Addressing Risky Alcohol Use With Other Behavioral Risk Factors

Brief
counseling is efficacious for addressing individual behavioral
risk factors such as smoking and risky drinking. However, its
efficacy in addressing multiple risk factors in a patient
remains unclear. Researchers summarized 6 systematic reviews
(focused primarily on cardiovascular disease and diabetes interventions)
to examine the evidence for addressing multiple behavioral risk
factors, including risky alcohol use, in primary care settings.

• Of secondary prevention trials for hypertension, 1
  of 3 that targeted risky drinking led to a reduction
  in alcohol use; the only primary prevention study that
  was identified did not significantly affect use.

• One study
  of general practices in Britain tested nurse counseling and follow-up
  for smoking, diet, exercise, and alcohol consumption. The intervention
  lowered cholesterol, blood pressure, and body mass index but had
  no effect on smoking or risky alcohol use.

Comments:

As

any primary care physician can attest, most people have

more than one health risk behavior. While evidence supports

the use of interventions for individual risk factors, the

efficacy and value of using an integrated approach to address

multiple risk factors, including risky drinking, has yet

to be clearly demonstrated. Nonetheless, the authors of

this review suggest that, for now, primary care clinicians

should address multiple risks with brief behavioral counseling

(the 5A’s: Assess, Advise, Agree on goals, Assist in developing

a plan, Arrange follow-up); system supports such as computer-decision

tools; clinician reminders to screen or intervene; staff

training; multidisciplinary nurse-led teams; and referrals.

Richard
Saitz, MD, MPH

Reference:

Goldstein MG, Whitlock
EP, DePue J, et al. Multiple behavioral risk factor interventions
in primary care: summary of research evidence. Am J Prev Med.
2004;27(2S):61–79.
(view
abstract)