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Research Summary

Implementation of Alcohol Screening and Brief Intervention Leads to Less Reduction in Risky Use: A Cautionary Tale

Controlled clinical trials have found efficacy for alcohol screening and brief intervention (ASBI), but dissemination of the practice has been difficult. Researchers in the Netherlands conducted a randomized trial of ASBI implementation in 70 general practices including 6318 patients, 712 of whom had nondependent risky drinking.* Intervention-group practices received ASBI training, reminder cards, practice guidelines, a feedback report, facilitated linkage with a local addiction treatment program, outreach visits, mailings and posters for patients, and personalized feedback for patients. Control-group practices were mailed practice guidelines and patient letters only.

  • At 2 years, patients in intervention practices were significantly less likely than patients in control practices to be abstinent or to have low-risk drinking (Alcohol Use Disorders Identification Test [AUDIT] scores <8) (36% versus 47%, respectively). They were also significantly more likely to be drinking hazardous amounts (AUDIT scores 8–15) (59% versus 47%, respectively).
*Alcohol Use Disorders Identification Test scores of 8–19.

Comments:

Despite efficacy in controlled trials, few clinical practices have implemented ASBI. As a result, large-scale implementation efforts have been undertaken. This trial of a substantial effort to implement ASBI (much more substantial than is likely widely feasible) found that patients in practices exposed to such efforts actually had increased, not decreased, alcohol risks. It appears that getting ASBI to work in the real world remains elusive, and results of such efforts may not be benign. Richard Saitz, MD, MPH

Reference:

Hilbink M, Voerman G, van Beurden I, et al. A randomized controlled trial of a tailored primary care program to reverse excessive alcohol consumption. J Am Board Fam Med. 2012;25(5):712–722.

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