weitzel et al., 2007; Witkiewitz et al., 2014). Weitzel et al. (2007)
found that the majority (65%) of participants preferred TMs delivered
to a handheld device versus another delivery method (e.g. e-mail).
Witkiewitz et al. (2014) reported that more than 90% of participants
stated they would recommend participation in the study to a friend.
3.1.5. Follow-up
Four of the interventions administered post-intervention follow-up
measures ranging from one month after the intervention period
(Mason, Ola, et al., 2014; Witkiewitz et al., 2014) to four (Gustafson et
al., 2014) and nine months post-intervention (Suffoletto et al., 2015).
The other four interventions administered follow-up measures at the
end of the intervention.
3.2. Intervention effectiveness
Table 2 highlights the key findings and conclusions from each study.
All but one of the studies in the present review included a control or as-
sessment-only comparison group, thereby lending greater confidence
in reaching conclusions regarding intervention success than had a con-
trol or assessment-only comparison not been included. The remaining
trial compared two distinct technology-based interventions (Gonzalez
& Dulin, 2015). Notably, outcome measures varied greatly among
interventions—from behavioral outcomes (e.g., reduction in number of
risky drinking days) to cognitive measures (e.g., readiness to
change)—although all trials included at least one behavioral measure
per inclusion criteria.
Five of the studies found significant positive effects of the interven-
tion on behavioral outcomes. Specifically, these studies found signifi-
cant changes in alcohol consumption behavior from a reduced average
number of risky drinking days (Gustafson et al., 2014), a decrease in
the number of heavy drinking days (Gonzalez & Dulin, 2015;
Suffoletto et al., 2012; Suffoletto et al., 2015), and a reduction in the
number of drinks per drinking day (Suffoletto et al., 2012; Suffoletto
et al., 2015; Weitzel et al., 2007). In addition, Agyapong et al. (2012)
reported both a marginally greater cumulative abstinence duration as
well as a trend towards lower units of alcohol per drinking day in the
intervention group. Notably, significant positive changes in alcohol con-
sumption behavior occurred among individuals seeking treatment for
alcohol use disorders (Gustafson et al., 2014), emergency department
patients who reported hazardous drinking (Suffoletto et al., 2012;
Suffoletto et al., 2015), minimally motivated individuals with alcohol
use disorders (Gonzalez & Dulin, 2015) and college student alcohol
users (Weitzel et al., 2007).
The interventions also had positive effects on several cognitive
measures. For instance, Suffoletto et al. (2012) found an increase in
goal-setting willingness to reduce binge drinking days. Mason, Ola, et
al. (2014) reported increases in readiness to change from beginning to
follow-up, but found no effects of the interventions on behavioral mea-
sures of alcohol use. Only one study found no effects of the intervention
on either alcohol-related cognitions or behavior, such that drinking
behavior and drinking related problems at one month follow-up did
not differ across conditions (Witkiewitz et al., 2014).
4. Discussion
4.1. Summary of evidence
The majority (n = 7) of the studies reviewed found positive effects
(e.g., increased readiness to change, decreased alcohol use) of the inter-
vention, even though the interventions themselves varied in theoretical
framework, message design, length, dosage, and target population.
Mobile technology provides a potential modality for the communication
and delivery of an intervention to reduce or eliminate problematic alco-
hol use that addresses the limitations inherent in traditional treatment
modalities (e.g., in-person counseling, brief motivational intervention).
Given the anonymity, ease of tailoring, and high fidelity afforded by SMS
communications—as well as the low cost, ubiquity, portability, and re-
ported ease of use of mobile phones (Witkiewitz et al., 2014)—this
method of intervention produces exciting possibilities for behavioral in-
terventions, and alcohol interventions more specifically, to affect a pop-
ulation that may otherwise not have access to treatment. The findings in
this review—supporting mobile technology-based interventions as an
effective approach to alcohol use reduction or cessation—echo a recent
meta-analysis of text message interventions for substance use among
adolescents and young adults, which found a summary effect size of
0.25 across 14 studies, indicating a general positive effect of text inter-
ventions on reducing substance use (Mason, Ola, et al., 2014). However,
findings of intervention efficacy should be interpreted with caution,
given that most studies in the present review were single blind and par-
ticipants were aware of group assignment. Another methodological
concern that should lead to cautious interpretation of effects is that
four of the eight studies assessed treatment effects at the end of the in-
tervention period, and therefore, long-term effects of those interven-
tions cannot be determined.
This review reports similar findings of evaluations of the literature
on technology-based interventions among other health behaviors. For
instance, in a review of the literature on technology-based interventions
among college students who use tobacco, evidence was also found
supporting technology-based interventions as an important and effec-
tive method of intervention delivery (Brown, 2013). Similarly, examin-
ing behavior change as affected by SMS interventions more broadly,
Fjeldsoe, Marshall, and Miller (2009) found that 13 of the 14 studies
reviewed in their article resulted in positive behavior change across a
variety of health-related behaviors, such as diabetes self-management,
smoking cessation, and physical activity.
4.2. Limitations
This review is not without limitations. Because null results are less
likely to be published, it may be that more unsuccessful mobile-based
interventions for alcohol use exist than reported in this review. Second-
ly, while our database search was extensive and included a search of five
relevant databases in the social, physical, and psychological sciences,
this article may not provide an exhaustive story of the current literature
on mobile technology interventions for adult users of alcohol. As previ-
ously noted, the heterogeneity of the interventions in this article did not
allow for a quantitative review of the evidence. Thusly, synthesized es-
timates of effect sizes for intervention outcomes were not attainable.
