Skip to main content

Advertisement

SpringerLink
Log in

Telehealth Treatment for Alcohol Misuse: Reviewing Telehealth Approaches to Increase Engagement and Reduce Risk of Alcohol-Related Hypertension

  • Telemedicine and Technology (HB Bosworth, Section Editor)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Telehealth interventions for alcohol misuse may be especially impactful in hypertensive populations because of the increased blood pressure associated with alcohol overconsumption. This review examines emerging telehealth interventions for alcohol misuse and categorizes them according to phases of the treatment process.

Recent Findings

Evidence for telehealth cognitive behavioral therapy (CBT) is preliminary but suggests it is efficacious and increased access to treatment. Evidence for contingency management (CM) is growing, and mobile adaptation of CM for alcohol misuse suggests it is efficacious in initial abstinence induction. Evidence for mobile health (mHealth) texts and applications is large and variable but generally suggests it is efficacious for reducing alcohol misuse and relapse prevention.

Summary

Variability in telehealth interventions for alcohol misuse may hinder conclusion implementation. Matching specific telehealth interventions with phases of alcohol misuse treatment and focusing on high-impact populations (i.e., those with hypertension) may maximize benefits on population health.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Carey RM, Whelton PK. Prevention, detection, evaluation, and management of high blood pressure in adults: synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline. Ann Intern Med. 2018;168(5):351–8. This paper provides the most recent guidelines for hypertension treatment. Among other recommendations, there are strong recommendations for limiting alcohol intake to ≤ 1 drink/day for women and ≤ 2 drinks/day for men and considering abstinence from alcohol with any significant comorbidities.

    Article  Google Scholar 

  2. • Grant BF, Chou SP, Saha TD, Pickering RP, Kerridge BT, Ruan WJ, et al. Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the United States, 2001–2002 to 2012–2013: results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry. 2017;74(9):911–23. This nationally representative epidemiologic survey established increased prevalence in alcohol use and alcohol misuse in general and among many subsamples of the general population. Moreover, numerous at-risk subsamples of the general population saw larger increasing in alcohol use and alcohol misuse than the overall sample.

    Article  Google Scholar 

  3. Roerecke M, Rehm J. Alcohol use disorders and mortality: a systematic review and meta-analysis. Addiction. 2013;108(9):1562–78.

    Article  Google Scholar 

  4. Roerecke M, Rehm J. Cause-specific mortality risk in alcohol use disorder treatment patients: a systematic review and meta-analysis. Int J Epidemiol. 2014;43(3):906–19.

    Article  Google Scholar 

  5. Costanzo S, Di Castelnuovo A, Donati MB, Iacoviello L, de Gaetano G. Alcohol consumption and mortality in patients with cardiovascular disease: a meta-analysis. J Am Coll Cardiol. 2010;55(13):1339–47.

    Article  Google Scholar 

  6. •• Degenhardt L, Charlson F, Ferrari A, Santomauro D, Erskine H, Mantilla-Herrara A, et al. The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry. 2018;5(12):987–1012. This report from the World Health Organization reviews a significant scope of evidence for the global burden of alcohol misuse on health outcomes. In particular, this review highlights the large impact of alcohol misuse on worldwide health due to cardiovascular disease.

    Article  Google Scholar 

  7. Rehm J, Anderson P, Prieto JA, Armstrong I, Aubin HJ, Bachmann M, et al. Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union. BMC Med. 2017;15(1):173.

    Article  Google Scholar 

  8. Wood AM, Kaptoge S, Butterworth AS, Willeit P, Warnakula S, Bolton T, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet. 2018;391(10129):1513–23.

    Article  Google Scholar 

  9. Nakanishi N, Makino K, Nishina K, Suzuki K, Tatara K. Relationship of light to moderate alcohol consumption and risk of hypertension in Japanese male office workers. Alcohol Clin Exp Res. 2002;26(7):988–94.

    Article  Google Scholar 

  10. Roerecke M, Kaczorowski J, Tobe SW, Gmel G, Hasan OS, Rehm J. The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis. Lancet Public Health. 2017;2(2):e108–20.

    Article  Google Scholar 

  11. Ebrahim S, Taylor F, Ward K, Beswick A, Burke M, Davey SG. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database Syst Rev. 2011;1(1):CD001561.

    Google Scholar 

  12. Steiner JF, Ho PM, Beaty BL, Dickinson LM, Hanratty R, Zeng C, et al. Sociodemographic and clinical characteristics are not clinically useful predictors of refill adherence in patients with hypertension. Circ Cardiovasc Qual Outcomes. 2009;2(5):451–7.

