Counseling General Hospital Patients Reporting Heavy Alcohol Use: Single Brief Sessions Not Enough; More Not Clearly Better

Prior systematic reviews have identified mixed results regarding the efficacy of brief counseling interventions for heavy drinking in general hospital patients. The most recent Cochrane Review found brief interventions associated with short-term reductions in alcohol consumption, although effects disappeared when the methodologically weakest study was excluded from analysis, and the reviewers aggregated interventions of varying intensity. This review grouped studies by intervention intensity (number and duration of sessions) and strategy (face-to-face versus pamphlets), summarizing their impact on alcohol consumption and numerous secondary outcomes. Twenty-two randomized and non-randomized trials met the inclusion criteria for a total of 5307 patients in general hospitals internationally. The heterogeneity of trials precluded meta-analytic techniques. The authors found:

• When compared with usual care, the 12 studies of single-session interventions found largely no impact on alcohol consumption, while the 5 studies of 2–3 session interventions found some decreased alcohol consumption among people with “non-dependent” alcohol use.
• Three studies comparing a 2–3 session intervention with a single-session intervention (N=2), and another study comparing a longer versus shorter 2-session intervention did not find reduced alcohol consumption between groups.
• Two studies comparing a brief intervention with self-help literature found no difference in alcohol consumption.
• No studies found that counseling had any impact on other outcomes.

Comments:

On the one hand, trials comparing multiple intervention sessions to usual care were positive, suggesting that interventions of more than a single session may be effective among this population. On the other hand, the few trials that compared interventions of different intensities found no benefit for greater intensity. The question of how best to intervene with hospital inpatients who have heavy alcohol use remains open.

Hillary Kunins, MD, MPH

Reference:

Mdege ND, Fayter D, Watson JM, et al. Interventions for reducing alcohol consumption among general hospital inpatient heavy alcohol users: a systematic review. Drug Alcohol Depend. 2013;131(1–2):1–22.