Screening and Brief Interventions for Unhealthy Alcohol Use in Adults: Mixed Results

Screening and brief intervention are effective for helping some heavy drinkers without alcohol dependence to reduce their alcohol consumption. Two new studies clarify that setting and severity of alcohol use may influence who will benefit.

In one randomized trial, researchers implemented alcohol screening by questionnaire in 39 primary care practices in Denmark. Patients who screened positive for risky drinking (>21 drinks per week for men; >14 for women) but did not have screening scores consistent with alcohol dependence received either no intervention or 10 minutes of counseling by trained physicians and a recommendation for a follow-up consultation.

• Of 7691 unique patients able to be screened (e.g., not inebriated, pregnant, acutely ill), 10% refused screening; 16% of those screened had risky drinking.
• Only 18% of the intervention group returned for the follow-up consultation.
• After 1 year (61% response rate), the usual number of drinks per week did not significantly differ between the intervention and control groups. 
• Furthermore, women in the intervention group had a significant increase in binge drinking.

class=”li-space”>

In another study, researchers in Scotland identified 215 inpatients in a general hospital who drank excessively but did not have alcohol dependence (according to written self-report). These inpatients were randomized to receive 20 minutes of self-efficacy counseling by an experienced mental-health nurse, a self-help booklet on sensible drinking, or usual care. Six months later, weekly drinking had significantly decreased in both intervention groups; the decreases were similar in both groups.

Comments:

Practice guidelines recommend that primary care clinicians conduct screening and brief counseling for their patients with nondependent heavy drinking. However, implementation is challenging, efficacy can be modest or nonexistent, and harm is possible, as suggested by the primary care study above.

Evidence for efficacy of brief in-hospital interventions has been mixed (particularly when patients with dependence, who compose a substantial proportion of screen-positive inpatients, are included). This latest trial in inpatients will not settle the question, but it does suggest that even written information can help, at least for drinkers without dependence.

Richard Saitz, MD, MPH

Reference:

Beich A, Gannik D, Saelan H, et al. Screening and brief intervention targeting risky drinkers in Danish general practice: a pragmatic controlled trial. Alcohol Alcohol. 2007; 42(6):593–603.

Holloway AS, Watson HE, Arthur AJ, et al. The effect of brief interventions on alcohol consumption among heavy drinkers in a general hospital setting. Addiction. 2007;102(11):1762–1770.