    Google Scholar 

  13. Bryson CL, Au DH, Sun H, Williams EC, Kivlahan DR, Bradley KA. Alcohol screening scores and medication nonadherence. Ann Intern Med. 2008;149(11):795–803.6.

    Article  Google Scholar 

  14. Braithwaite RS, McGinnis KA, Conigliaro J, Maisto SA, Crystal S, Day N, et al. A temporal and dose-response association between alcohol consumption and medication adherence among veterans in care. Alcohol Clin Exp Res. 2005;29(7):1190–7.

    Article  Google Scholar 

  15. Vrijens B, Antoniou S, Burnier M, de la Sierra A, Volpe M. Current situation of medication adherence in hypertension. Front Pharmacol. 2017;8:100.

    Article  Google Scholar 

  16. Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, brief intervention, and referral to treatment (SBIRT) toward a public health approach to the management of substance abuse. Subst Abus. 2007;28(3):7–30.

    Article  Google Scholar 

  17. Glass JE, Hamilton AM, Powell BJ, Perron BE, Brown RT, Ilgen MA. Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials. Addiction. 2015;110(9):1404–15.

    Article  Google Scholar 

  18. •• Ramsey AT, Satterfield JM, Gerke DR, Proctor EK. Technology-based alcohol interventions in primary care: systematic review. J Med Internet Res. 2019;21(4):e10859 This recent review establishes initial meta-analytic evidence that telehealth-based interventions for alcohol misuse are effective in reducing consumption levels when delivered within a primary care setting.

    Article  Google Scholar 

  19. PROJECT MATCH RESEARCH Group. Matching alcoholism treatment to client heterogeneity: Project MATCH posttreatment drinking outcomes. J Stud Alcohol. 1997;58:7–30.

    Article  Google Scholar 

  20. Anton RF, O'Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence the COMBINE study: a randomized controlled trial. JAMA. 2006;295:2003–17.

    Article  CAS  Google Scholar 

  21. Carroll KM, Kiluk BD. Cognitive behavioral interentions for alcohol and drug use disorders: through the stage model and back again. Psychol Addict Behav. 2017;31:847–61.

    Article  Google Scholar 

  22. Magill M, Ray LA. Cognitive-behavioral treatment with alcohol and illicit drug users: a meta-analysis of randomized controlled trials. J Stud Alcohol Drugs. 2009;70:516–27.

  23. Haas LJ, Benedict JG, Kobos JC. Psychotherapy by telephone: risks and benefits for psychologists and consumers. Prof Psychol Res Pract. 1996;27:154–60.

    Article  Google Scholar 

  24. • Jiang S, Wu L, Gao X. Beyond face-to-face individual counseling: a systematic review on alternative modes of motivational interviewing in substance abuse treatment and prevention. Addict Behav. 2017;73:216–35. This meta-analysis of 11 studies found that all 11 trials supported the effectiveness, acceptability, and feasibility of telehealth motivational enhancement therapy for substance abuse.

    Article  Google Scholar 

  25. Muller I, Yardley L. Telephone-delivered cognitive behavioral therapy: a systematic review and meta-analysis. J Telemed Telecare. 2011;17:177–84.

    Article  Google Scholar 

  26. Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addiction Science & Clinical Pratice. 2015;10:14.

    Article  Google Scholar 

  27. Gates P, Abertella L. The effectiveness of telephone counseling in the treatment of illicit drug and alcohol use concerns. J Telemed Telecare. 2015;22:18–28.

    Article  Google Scholar 

  28. Varker T, Brand, RM, Ward J, Terhaag S, Phelps A 2018. Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: a rapid evidence assessment. Psychol Serv, 2018

  29. Baca CT, Alverson DC, Knapp-Manuel J, Blackwell GL. Telecounseling in rural areas for alcohol problems. Alcohol Treat Q. 2007;25:31–45.

    Article  Google Scholar 

  30. Kalapatapu RJ, Ho J, Cai X, Vinogradov S, Batki SL, Mohr DC. Cognitive-behavioral therapy in depressed primary care patients with co-occuring problematic alcohol use: effect of telephone-administered vs. face-to-face treatment – a secondary analysis. J Psychoactive Drugs. 2014;46:85–92.

    Article  Google Scholar 

  31. Kollins SH, McClernon FJ, Van Voorhees EE. Monetary incentives promote smoking abstinence in adults with attention deficit hyperactivity disorder (ADHD). Exp Clin Psychopharmacol. 2010;18:221–8.

    Article  Google Scholar 

  32. Petry NM, DePhilippis D, Rash CJ, Drapkin M, McKay JR. Nationwide dissemination of contingency management: the veterans administration initiative. Am J Addict. 2014;23(3):205–10.

