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Am Fam Physician. 2005;72(9):1867

High-risk drinking may occur in up to 10 percent of patients seen in primary care. Studies have shown that brief interventions can have an impact on health-related behaviors, including high-risk drinking. Reiff-Hekking and colleagues, for Project Health, reported on patterns of change from high-risk to safe drinking behaviors at 12-month follow-up after counseling interventions.

In the Project Health study, patients engaged in high-risk drinking were randomized by site to special intervention or usual care. High-risk drinking was defined as: (1) more than 12 standardized drinks per week for men and more than nine per week for women; or (2) one or more instances of binge drinking in the previous month (i.e., five or more drinks per occasion for men or four or more for women). Patients at four clinical sites were identified through a survey that included alcohol-related questions embedded in a general health-habit questionnaire. Of 9,772 patients, 1,760 screened positive for high-risk drinking, and these patients were contacted to complete a more extensive lifestyle interview. This additional survey identified 703 eligible study participants who were interviewed at six and 12 months after intervention. The intervention consisted of a patient-centered, five- to 10-minute alcohol counseling sequence by the physician. An office-based support system included reminders and interview summaries placed on the patients’ charts. Patients in the special intervention and usual care groups received a booklet containing advice on healthy habits, and all physicians were encouraged to talk with their patients about alcohol consumption issues. Primary endpoints included total number of drinks consumed per week and number of binge drinking episodes per month.

The usual care group and the special intervention group were similar at baseline. At 12 months, the special intervention group had a significantly greater mean reduction in the number of drinks consumed per week compared with the usual care group (−5.7 versus ‒3.2 drinks per week), with a number needed to treat of eight high-risk drinkers for each patient whose drinking was successfully reduced to safe levels. The difference of 0.4 binges per month between the two groups, however, was not statistically significant. Overall, a significantly greater percentage of participants in the special intervention group (42 percent) progressed to safe drinking levels at 12 months compared with participants in the usual care group (29 percent).

The authors conclude that a five- to 10-minute intervention consisting of brief counseling by the physician produces lasting reductions in high-risk drinking compared with usual care.

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