Effectiveness of nurse-led interventions for alcohol-related outcomes: a systematic review and meta-analysis of randomized controlled trials

Alcohol consumption is associated with substantial health and social harms. Nurses may have opportunities to identify alcohol-related risks and deliver interventions during routine patient care, but the effects of nurse-led alcohol interventions among adults have not been quantitatively synthesized. This systematic review and meta-analysis examined the effects of nurse-led alcohol interventions on alcohol-related outcomes in adult populations. PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from database inception to August 22, 2026. Randomized controlled trials (RCTs) were eligible if they evaluated nurse-led alcohol interventions among adults with hazardous, harmful, risky, heavy, or unhealthy alcohol use. Outcomes included AUDIT/AUDIT-C scores, alcohol consumption (e.g., quantity of drinking), alcohol-related consequences, favorable drinking outcomes (e.g., abstinence or low-risk drinking), and heavy/binge drinking outcomes. Random-effects meta-analyses were conducted where appropriate. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. The certainty of evidence for the major outcomes was assessed using the GRADE approach. Sixteen RCTs involving 2,488 participants were included. Compared with control conditions, nurse-led alcohol interventions were associated with lower AUDIT/AUDIT-C scores (standardized mean difference [SMD] = − 0.49, 95% confidence interval [CI] − 0.84 to − 0.14; I ² = 83%) and lower alcohol consumption (SMD = − 0.35, 95% CI − 0.51 to − 0.18; I ² = 40%). For favorable drinking outcomes, the pooled estimate suggested a higher likelihood of achieving a favorable outcome, although the difference was not statistically significant (risk ratio = 1.49, 95% CI 0.99–2.24; I ² = 72%). Nurse-led interventions were also associated with lower heavy or binge drinking (SMD = − 0.35, 95% CI − 0.60 to − 0.10; I ² = 59%). Evidence regarding alcohol-related consequences was limited. Heterogeneity was substantial for several pooled outcomes ( I ² = 59%–83%). Only one study was assessed as having a low risk of bias, while eight had some concerns and seven were at high risk of bias. Sensitivity analyses excluding studies at high risk of bias produced similar results. The certainty of evidence ranged from very low to moderate across the major outcomes. Nurse-led alcohol interventions were associated with reductions in AUDIT/AUDIT-C scores, alcohol consumption, and heavy or binge drinking among adults, while evidence for favorable drinking outcomes was less certain. However, these findings should be interpreted cautiously given the risk-of-bias concerns, substantial heterogeneity, and limited certainty of the evidence. Further high-quality studies are needed to clarify the effects of nurse-led alcohol interventions. PROSPERO CRD420261380636. Not applicable.