Do Primary Care-based Interventions Decrease Alcohol Use in Older Drinkers?

The benefit of alcohol brief intervention (BI) for older drinkers is uncertain. Prior research showed efficacy but defined at-risk drinking narrowly and did not take into account risk factors more common to older drinkers such as interaction with medications or comorbidities. In this study, researchers randomized 631 at-risk* drinkers aged ≥55 years to intervention (advice from a primary-care provider, personalized printed information, educational material, and telephone follow-up with a health educator at 2, 4, and 8 weeks) or to a control group (educational material only). Participants were primarily male, white, and well-educated. Self-reported baseline consumption averaged 15 drinks per week.

• At 3 months, intervention-group participants reported fewer drinks per week (8.9 versus 10.7) and were less likely to be at-risk drinkers (50% versus 61%) than controls. However, only fewer drinks per week (9.4 versus 10.7 drinks) remained significant at 12 months.

• Attrition rates were higher in the intervention group (21% at 3 months and 29% at 12 months) than in the control group (4% at 3 months and 7% at 12 months).

Comments:

The intervention may have decreased alcohol use, but given the significant difference in attrition, the observed benefit could also be the result of dropout by at-risk drinkers. Furthermore, the observation that drinking outcomes improved in both intervention and control groups at 3 and 12 months compared with baseline suggests a research-assessment effect, natural history, potential contamination at the study sites, and/or a stronger than expected effect from the educational materials given to controls. “Booster” follow-up sessions may need to extend beyond 8 weeks to maintain a positive effect in older drinkers.

Kevin L. Kraemer, MD, MSc

Reference:

Moore AA, Blow FC, Hoffing M, et al. Primary care-based intervention to reduce at-risk drinking in older adults: a randomized controlled trial. Addiction. 2011;106 (1):111–120.