For People Who Drink Heavily, Alcohol Consumption Decreases after a Health-Care Visit without Brief Intervention
In many studies of alcohol brief intervention (BI), the effects of BI delivered at what are thought to be “teachable moments” are dwarfed by the decreases in consumption seen in both intervention and control groups. Investigators followed general-practice outpatients and general hospital inpatients identified by screening as having unhealthy alcohol use* for 12 months. These patients were BI randomized trial participants who were in the control groups and thus did not receive the intervention.
- At 1 year, half (or fewer) were either abstinent or drinking <30 g alcohol per day for men or <20 g per day for women. Lower risk consumption was more common in inpatients (50%) than in outpatients (26%).
- Receipt of alcohol-related treatment or advice during the year (18–29% received some form of treatment) was not associated with changes in consumption at follow-up.
*Drinking risky amounts (20/30 g alcohol daily) or meeting DSM-IV criteria for abuse or dependence.
Comments:
The authors summarize their results succinctly: “treatment is a window of opportunity for self-change.” Unhealthy alcohol use improves after a health-care visit—which may be a “learnable moment,” even when there has been no alcohol counseling. This makes sense, because patients themselves may connect their visit with their alcohol use and change their drinking as a result. It is also possible that patients changed as a result of screening or coincidentally. Regardless of the cause, the observed improvement means as many as half of patients won’t benefit from BI, since they will improve on their own. It also suggests that research should identify which patients are less likely to change spontaneously, and thus might benefit from counseling. A “learnable moment” may have even greater impact than a “teachable moment.”
Richard Saitz, MD, MPH
Reference:
Bischof G, Freyer-Adam J, Meyer C, et al. Changes in drinking behavior among control group participants in early intervention studies targeting unhealthy alcohol use recruited in general hospitals and general practices. Drug Alcohol Depend. 2012;125(1–2):81–88.