Effect of Integrated Internet-Based Acceptance and Commitment Therapy and Behavioral Activation Among Ethnic Minority Young Adults With Alcohol Use Disorder in Hong Kong: Pilot Randomized Controlled Trial.

TL;DR

A pilot trial found that an integrated internet-based acceptance and commitment therapy plus behavioral activation intervention reduced drinking days and drinks per occasion in ethnic minority young adults with alcohol use disorder, with medium to large effect sizes . The study is too small to confirm efficacy but demonstrates feasibility for a larger trial.

What the Study Found

Alcohol use disorder in ethnic minority populations carries distinct pressures. Young adults from ethnic minorities face compounded stressors including acculturation challenges, discrimination, and social marginalization, all of which research suggests amplify problematic drinking patterns. This pilot study tested whether an internet-delivered combination of acceptance and commitment therapy (ACT) and behavioral activation (BA) could address these barriers in a Hong Kong sample of 40 ethnic minority young adults meeting DSM-5 criteria for AUD.

The intervention integrated two therapeutic approaches with complementary logic. ACT targets psychological flexibility and values-based action despite difficult thoughts and emotions. Behavioral activation addresses the specific problem that ACT alone may not adequately engage people in concrete, rewarding activities. The combined approach was delivered online over six sessions. The control group received treatment-as-usual (TAU), which typically includes standard community services.

The intervention group showed measurable reductions in drinking metrics. Participants receiving ACT-BA reduced drinking days by approximately 4 days over the follow-up period (B=-4.12, 95% CI -8.10 to -0.13; P=.04, d=-0.57) and drinks per drinking day by roughly 1.5 drinks (B=-1.56, 95% CI -3.06 to -0.07; P=.04, d=-1.89). The effect size for drinks per occasion was large (d=-1.89). Secondary outcomes also favored the intervention: alcohol abstinence self-efficacy improved significantly (B=11.95, 95% CI 0.10-23.81; P=.048, d=0.81), and psychological flexibility improved as measured by the Acceptance and Action Questionnaire-version II (B=-6.41, 95% CI -12.77 to -0.06; P=.04, d=-0.65). Readiness to change and everyday discrimination scores did not reach statistical significance, though the study was underpowered to detect effects on these measures.

From a feasibility perspective, the intervention showed real-world promise. Of 148 screened individuals, 40 completed randomization (27% enrollment rate after screening). Retention was 82.5% at follow-up, with 75% completing the postintervention assessment. Critically, adherence to the six-session program was 81.7%, and no adverse effects were reported. These metrics suggest the format and content were acceptable to participants. Qualitative interviews conducted after the trial added contextual support, though the abstract does not detail those findings.

What This Means for You

This study is preliminary evidence, not proof of efficacy. The sample size of 20 per group is typical for a pilot trial designed to test feasibility and generate effect size estimates for larger studies, not to confirm that a treatment works. Larger, longer-term trials are needed before this intervention could be recommended as standard treatment.

That said, the direction and magnitude of effects are encouraging. Reductions in drinking days and drinks per occasion are clinically meaningful metrics in AUD treatment. The large effect size for drinks per occasion suggests the combination of ACT and BA may address a real mechanism in this population. The fact that psychological flexibility improved alongside drinking reductions aligns with ACT theory, which posits that learning to act consistently with values despite uncomfortable internal experiences drives behavior change.

The internet delivery format is particularly relevant for ethnic minority communities facing barriers to in-person mental health care, including transportation, stigma, scheduling conflicts, and limited culturally competent providers. A self-guided online intervention that achieved 82% session completion suggests digital delivery can work for this group when the content is appropriately designed.

If you or someone you know has alcohol use disorder, this study does not yet establish this specific intervention as a treatment option. Current evidence-based treatments include cognitive behavioral therapy, motivational enhancement therapy, and medications like naltrexone or acamprosate. However, this pilot suggests that integrated ACT-BA delivered online warrants investment in a fully powered trial, which the authors appropriately call for.

Study Details

Sources

Tran, B. X., et al. (2025). Effect of Integrated Internet-Based Acceptance and Commitment Therapy and Behavioral Activation Among Ethnic Minority Young Adults With Alcohol Use Disorder in Hong Kong: Pilot Randomized Controlled Trial. Journal of Medical Internet Research. https://pubmed.ncbi.nlm.nih.gov/42166789