Alcohol Screening and Brief Intervention Not Effective in Clinical Practice

Randomized controlled-efficacy trials consistently find modest favorable effects of brief intervention (BI) for nondependent unhealthy alcohol use identified by screening in primary care settings. Whether those effects are retained when translated into clinical practice is unknown. Investigators randomly assigned 24 primary care practices to implement screening for unhealthy alcohol use (universal or selective, two different tools) and then either a patient information brochure, 5 minutes of brief advice (by practice staff trained by the researchers), or 20 minutes of health behavior change counseling during a subsequent appointment with an alcohol counselor trained to competence.

• Practices were paid £3000 plus additional compensation for each screening and each intervention. Five practices did not recruit the requisite 31 patients and were replaced; 5 practices were reassigned to one of the more intensive interventions after completing initial recruitment targets. Due to slow recruitment, research staff accomplished the screening and BI in 10 of the practices.

• Of 756 patients enrolled, 81% had 6-month outcome data; only 57% of those assigned to counseling received it.

• The odds of having an Alcohol Use Disorders Identification Test score of <8 (i.e., no unhealthy use) were lower, though not significantly different for advice (odds ratio [OR], 0.85) and counseling (OR, 0.78), versus information only. Intention-to-treat and per-protocol analyses yielded similar results. 

Comments:

This large study has clear results: screening and BI were both challenging to implement (apparently impossible in many cases, despite substantial efforts) and ineffective in primary care practices. These findings should be carefully considered by those involved in major implementation efforts worldwide and serve as a reality check for physicians working to implement alcohol screening and BI in their practices.

Richard Saitz, MD, MPH

Reference:

Kaner E, Bland M, Cassidy P, et al. Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial. BMJ 2013;346:e8501.