Systematic Review: No Evidence for Efficacy of Screening and Brief Intervention among Dependent and Heavy Drinkers

As screening for unhealthy alcohol use is more widely incorporated into primary-care settings, large numbers of patients with dependence and heavy drinking will be identified. Most studies of screening and brief intervention (SBI) in primary care have excluded such patients, limiting generalizability. This systematic review included randomized controlled trials of primary-care patients receiving in-person brief intervention, with unhealthy drinking detected by screening. Sixteen randomized controlled trials met inclusion criteria.

• Fourteen studies excluded patients with dependence or heavy alcohol use.

• The 2 remaining studies were small, single-site trials conducted in specific populations (1 in women and 1 in Mexican Americans). Neither found an association between SBI and improved drinking or addiction-severity outcomes.

Comments:

The most striking finding in this systematic review is the dearth of evidence examining the effect of BI on primary-care patients identified as having dependence or very heavy drinking. Although there are some methodologic limitations, including a single rater and reliance on prior systematic reviews to identify sources, results highlight the need to develop and test interventions, whether brief or more intensive, for patients with severe alcohol use disorders identified by screening in primary care.

Hillary Kunins, MD, MPH, MS

Reference:

Saitz R. Alcohol screening and brief intervention in primary care: absence of evidence for efficacy in people with dependence or very heavy drinking. Drug Alc Rev. 2010;29(6):631–640.