Published: March 2025 | Contact: Katy Sutcliffe
What do we want to know?
Problems with drugs and alcohol can cause harms to people, their families and communities. Treating people and helping them to recover can lessen these harms.
Having treatment usually means meeting in-person with a health care provider in a clinic. These days, some treatment is provided over the telephone or on a computer. This is called ‘remote therapy’. There are lots of different types of remote therapies, and they can be given either in addition to in-person treatment or instead of some, or all, of it.
We wanted to find out if remote therapies are as good as, or better, than in-person treatment. We had three questions:
- How well do remote therapies help to reduce drug/alcohol use?
- What types of remote therapies work best at reducing drug/alcohol use?
- Do remote therapies help some groups of people more than others?
Who wants to know?
The review was commissioned by NIHR on behalf of the Office for Health Improvement and Disparities (OHID) and will be of interest to policymakers and practitioners interested in alcohol/drug treatment and/or remote delivery of services.
What did we find?
We found 49 studies initially and five more when we updated our searches. The studies were different from each other in many ways: the types of remote therapy were not all the same; they were given at different treatment points; and what the remote therapy was compared to was different. Also, the remote therapy could be for people receiving treatment for drug use, for alcohol use, or for both.
How well do remote therapies help to reduce drug/alcohol use?
People who received remote therapy in addition to in-person treatment used drugs/alcohol on fewer days than those who only got in-person treatment and/or were less likely to start using drugs/alcohol again.
When remote therapies were given instead of in-person treatment, there was no clear difference in the number of days people used drugs/alcohol but fewer people started using drugs/alcohol again.
What types of remote therapies work best at reducing drug/alcohol use?
The studies that reduced drug/alcohol use the most had three things in common. First, they met the treatment and recovery needs of people. This meant offering enough remote therapy and either motivating people to become or remain drug/alcohol free or offering remote therapy to those with more serious problems with drugs/alcohol. Second, they took a person-centred approach. This meant either designing the remote therapy for a specific group of people, or responding to individuals’ needs and preferences. Third, they supported service use. This meant that the remote therapy was designed to support continued participation in in-person treatment, or encouraged the use of other available services. The studies which reduced drug/alcohol use the least did not have these features.
Do remote therapies help some groups of people more than others?
Almost all of the studies did not let some people take part in the research. Most often this was people who had mental health problems and people who did not have access to technology. Very few studies looked at whether the remote therapy helped some groups of people more than others.
What are the implications?
When delivered in addition to in-person treatment, remote therapies appear to help to reduce the likelihood of using drugs/alcohol and the number of days of drug/alcohol use. When delivered instead of in-person treatment, the findings are less clear. We cannot say for sure if remote therapies are the same or better than in-person treatment.
Three features of remote therapies seem to be important: 1) meeting treatment and recovery needs, 2) taking a person-centred approach and 3) maximising service use.
How did we get these results?
We conducted systematic searching and screening to identify studies evaluating remote therapy interventions.
Analysis 1 – effectiveness: We conducted four effectiveness syntheses using meta-analysis and narrative synthesis; we examined two outcomes (relapse and days of use) for each of two comparison types (remote therapy as a supplement to in-person care; and remote therapy as a replacement or partial replacement for in-person care components).
Analysis 2 – intervention characteristics: We used Intervention Component Analysis (ICA) and Qualitative Comparative Analysis (QCA) to explore which combinations of features were associated with the most and least effective remote therapy interventions.
Analysis 3 – population equity: We explored which population sub-groups were excluded from, and who participated in, the studies. We also sought to explore whether population characteristics were associated with the interventions’ effectiveness.
To ensure these findings are as up-to-date as possible, we updated the initial search (undertaken in November/December 2021) to Aug 2023, and conducted analyses to identify whether newly identified studies were consistent with, or changed, our original findings.
