Parlier-Ahmad AB, Boss N, Green AR, et al. Digital Cognitive Behavioral Therapy Reduces Heavy Drinking Among a Non-Treatment Sample of People With Alcohol Use Disorder: A Feasibility Trial With CBT4CBT. Alcohol Clin Exp Res (Hoboken). 2026;50(8):e70383. doi:10.1111/acer.70383
This feasibility randomized controlled trial evaluated the usability and acceptability of CBT4CBT, a web-delivered cognitive behavioral therapy program for individuals not receiving substance use disorder treatment. While CBT4CBT has been validated in other settings, people with lifetime alcohol use disorder (AUD) and current heavy drinking are an underserved population who may benefit from access to digital treatment options that do not have the same barriers as seeking traditional care. Participants were randomized 3:1 to CBT4CBT (n=122) or an assessment-only control condition and had 8 weeks to access the program. Overall, the results indicated positive usability and acceptability. 65.6% of the participants assigned to CBT4CBT completed at least one module, with an average of 3.1 (SD=3.1, range=0–7) modules completed among all participants assigned to CBT4CBT and 4.7 (SD=2.7) among those who started the program. 80.9% of participants who started using CBT4CBT reported being satisfied or very satisfied. Both measures were comparable to previous findings focused on individuals who were also receiving traditional substance use disorder treatment. Positive alcohol-related outcomes were also seen. At the 1-month follow-up in the intention-to-treat analyses and among study completers, participants in the CBT4CBT group reported a lower percentage of no heavy drinking days compared to the control group. Among participants who reported any heavy drinking days, however, those in the CBT4CBT group had significantly more heavy drinking days than the control group at both follow-up assessments, potentially indicating additional required support for heavier drinkers. Participants receiving CBT4CBT also reduced their percentage of drinking days faster than those in the control condition. However, there were no significant differences between groups in the proportion reporting any alcohol use, mean number of drinking days, or SURE score at either follow-up. CBT4CBT may be useful in populations with low treatment-seeking behavior. Here, the data showed promising usability, acceptability, and some alcohol-related benefits. Future studies should use follow-up periods of at least 6 months to capture possible continued improvement.