Lastly, the present review attempted to isolate a specific population of
alcohol users, namely adults, to examine the efficacy of mobile-technol-
ogy based interventions for the reduction of alcohol use among this
group, and therefore it should be noted that literature does exist that ex-
amines the efficacy of technology based interventions among other
populations (e.g. war veterans, adolescents).
4.3. Concluding remarks and future directions
Despite the aforementioned limitations, the current review provides
preliminary evidence for the efficacy of mobile technology-based inter-
ventions, and in particular SMS interventions, among dependent and
nondependent adult users of alcohol. Findings suggest that there may
be something uniquely effective about an intervention delivered
through a mobile device, independent of a specific theoretical frame-
work, that allows for inexpensive, immediate, non-stigmatized accessi-
bility of information and support with reasonable fidelity that can be
easily tailored to an individual. However, the results of this systematic
review also emphasize the dearth of research in this potentially very
 L.A. Fowler et al. / Addictive Behaviors 62 (2016) 25–34
promising field; only eight studies met the inclusion criteria and the
majority of the studies in this review were pilot studies, feasibility stud-
ies, or preliminary in nature.
One significant gap in the literature is an understanding of whether
there are features of mobile technology-based interventions that are
more or less effective when targeting alcohol use. The results of this
study did not allow for conclusions of efficacy that specify ideal modal-
ity (e.g. SMS or application), dosage, or duration of intervention. Given
the variability in length and dosage among the five reviewed SMS inter-
ventions, future research should elucidate the most effective length of
time as well as how often individuals should receive messages for max-
imum benefit. Positive cognitive effects of a 4 day SMS intervention
were noted by Mason, Ola, et al. (2014), and decreases in self-reported
alcohol consumption were found after a 6 week m-tech intervention
(Gonzalez & Dulin, 2015). However, long-term behavioral changes
were only documented for interventions that were at least 12 weeks
long (e.g., Suffoletto et al., 2015), suggesting that trials lasting multiple
months may be more ideal for producing sustained behavioral interven-
tion effects. It is possible that several studies in the present review may
have had too brief an intervention to elicit change in drinking behaviors
among heavy episodic drinkers (Mason, Ola, et al., 2014; Witkiewitz et
al., 2014), and that intervention lengths should be tailored for specific
target groups. Both trials that used smartphone applications for the de-
livery of the intervention found positive behavioral effects (Gonzalez &
Dulin, 2015; Gustafson et al., 2014), suggesting that this modality may
be especially promising for this field. Two trials included in this review
did find sustained intervention effects 4 months (Gustafson et al., 2014)
and 6 months (Suffoletto et al., 2015) post-intervention—suggesting the
potential of mobile technology-based interventions to effect long-term
change on alcohol consumption behavior among adults. However, stud-
ies with adequate power and valid design are necessary to evaluate the
potential of mobile technology-based interventions on long-term alco-
hol behavior outcomes, and future research should aim to increase fol-
low-up lengths.
Another important gap in the literature is whether specific popula-
tions may benefit more from mobile technology-based interventions
than others. For instance, alcohol may be used for different reasons
among different age and vulnerability populations (Gregg,
Barrowclough, & Haddock, 2007; Kuntsche, Knibbe, Gmel, & Engels,
2005), and mobile technology acceptance may differ by age and gender
(Wang, Wu, & Wang, 2009). Therefore, future research should also focus
on examining the moderating role of acceptance, culture, and other var-
iables on intervention outcomes, and determine if mobile technology-
based interventions should be designed differently for certain sub-
groups of the targeted population, or targeted to only subgroups that ac-
cept mobile technology.
Many questions remain as to the role of mobile technology in the fu-
ture of behavioral interventions. Do mobile technology-based interven-
tions provide greater access to care for previously underserved or
unreached populations or are they merely a less expensive alternative?
Are mobile technology-based interventions a viable replacement of tra-
ditional treatment modalities or do they offer more as a supplemental
tool? Future research should seek to determine the comparative effec-
tiveness of efficacious mobile technology-based interventions, the com-
parative effectiveness of mobile technology-based interventions with
different technological modalities (e.g., Web), and the comparative ef-
fectiveness of efficacious mobile technology-based interventions with
current recommended treatment methods of problematic alcohol use
such as psychological or behavioral interventions (e.g., cognitive behav-
ioral therapies). Future research might also further explore the mecha-
nisms driving behavior change, or examine why some studies find
changes in alcohol-related cognitions (e.g., motivation to change, alco-
hol use intentions), but fail to find positive effects of the intervention
on alcohol consumption behavior. Lastly, given the documented success
of mobile interventions in the area of alcohol use, the efficacy of these
types of interventions should be examined for other health behaviors
33
including primary disease prevention behaviors (e.g., diet and physical
activity), secondary prevention behaviors (e.g., cancer screenings),
and even across other addictive substance use.
As applications and other mobile technology targeted towards those
who seek behavior change continue to grow in popularity, with it grows
the need to evaluate the efficacy of these burgeoning interventions. In
an age of rapid technological change and widespread adoption, mobile
technology-based interventions that provide high fidelity, maximize
anonymity, are cost-efficient, highly accessible, and easily tailored to
an individual may provide an exciting and promising route to facilitate
wide-scale behavior change.
Role of funding sources
This study was not supported by any funding.
Contributors
All authors developed the method and searched databases for the review. Authors S.H.
and D.J. conducted literature searchers, provided summaries of previous research, and
drafted the introduction. Author L.F. drafted the method, results, and discussion. All au-
thors contributed to and approved of the final manuscript.
Conflict of interest
The authors declare that there are not any conflicts of interest.
Acknowledgements
The authors would like to thank Drs. Tonya Dodge, Philip Moore and Lisa Bowleg for
their advisory support, and the graduate students of Current Topics in Social Psychology:
Addiction for their input.
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