Screening and Brief Intervention for Risky Drinking in General Practice

National professional organizations recommend that primary care clinicians conduct alcohol screening and brief intervention. Although systematic reviews support the efficacy of brief intervention, questions remain about its benefit in routine primary care practice. To examine the efficiency of screening and the efficacy of subsequent counseling, researchers performed a systematic review and meta-analysis of 8 randomized clinical trials that used screening as a precursor to brief intervention for risky (but not dependent) drinkers.

In the studies examined, 9% of the adults screened drank risky amounts, and 3% received brief intervention (including physician feedback, information, and advice). The pooled reduction in absolute risk of drinking risky amounts was 10.5% (from 69% of patients drinking risky amounts to 57%). Based on this reduction, 10 risky drinkers would need brief intervention to yield 1 patient no longer drinking risky amounts. The authors also calculated that screening 1000 patients (and then conducting brief intervention with those screening positive) would yield 2–3 patients no longer drinking risky amounts.

Comments:

This review raises a concern about the effort required to achieve a benefit from alcohol screening and intervention. However, as an editorialist points out, the small proportion of patients reported to have received brief intervention is overly pessimistic given that the research studies excluded many more patients than would be excluded from interventions in clinical practice. This review confirms what recent clinical trials suggest—brief intervention in primary care settings is efficacious for decreasing alcohol use by risky drinkers. And based on the reported number-needed-to-treat, screening and intervention efforts appear to be at least as effective as other preventive health measures.

Richard Saitz, MD, MPH

Reference:

Beich A, Thorsen T, Rollnick S. Screening in brief intervention trials targeting excessive drinkers in general practice: systematic review and meta-analysis. BMJ. 2003;327(7414):536–542.
(view abstract)