Technology-Based Prevention and Harm Reduction Interventions for Substance Use Among Young Adults: A Systematic Review and Meta-Analysis

Background and Purpose. The use of drugs and alcohol among young adults (YA) and college students (CS) presents serious concerns, and the need for interventions focused on prevention and harm associated with the use and misuse of substance is clear. Prevention of substance use and related harms is critical, and evidence is growing for technology-based programs designed to prevent substance use and reduce the harms associated with use and misuse. We assessed the effectiveness of digital prevention, early interventions, and harm reduction of alcohol and drug use among YA/CS compared to control conditions.

Methods. Nine electronic databased were searched; studies were limited to randomized control trial (RCT) design. The systematic review included individuals at risk for substance use disorders; participants were young adults ages 18-24 or college students. Two reviewers independently screened studies, extracted data, and assessed risks of bias. We used robust variance estimation in meta-regression for synthesizing effect sizes and moderator analyses. Sensitivity analysis and publication bias assessment were also performed.

Results. A total of 3,590 studies were screened, and 37 met the criteria and were included in the present review. About 80% of the TBIs in this review (n=30, 81.1%) utilized web-based platforms. Two studies utilized text/MMS (5.4%), three used apps or social media (8.1%), and two studies’ TBIs used multiple forms of technology (5.4%). The overall effect size representing TBI’s effects on prevention/harm reduction outcomes compared to controls, with 264 effect sizes from 37 studies, was d= .25 and statistically significant (95% CI= .13, .37). The effect size for TBIs’ effects for substance use prevention was statistically significant and d=.25 (95% CI=.10, .40) compared to the effect size for protective behaviors/harm reduction outcomes which was marginally significant (d=.18, 95% CI=.00, .36) but did not reach statistical significance. The effect size for TBIs’ effects for the general young adult population was not significant (d=-.03, 95% CI=-5.95, 5.89), and TBIs’ effects for the college student population was d=.26 (95% CI=.14, .37) and significant. The effect size for web-based TBIs was significant (d=.23, 95% CI=.06, .40), and the effect sizes for TBIs using emails (d=.23, 95% CI=-.37, .82), text messaging (d=.37, 95% CI=-.77, 1.52), and multiple technology (d=.18, 95% CI=-.16, .52) were not significant. The effect size for TBIs without human contact was d=.28 (95% CI=.17, .39) and statistically significant, whereas the effect size for TBIs with some human contact was not significant (d=.10, 95% CI=-.64, .84).

Conclusion and Implications. Findings from this review indicate that TBI’s have the potential to be effective tools for preventing substance use and related harms, particularly with the use of web-based platforms to reduce substance use by way of prevention strategies. Findings from this review support the integration of prevention-focused strategies into substance use treatment programs for YA/CS, particularly among college students. Overall, this study highlights the need for continued monitoring of technology-driven interventions for substance use,and can provide valuable insights into ways that evolving technology can be developed for substance use interventions.