Efficacy of Brief Intervention for Heavy Drinking in Hospitalized Patients Questionable

Brief intervention (BI) is being widely advocated for addressing heavy alcohol use among general hospital patients. To determine whether BI improves outcomes for such patients, researchers performed a systematic review of controlled trials. Eleven studies with 2441 participants were identified. Five studies took place on general medical wards, 3 in trauma centers, 2 in a variety of settings, and 1 in an orthopedic/trauma center. Most studies tested 1 intervention session, 2 studies involved 2 sessions, and 1 study involved 3 sessions.

• Intervention was associated with self-report of less weekly alcohol consumption in the 3 studies that examined 6-month outcomes. But, results were heterogeneous and nonsignificant when 1 of the studies, which tested 3 sessions and had nonblinded outcome assessments, was excluded.

• No studies found differences in consumption between BI patients and controls at 1 year.

• Among the studies presenting change score data on mean alcohol consumption per week, decreases in weekly drinking were greater among BI patients than controls at 12 months (assessed in 2 studies) but not at 6 months (assessed in 2 studies).

• No studies found significant differences between BI patients and controls for laboratory markers, heavy drinking episodes, driving offenses, or death.

Comments:

In hospitals, the severity of heavy alcohol use is greater than that seen in outpatient primary care settings, and patient-provider relationships are not usually longitudinal. This context differs greatly from primary care settings where BI has proven efficacy. This review suggests some promise for BI in hospital settings but raises serious questions about whether it will have substantial efficacy. Such evidence should be seriously considered when deciding whether additional treatment services should be coupled with alcohol screening and BI in general hospitals.

Richard Saitz MD, MPH

Reference:

McQueen J, Howe TE, Allan L, et al. Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database Syst Rev. 2009;3:CD005191.