Effectiveness of brief alcohol interventions in primary care populations.

Kaner EFS, Beyer F, Dickinson HO, Pienaar E, Campbell F, Schlesinger C, Heather N, Saunders J, Burnand B

Summary

Excessive drinking contributes significantly to social problems, physical and psychological illness, injury and death. Hidden effects include increased levels of violence, accidents and suicide. Most alcohol-related harm is caused by excessive drinkers whose consumption exceeds recommended drinking levels, not the drinkers with severe alcohol dependency problems. One way to reduce consumption levels in a community is to provide a brief intervention in primary care over one to four sessions. This is provided by healthcare workers such as general physicians, nurses or psychologists. In general practice, patients are routinely asked about alcohol consumption during registration, general health checks and as part of health screening (using a questionnaire). They tend not to be seeking help for alcohol problems when presenting. The intervention they are offered includes feedback on alcohol use and harms, identification of high risk situations for drinking and coping strategies, increased motivation and the development of a personal plan to reduce drinking. It takes place within the time-frame of a standard consultation, 5 to 15 minutes for a general physician, longer for a nurse. Laboratory markers of drinking are blood mean corpuscular volume or gamma-glutamyltransferase levels.
A total of 28 controlled trials from various countries were identified, in general practice (23 trials) or an emergency setting (five trials). Participants drank an average of 320 grams (over 30 standard drinks) on entry to the trial. Over 7000 participants with a mean age of 42 years were randomized to receive a brief intervention or a control intervention, including assessment only. Brief interventions consistently reduced alcohol consumption with an average drop of four standard drinks per week. At one year's follow up (17 trials), people who had received the brief intervention drank less alcohol (a difference of 6 to 25 grams per week, mean 41 grams). For men (some 70% of participants), the benefit of brief intervention was a reduction of 57 grams/week, range 25 to 89 grams (six trials). The benefit was not clear for women. The reduction in drinking was similar in the normal clinical setting as in a research setting with greater resources. Longer counselling had little additional benefit.