Telephone-based Stepped Care for Unhealthy Alcohol Use
Telephone-based, stepped care strategies have the potential to improve delivery of alcohol interventions in primary care settings. In a controlled trial, researchers randomized 408 primary care patients with at-risk drinking,* heavy drinking,** alcohol abuse, and alcohol dependence to full care (computerized feedback plus four 30-minute telephone interventions), stepped care (computerized feedback plus up to three 40-minute telephone interventions, depending on response), or a control group (no alcohol intervention). Telephone interventions were based on motivational interviewing and delivered by trained psychologists.
- The baseline ranges of unhealthy alcohol use levels among the 3 arms were as follows:
- at-risk drinking, 21–33%
- heavy drinking, 24– 30%
- alcohol abuse, 12–17%
- alcohol dependence, 26–38%
- Compared with controls, participants in the intervention groups (full care and stepped care combined) reported a greater decrease in grams of alcohol per day from baseline to 12 months (-12.6 versus -6.3 in the overall sample; -17.9 versus -3.7 in the alcohol abuse/at-risk drinking subgroup) and a lower proportion of binge drinking at 12 months (25% versus 41%) in the alcohol abuse/at-risk drinking subgroup.
- Outcomes did not differ between the control and intervention groups for subjects with alcohol dependence or heavy drinking.
- Outcomes were similar in the full care and stepped care groups.The stepped care group received 50% of the counseling time (40 versus 80 minutes) received by the full care group.
*average use of >30 grams of alcohol (about 3 drinks) per day for men and >20 grams of alcohol (about 2 drinks) per day for women over the past 4 weeks.
**average use of >80 grams of alcohol (about 8 drinks) for men and >60 grams of alcohol (about 6 drinks) for women on 2 or more occasions over the past 4 weeks.
Comments:
These findings suggest a combination of computerized feedback and telephone-based interventions has the potential to decrease alcohol use in primary care patients. “As-needed” telephone intervention sessions appear to be as effective as “fixed” doses of telephone counseling for patients with alcohol abuse/at-risk drinking, but neither was effective for alcohol dependence and heavy drinking. It is not known how this type of intervention would fare in a direct comparison with face-to-face briefer interventions, which can be effective for nondependent at-risk drinking.
Kevin L. Kraemer, MD, MSc
Reference:
Bischof G, Grothues JM, Reinhardt S, et al. Evaluation of a telephone-based stepped care intervention for alcohol-related disorders: a randomized controlled trial. Drug Alcohol Depend. 2008;93(3):244–251.