Efficacy of Brief Interventions in Primary Care to Reduce Risky and Harmful Alcohol Use
To inform the clinical guidelines of the U.S. Preventive Services Task Force (USPSTF), researchers systematically reviewed studies on the efficacy of brief behavioral counseling interventions in primary care to reduce risky and harmful alcohol consumption. Twelve controlled trials met strict criteria for inclusion.
- Patients who received brief multi-contact behavioral counseling interventions (initial session up to 15 minutes and at least 1 follow-up) reduced their average weekly alcohol intake by 13%–34% more than controls in 4 trials (all of good quality) of 7. Further, 10%–19% more intervention participants than controls drank safe amounts in the 5 trials (all of good quality) that reported safe use.
- Very brief (up to 5 minutes) or brief single-contact interventions, which were tested in 8 trials of fair to good quality, were ineffective or less effective than multi-contact interventions in reducing risky or harmful alcohol use.
- All effective interventions included at least 2 of 3 key elements: feedback, advice, and goal setting.
- No significant differences were found among men and women receiving brief interventions.
Based on these findings, the USPSTF gave a grade B recommendation (at least fair evidence of improved health outcomes and benefits outweighing potential harms) to screening and brief counseling in primary care settings to reduce risky or harmful alcohol use among adults. Unfortunately, busy primary care physicians are more likely to perform very brief interventions that are not as effective. Better strategies to implement screening and more effective brief interventions in actual clinical practice must be developed.Kevin L. Kraemer, MD, MSc
Whitlock EP, Polen
MR, Green CA, et al. Behavioral counseling interventions in primary
care to reduce risky/harmful alcohol use by adults: a summary of the
evidence for the U.S. Preventive Services Task Force. Ann Intern
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U.S. Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med. 2004;140(7):554–556.
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