    Article  Google Scholar 

  33. Davis DR, Kurti AN, Skelly JM, Redner R, White TJ, Higgins ST. A review of the literature on contingency management in the treatment of substance use disorders, 2009-2014. Prev Med. 2016;92:36–46.

    Article  Google Scholar 

  34. Dutra L, et al. A meta-analytic review of psychosocial interventions for substance use disorders. Am J Psychiatry. 2008;165(2):179–87.

    Article  Google Scholar 

  35. Petry NM, Martin B, Cooney JL, Kranzler HR. Give them prizes, and they will come: contingency management for treatment of alcohol dependence. J Consult Clin Psychol. 2000;68(2):250–7.

    Article  CAS  Google Scholar 

  36. Tidey JW, O’Neill SC, Higgins ST. Contingent monetary reinforcement of smoking reductions, with and without transdermal nicotine, in outpatients with schizophrenia. Exp Clin Psychopharmacol. 2002;10:241–7.

    Article  Google Scholar 

  37. Cohen E, Feinn R, Arias A, Kranzler HR. Alcohol treatment utilization: findings from the National Epidemiologic Survey on alcohol and related conditions. Drug Alcohol Depend. 2007;86:214–21.

    Article  Google Scholar 

  38. Hagedorn HJ, Noorbaloochi S, Simon AB, Bangerter A, Stitzer ML, Stetler CB, et al. Rewarding early abstinence in Veterans Health Administration addiction clinics. J Subst Abus Treat. 2013;45(1):109–17.

    Article  Google Scholar 

  39. Campbell AN, et al. Internet-delivered treatment for substance abuse: a multisite randomized controlled trial. Am J Psychiatr. 2014;171(6):683–90.

    Article  Google Scholar 

  40. Alessi SM, Petry NM. A randomized study of cellphone technology to reinforce alcohol abstinence in the natural environment. Addiction. 2013;108(5):900–9.

    Article  Google Scholar 

  41. Koffarnus MN, Bickel WK, Kablinger AS. Remote alcohol monitoring to facilitate incentive-based treatment for alcohol use disorder: a randomized trial. Alcohol Clin Exp Res. 2018;42(12):2423–31.

    Article  Google Scholar 

  42. Wojcik MH, Hawthorne JS. Sensitivity of commercial ethyl glucuronide (ETG) testing in screening for alcohol abstinence. Alcohol Alcohol. 2007;42(4):317–20.

    Article  CAS  Google Scholar 

  43. McDonell MG, Leickly E, McPherson S, Skalisky J, Srebnik D, Angelo F, et al. A randomized controlled trial of ethyl glucuronide-based contingency management for outpatients with co-occurring alcohol use disorders and serious mental illness. Am J Psychiatr. 2017;174(4):370–7.

    Article  Google Scholar 

  44. Mathias CW, Hill-Kapturczak N, Karns-Wright TE, Mullen J, Roache JD, Fell JC, et al. Translating transdermal alcohol monitoring procedures for contingency management among adults recently arrested for DWI. Addict Behav. 2018;83:56–63.

    Article  Google Scholar 

  45. Andresen-Streichert H, Beres Y, Weinmann W, Schröck A, Müller A, Skopp G, et al. Improved detection of alcohol consumption using the novel marker phosphatidylethanol in the transplant setting: results of a prospective study. Transpl Int. 2017;30(6):611–20.

    Article  CAS  Google Scholar 

  46. Viel G, Boscolo-Berto R, Cecchetto G, Fais P, Nalesso A, Ferrara S. Phosphatidylethanol in blood as a marker of chronic alcohol use: a systematic review and meta-analysis. Int J Mol Sci. 2012;13(11):14788–812.

    Article  CAS  Google Scholar 

  47. Hartmann S, Aradottir S, Graf M, Wiesbeck G, Lesch O, Ramskogler K, et al. Phosphatidylethanol as a sensitive and specific biomarker: comparison with gamma-glutamyl transpeptidase, mean corpuscular volume and carbohydrate-deficient transferrin. Addict Biol. 2007;12(1):81–4.

    Article  CAS  Google Scholar 

  48. Sundström C, Blankers M, Khadjesari Z. Computer-based interventions for problematic alcohol use: a review of systematic reviews. Int J Behav Med. 2017;24(5):646–58.

