• Brief alcohol interventions

    Until I read the Cochrane Database of Systematic Reviews paper on brief alcohol interventions in primary care (Kaner et al. 2009), I didn’t appreciate how the target population for brief alcohol interventions differs from that for AA or other twelve-step programs. Brief interventions are one to four, typically 5-15 minute, patient-provider sessions designed to reduce risky alcohol consumption or related problems. In the primary or emergency care settings, they are usually initiated when an individual presents for other reasons.

    And that’s the difference. Brief interventions focus on risky alcohol consumption or consumption identified as excessive or producing harm. They are also opportunistic, not planned. In contrast, AA has focus on those with alcohol dependence (the two populations can overlap, of course), and AA is initiated as a planned alcohol-related intervention. Epidemiologists have determined that the most population-level, alcohol-related harm is due to excessive drinking as opposed to alcohol dependence. The former is a lot more common than the latter.

    Kaner et al. examined 29 randomized controlled trials of brief interventions in the primary and emergency care settings and found that,

    Participants drank an average of 306 grams of alcohol (over 30 standard drinks [link]) per week on entry to the trial. […] After one year or more, people who received the brief intervention drank less alcohol than people in the control group (average difference 38 grams/week, range 23 to 54 grams). For men (some 70% of participants), the benefit of brief intervention was a difference of 57 grams/week, range 25 to 89 grams (six trials). The benefit was not clear for women.

    Most studies analyzed did not study health outcomes. The few that did found that brief interventions, relative to no treatment, were associated with 0.5 fewer ER visits (Crawford 2004), a 47% reduction in new injuries requiring emergency or trauma center care, a 48% reduction in hospital readmission (Gentillelo 1999), and lower Drinker Inventory of Consequences (pdf) scores and Injury Behavior Checklist (pdf) scores (Longabaugh 2001). All of the forgoing results were statistically significant. No other reported health outcomes were.

    Kane et al. conclude that positive impacts of brief interventions have already been proven in male populations and that future research should focus on implementation issues. (I’m reading another review of studies of  brief interventions in the inpatient setting. The results are different. I’ll write that up in a separate post.)

    References

    Crawford MJ, Patton R, Touquet R, Drummond C, Byford S, Barrett B, et al.Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial. Lancet 2004;364(9442):1334–9.

    Gentillelo LM, Rivara FP, Donovan DM, Jurkovich GJK, Daranciang E, Dunn CW, et al.Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Annals of Surgery 1999;230(4):473–83.

    Longabaugh R, Woolard RF, Nirenberg TD, Minugh AP, Becker B, Clifford PR, et al.Evaluating the effects of a brief motivational intervention for injured drinkers in the emergency department. Journal of Studies on Alcohol 2001;62:806–16.

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    • It’s wonderful to see economists (or anyone!) pay attention to the 30 years of research on alcohol screening and brief intervention. But also for someone newly acquainted with the research to actually grasp the implications for understanding what the larger part of the alcohol problem is–that is really unusual. Congratulations and thanks.

      This preventive clinical service has been found to be the 4th most cost-effective and beneficial thing medical providers can do, but we are still having a hard time getting it into practice. So if you’d be willing to do more on the issue, I’d be happy to supply you with all the references you need.

      Cheers,

      John H-B

    • First I am amazed by your productivity.
      Ten years ago I though that there would have been effective drug treatments for alcoholism and drug addiction by now.

    • Excellent summary