Are Brief Alcohol Interventions Likely to be Effective in Routine Primary Care Practice?

A number of meta-analyses have demonstrated the modest efficacy of brief intervention (BI) for nondependent unhealthy alcohol use in primary care settings. Whether this level of efficacy can be expected when BIs are delivered outside of research studies in not known. This systematic review identified 22 randomized trials including over 5800 patients. Investigators classified the trials on a spectrum from tightly controlled (efficacy design) to real world (effectiveness design) studies. The scale considered whether patients presented to health care with a range of conditions, whether practices delivered a full range of medical services, whether practitioners routinely worked in the service rather than being funded by the trial, and whether the intervention could be delivered within standard visit times.

• Participants who received BI drank 38 g of alcohol (i.e., approximately 3 standard drinks) per week less than those who did not.

• Longer duration of intervention was not significantly associated with a larger effect.

• The effect of BI on drinking was similar in studies regardless of whether they were tightly controlled or had more real world characteristics.

Comments:

This review confirms the efficacy of BI for nondependent unhealthy alcohol use in primary care. Although the findings are encouraging regarding the potential to see similar effects in routine practice, these research studies tend to provide training and materials to clinicians that are already willing and interested. Because the effects of BI are small, any decrease from what has been seen in trials could wipe out the benefits. As such, we should look to studies in practice-based research networks, other community settings, and other implementation programs to inform policy and practice as the service is disseminated.

Richard Saitz, MD, MPH

Reference:

Kaner EF, Dickinson HO, Beyer F, et al. The effectiveness of brief alcohol intervention in primary care settings: a systematic review. Drug Alcohol Rev. 2009; 28(3):301–323.