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Research Summary

Addressing Risky Alcohol Use With Other Behavioral Risk Factors

Brief counseling is efficacious for addressing individual behavioral risk factors such as smoking and risky drinking. However, its efficacy in addressing multiple risk factors in a patient remains unclear. Researchers summarized 6 systematic reviews (focused primarily on cardiovascular disease and diabetes interventions) to examine the evidence for addressing multiple behavioral risk factors, including risky alcohol use, in primary care settings.

  • Of secondary prevention trials for hypertension, 1 of 3 that targeted risky drinking led to a reduction in alcohol use; the only primary prevention study that was identified did not significantly affect use.
  • One study of general practices in Britain tested nurse counseling and follow-up for smoking, diet, exercise, and alcohol consumption. The intervention lowered cholesterol, blood pressure, and body mass index but had no effect on smoking or risky alcohol use.


As any primary care physician can attest, most people have more than one health risk behavior. While evidence supports the use of interventions for individual risk factors, the efficacy and value of using an integrated approach to address multiple risk factors, including risky drinking, has yet to be clearly demonstrated. Nonetheless, the authors of this review suggest that, for now, primary care clinicians should address multiple risks with brief behavioral counseling (the 5A's: Assess, Advise, Agree on goals, Assist in developing a plan, Arrange follow-up); system supports such as computer-decision tools; clinician reminders to screen or intervene; staff training; multidisciplinary nurse-led teams; and referrals.

Richard Saitz, MD, MPH


Goldstein MG, Whitlock EP, DePue J, et al. Multiple behavioral risk factor interventions in primary care: summary of research evidence. Am J Prev Med. 2004;27(2S):61–79.
(view abstract)