Podcast: Effectiveness of brief alcohol interventions in primary care populations

The Cochrane Drugs and Alcohol Group specialises in reviews that assess, among other things, ways to reduce hazardous or harmful drinking of alcohol. One of these reviews looks at the evidence on practitioner-delivered brief interventions and we asked one of the authors, Fiona Beyer from Newcastle University in the UK to tell us about the findings from the update in February 2018.

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John: Hello, I'm John Hilton, editor in the Cochrane Editorial and Methods department. The Cochrane Drugs and Alcohol Group specialises in reviews that assess, among other things, ways to reduce hazardous or harmful drinking of alcohol. One of these reviews looks at the evidence on practitioner-delivered brief interventions and we asked one of the authors, Fiona Beyer from Newcastle University in the UK to tell us about the findings from the update in February 2018.

Fiona: Hazardous or harmful drinking can involve regular consumption of alcohol over the recommended limits, or occasional consumption of high volumes, known as binging. It causes more than 60 diseases, as well as many injuries and early deaths. After updating our review, we have shown that brief interventions delivered by doctors and nurses in general practice or emergency care can lead to small but significant reductions in drinking for at least a year after the intervention.
The brief interventions are designed for people who are drinking at levels that may harm their health, but who are not dependent on or addicted to drinking; and we defined interventions as no more than five sessions with a total duration of less than 60 minutes. Typically, the interventions give a person feedback about their alcohol use and potential harmful impacts, identify high risk situations for heavy drinking, and provide strategies and a personal plan to help cut down drinking. The interventions were originally designed to be delivered in regular primary care consultations, but because many are longer than a standard consultation, people sometimes receive them in a separate appointment.
We looked for randomised trials that recruited people who lived at home, were visiting their doctor or the emergency department for a reason other than to get help for their drinking, and answered a questionnaire suggesting they drank over recommended limits. Our particular interest was in the comparison of a brief intervention with either a minimal intervention or no alcohol-related intervention, where a minimal intervention might be simple advice or written information about alcohol or general health matters.
The first version of this review was published in 2007 and this 2018 update now includes 69 studies, of which 34 reported an outcome that we could include in our primary meta-analysis.
We found that, on average, people receiving a brief intervention drank 20 grams less alcohol per week compared to those who did not after one year. That’s just over a pint of beer or just less than a third of a bottle of wine each week. Although this is small compared to the amount some people were drinking in the first place, if brief interventions were widely used and the benefit was seen in a large population, it could have a major impact on alcohol-related diseases and harms. This update has also shown, for the first time, that brief interventions are beneficial for women as well as for men.
Our take home message, therefore, is that practitioner-delivered brief interventions provide a small but significant reduction in drinking in both women and men for at least one year following the intervention.

John: If you would like to read more about these brief interventions, and to look at the evidence on more extended interventions, you can find the full review online. Just go to Cochrane Library dot com and search 'brief alcohol interventions'.

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