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Aims  To test the efficacy of a therapist‐guided high‐intensity internet intervention compared with an unguided low‐intensity internet intervention among individuals with alcohol use disorder.    Design  A three‐group randomized controlled trial with follow‐up assessments post‐treatment (12 weeks) and 6 months post‐randomization (primary end‐point).    Settings  General population sample in Sweden.    Participants  A total of 166 on‐line self‐referred adults (49% males) with a score of 14 (females)/16 (males) or more on the Alcohol Use Disorders Identification Test, a preceding week alcohol consumption of 11 (females)/14 (males) or more standard drinks and an alcohol use disorder according to a diagnostic interview.    Interventions and comparators  Both the high‐ ( n  = 72) and low‐intensity internet interventions ( n  = 71) consisted of modules based on relapse prevention. Controls were on a waiting‐list ( n  = 23), and were only followed until the post‐treatment follow‐up. Participants were randomized at a 7 : 7 : 2 ratio.    Measurements  Primary outcome was self‐reported alcohol consumption in the preceding week measured as (1) number of standard drinks and (2) number of heavy drinking days at the 6‐month follow‐up.    Findings  Alcohol use disorders were largely in the severe category (74.7%), with the majority of participants having had alcohol problems for more than 5 years.  Attrition was 13 and 22% at the post‐treatment and 6‐month follow‐up, respectively. At the 6‐month follow‐up, an intent‐to‐treat analysis showed no significant differences in alcohol consumption between the high‐ and low‐intensity interventions [standard drinks  d  = −0.17, 95% confidence interval (CI) = −0.50 to 0.16; heavy drinking days:  d  = −0.07, 95% CI = −0.40 to 0.26]. Prevalence of negative effects was somewhat low (8–14%) in both intervention groups, as was deterioration (3–5%).    Conclusions  At 6‐month follow‐up, there were no significant differences between a therapist‐guided high‐intensity internet intervention and an unguided low‐intensity internet intervention in reducing alcohol consumption among individuals with an alcohol use disorder.

High‐ versus low‐intensity internet interventions for alcohol use disorders: results of a three‐armed randomized controlled superiority trial