Abstract
Binge drinking (BD) is defined as a pattern of alcohol consumption that results in a blood alcohol concentration of 0.08 g/dL or higher, typically achieved after consuming approximately 70 g of pure alcohol (about five drinks for men) or 56 g (about four drinks for women) within roughly two hours. It is highly prevalent among adolescents and young adults and has significant physical, psychological, and social consequences. Despite numerous interventions to reduce BD, there is limited systematic evidence on their effectiveness. This study presents a systematic review of randomized controlled trials (RCTs) evaluating interventions to reduce BD, focusing on their impact on frequency, intensity, and associated physical, psychological, or social outcomes. The review followed PRISMA 2020, and the protocol was registered with PROSPERO (CRD42024623481). A comprehensive search was conducted in multidisciplinary and specialized databases. Included studies were RCTs targeting BD in clinical or community populations of any age. Non-empirical and observational studies, or studies not specifically focused on BD were excluded. The risk of bias was assessed using RoB 2, and a total of 21 studies (N = 14,754 participants) were included, showing high variability in design, format, and theoretical basis. Brief, individual digital interventions predominated, although face-to-face group and multimodal interventions proved more effective. Eleven studies reported significant reductions in BD frequency or prevalence; fewer addressed intensity. Interventions based on motivational and cognitive behavioral approaches, especially in structured programmes with prolonged follow-up, were the most effective. Improvements were observed in psychosocial variables (e.g., negative consequences, self-efficacy, expectations, social norms, and intention to consume), but not in physical health or consumption of other substances. Most studies had a moderate risk of bias, and few demonstrated long-term effects. More robust, comparative, and longitudinal studies are needed.