    Article  Google Scholar 

  49. •• Kaner EF, Beyer FR, Garnett C, Crane D, Brown J, Muirhead C, Redmore J, O’Donnell A, Newham JJ, De Vocht F, Hickman M. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations. Cochrane Database Syst Rev. 2017(9). This Cochrane review of 57 studies found an average decrease of 1.5 drinks per week and one binge-drinking episode less per month in patients in mHealth interventions compared with patients in other arms (typically no or minimal intervention). The persistence of these alcohol consumption reductions was variable but generally remained at 6- and 12-month follow-ups. No other alcohol-related outcomes aside from the number of drinks and binge-drinking episodes were consistently affected by mHealth interventions. This review also concluded that mHealth interventions facilitating problem-solving, behavior substitution, and delivering educational information from a credible source were the most likely to produce reductions in alcohol consumption. There were no differences in the effectiveness of initial and sustained alcohol consumption reduction across web-based, telephone, or mHealth text and app modalities.

  50. Fowler LA, Holt SL, Joshi D. Mobile technology-based interventions for adult users of alcohol: a systematic review of the literature. Addict Behav. 2016;62:25–34.

    Article  Google Scholar 

  51. Kazemi DM, Borsari B, Levine MJ, Li S, Lamberson KA, Matta LA. A systematic review of the mHealth interventions to prevent alcohol and substance abuse. J Health Commun. 2017;22(5):413–32.

    Article  Google Scholar 

  52. Tofighi B, Nicholson JM, McNeely J, Muench F, Lee JD. Mobile phone messaging for illicit drug and alcohol dependence: a systematic review of the literature. Drug Alcohol Rev. 2017;36(4):477–91.

    Article  Google Scholar 

  53. Song T, Qian S, Yu P. Mobile health interventions for self-control of unhealthy alcohol use: systematic review. JMIR mHealth and uHealth. 2019;7(1):e10899.

    Article  Google Scholar 

  54. Leightley D, Puddephatt JA, Jones N, Mahmoodi T, Chui Z, Field M, et al. A smartphone app and personalized text messaging framework (InDEx) to monitor and reduce alcohol use in ex-serving personnel: development and feasibility study. JMIR mHealth and uHealth. 2018;6(9):e10074.

    Article  Google Scholar 

  55. Suffoletto B, Chung T, Muench F, Monti P, Clark DB. A text message intervention with adaptive goal support to reduce alcohol consumption among non-treatment-seeking young adults: non-randomized clinical trial with voluntary length of enrollment. JMIR Mhealth Uhealth. 2018;6(2):e35.

    Article  Google Scholar 

  56. Adler AJ, Casas JP, Martin N, Free C, Perel P. Cochrane corner: text messaging to improve adherence to drugs for secondary prevention of cardiovascular disease. Heart. 2018;104:1814–6.

    Article  Google Scholar 

  57. Gollwitzer PM, Sheeran P. Implementation intentions and goal achievement: a meta-analysis of effects and processes. Adv Exp Soc Psychol. 2006;38:69–119.

    Google Scholar 

  58. Ehret PJ, Sherman DK. Integrating self-affirmation and implementation intentions: effects on college student drinking. Ann Behav Med. 2018;52(8):633–44.

    Article  Google Scholar 

  59. Moody LN, Tegge AN, Poe LM, Koffarnus MN, Bickel WK. To drink or to drink less? Distinguishing between effects of implementation intentions on decisions to drink and how much to drink in treatment-seeking individuals with alcohol use disorder. Addict Behav. 2018;83:64–71.

    Article  Google Scholar 

Download references

Funding

Dr. Blalock was supported by Grant Number TPH 21-000 from the Department of Veterans Affairs Office of Academic Affiliations. Dr. Dedert was supported by Merit Review Award Number I01 CX001757-01A2 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences R&D (CSRD) Service.

Author information

Authors and Affiliations

  1. Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA

    Dan V. Blalock, Patrick S. Calhoun, Matthew J. Crowley & Eric A. Dedert

  2. Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA

    Dan V. Blalock, Patrick S. Calhoun & Eric A. Dedert

  3. Durham, USA

    Dan V. Blalock

  4. VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC, USA

    Patrick S. Calhoun & Eric A. Dedert

  5. Durham Veterans Affairs Medical Center, Durham, NC, USA

    Patrick S. Calhoun & Eric A. Dedert

  6. Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, USA

    Matthew J. Crowley

Authors
  1. Dan V. Blalock
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick S. Calhoun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew J. Crowley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eric A. Dedert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dan V. Blalock.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Telemedicine and Technology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Blalock, D.V., Calhoun, P.S., Crowley, M.J. et al. Telehealth Treatment for Alcohol Misuse: Reviewing Telehealth Approaches to Increase Engagement and Reduce Risk of Alcohol-Related Hypertension. Curr Hypertens Rep 21, 59 (2019). https://doi.org/10.1007/s11906-019-0966-3

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11906-019-0966-3

Keywords

Search

Navigation