Brief interventions for alcohol misuse

• Published in: Canadian Medical Association journal (CMAJ) 2015-04, Vol.187 (7), p.502-506
• Main Authors: Moyer, Anne, PhD, Finney, John W., PhD
• Format: Article
• Language: English
• Subjects: Alcohol Drinking - epidemiology; Alcohol use; Alcohol-Related Disorders - prevention & control; Alcohol-Related Disorders - therapy; Alcoholism; Binge Drinking - prevention & control; Care and treatment; Health care; Health promotion; Humans; Internal Medicine; Intervention; Life Style; Medical screening; Methods; Review; Surveys and Questionnaires; Systematic review
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.140254

The intensity of contact varies from very brief (less than 5 minutes, with no follow-up) through brief (less than 15 minutes, with no follow-up) to brief but repeated (individual sessions of less than 15 minutes, with multiple follow-up contacts).19 One example of a very brief intervention consisted of just five minutes of advice (feedback of screening results and review of associated adverse health consequences) delivered by a nurse to patients aged 55 and older with hazardous drinking levels.20 An example of a brief multicontact intervention was directed at college students during routine visits with their primary care providers at five US and Canadian health clinics.21 A 15-minute intervention and a 15-minute reinforcement session with the physician were scheduled one month apart, followed by two telephone calls from a primary care interventionist. The sessions involved motivational interviewing techniques. Students were given a manual that included feedback about their drinking, descriptions of drinking norms and the adverse effects of drinking among college students, exploration of personal likes and dislikes related to drinking, worksheets on drinking cues, instruction on how to calculate blood alcohol levels, consideration of the effects of alcohol on life goals, strategies for cutting down, a drinking contract and drinking diary cards. Much investigation has been directed at establishing the effectiveness (real-world performance) of brief interventions for alcohol abuse in primary care. One recent comprehensive and rigorous systematic review of published systematic reviews provided an authoritative summary of this evidence.22 Overall, across 24 systematic reviews (summarizing a total of 56 individual trials), brief alcohol interventions delivered in primary health care settings were effective in reducing harmful and hazardous drinking, despite a lack of positive findings in some individual trials. The authors noted that such null effects might be due to a Hawthorne effect, whereby simply joining a trial or having one's drinking recorded influenced the level of drinking. The most commonly assessed drinking outcome was weekly alcohol consumption, with one representative review23 suggesting that brief interventions reduced this variable by 38 g per week (95% confidence interval [CI] 23 to 54 g) for 22 trials of interventions in primary care after one year of follow-up. This review of reviews22 also reported only limited or mixed evidence in terms of t