Am Fam Physician. 2006;73(1):150-158
The excessive consumption of alcohol is a major health concern in the United States. Numerous studies have attempted to address the impact of the brief alcohol intervention program on this problem. This program has the potential to reduce adverse outcomes secondary to excessive alcohol consumption. The intervention has been studied in various settings that may have an influence on the outcomes. One of the most important settings studied is the primary care visit where patients are not seeking help for their alcohol problems. Bertholet and associates performed a systematic review of the literature and evaluated the impact of a brief alcohol intervention on long-term alcohol use and its negative consequences among patients attending primary health care centers for non–alcohol-related concerns.
The study design was a systematic review and meta-analysis of the literature concerning alcohol consumption and the brief intervention. Studies were included in the analysis if they had at least one outcome related to alcohol consumption and were conducted on patients seeking care in primary care centers. The data sources included multiple databases, such as the Cochrane Central Register for Controlled Trials and MEDLINE. The data were abstracted independently and in duplicate, and the validity of the studies was assessed. A meta-analysis was performed on studies that reported alcohol consumption at six or 12 months of follow-up.
There were 612 references obtained from the various sources, with 135 selected for detailed evaluation based on the inclusion criteria. After the detailed review, 24 reports of 19 trials were included in the study. These trials had 5,639 total participants, all randomly assigned to receive a brief alcohol intervention or no intervention.
Eight of 17 trials that reported measures of alcohol consumption showed a significant benefit in reduction of alcohol consumption after a brief intervention when compared with no intervention. The mean pooled difference in alcohol consumption reduction for the intervention group was a decrease of 38 g of alcohol (approximately four drinks) per week. Evaluation of other outcome measures from the various studies was inconclusive.
The authors conclude that brief interventions of five to 15 minutes (including written material and scheduling of a follow-up visit) in primary care patients seeking health care for reasons unrelated to alcohol can have a significant positive effect on reducing alcohol consumption at six and 12 months.
editor’s note: A continuing problem for family physicians is how to impact the lifestyles of patients within the time constraints of a busy practice. One of the most powerful interventions is counseling patients about their unhealthy lifestyles. The U.S. Preventive Services Task Force guidelines recommend that physicians screen and counsel patients with regard to their alcohol consumption.1 Bertholet and colleagues2 have demonstrated the effectiveness of a brief intervention for alcohol consumption in the primary care setting when patients are not seeking care for alcohol-related issues. The intervention takes 15 minutes and includes written material for the patient and the scheduling of a follow-up appointment to assist patients in reducing alcohol intake. This time is well spent and can have a significant impact on patient health.—k.e.m.