Efficacy of Brief Interventions in Primary Care to Reduce Risky and Harmful Alcohol Use

To inform the
clinical guidelines of the U.S. Preventive Services Task Force
(USPSTF), researchers systematically reviewed studies on the efficacy
of brief behavioral counseling interventions in primary care to
reduce risky and harmful alcohol consumption. Twelve controlled
trials met strict criteria for inclusion.

• Patients
  who received brief multi-contact behavioral counseling interventions
  (initial session up to 15 minutes and at least 1 follow-up) reduced
  their average weekly alcohol intake by 13%–34% more than
  controls in 4 trials (all of good quality) of 7. Further, 10%–19%
  more intervention participants than controls drank safe amounts
  in the 5 trials (all of good quality) that reported safe use.
• Very brief
  (up to 5 minutes) or brief single-contact interventions, which
  were tested in 8 trials of fair to good quality, were ineffective
  or less effective than multi-contact interventions in reducing
  risky or harmful alcohol use.
• All effective
  interventions included at least 2 of 3 key elements: feedback,
  advice, and goal setting.
• No significant
  differences were found among men and women receiving brief interventions.

Comments:

Based on these
findings, the USPSTF gave a grade B recommendation (at least
fair evidence of improved health outcomes and benefits outweighing
potential harms) to screening and brief counseling in primary care
settings to reduce risky or harmful alcohol use among adults. Unfortunately,
busy primary care physicians are more likely to perform very brief
interventions that are not as effective. Better strategies to implement
screening and more effective brief interventions in actual clinical
practice must be developed.

Kevin
L. Kraemer, MD, MSc

Reference:

Whitlock EP, Polen
MR, Green CA, et al. Behavioral counseling interventions in primary
care to reduce risky/harmful alcohol use by adults: a summary of the
evidence for the U.S. Preventive Services Task Force. Ann Intern
Med. 2004;140(7):557–568.
(view
full article)

U.S. Preventive Services Task Force. Screening and behavioral counseling
interventions in primary care to reduce alcohol misuse: recommendation
statement. Ann Intern Med. 2004;140(7):554–556.
(view full article)