Brief Interventions in Doctor’s Offices Can Reduce Drinking by One Day Per Month.
Brief Interventions in Doctor’s Offices Can Reduce Drinking by One Day Per Month
Conversations under 30 minutes between patients and their doctors in general practice settings can lead to small, beneficial reductions in alcohol consumption.
Brief interventions (BIs)—short, structured, one-on-one conversations delivered in medical settings to motivate patients to change risky behaviors—are one of few strategies that healthcare workers currently rely upon to reduce alcohol and drug use.
A new systematic review and analysis co-authored by a School of Public Health researcher has found that alcohol-targeted BIs can produce small but useful reductions in drinking when delivered in doctor’s offices and similar medical settings, versus an emergency department or other trauma center settings.
Published in the journal Addiction, the comprehensive review synthesized findings from 116 trials administered since 1990 with 64,439 total participants to estimate the effectiveness of BIs for alcohol and other drug use delivered in general medical settings. The review confirmed previous research that indicated alcohol-targeted BIs yielded small beneficial effects on alcohol use; specifically, a reduction from 11.6 to 10.7 drinking days per month, or the equivalent of one drinking day per month.
However, the researchers found no evidence of an effect on the consequences of drinking, and only limited evidence on the effects of drug-targeted BIs on drug use. They found no effect on the use of cannabis.
The small benefits from alcohol-targeted BIs in primary care settings may result from differences in expectations, familiarity, and trust between patients and their doctors, says study senior author Richard Saitz, professor of community health sciences at SPH, and professor of medicine at the School of Medicine.
“Part of the way these interventions work are by establishing or having a relationship with the patient that includes empathy,” Saitz says. “In general practice and primary care settings, patients have or will have a longitudinal relationship with a clinician who is responsible for long-term health, distinguished from someone the patient just met and may never see again.”
The most common intervention components reported in the analysis were personal feedback, prescriptive advice, information booklets, and goal-setting exercises. Each session lasted an average of 26 minutes, with a behavioral specialist, primary care doctor, or a doctor other than the patient’s primary care physician.
“A reduction of one drinking day per month may not sound like much, but small individual reductions can add up to a substantial reduction in population level harms,” says study lead author Emily Tanner-Smith, Thomson Professor in the College of Education at the University of Oregon. “Given their brevity, low cost, and minimal clinician effort, brief interventions may be a promising way to reduce alcohol use, one patient at a time.”
Saitz cautions, however, that a population health benefit from BIs is still “speculative, because it assumes that enough people will receive these interventions in general practice settings.
“After 50 years of clinical trials and about 30 years of recommendations for these interventions, they are not being done well or widely,” Saitz says. “I think it is very likely that to see true population health benefits, we will need strategies outside those that can be implemented in doctor’s offices—such as those related to marketing, taxes, advertising and cultural norm shifting.”
BIs do remain promising as a potentially effective strategy to reduce youth alcohol consumption, he says, because adolescents have not yet developed long-established health behaviors. They also routinely see clinicians for school-related exams and immunizations, so there is already an opportunity for most youth to receive BIs at a critical stage of development.
“Adolescence, and soon after, is also a period when drinking increases and coincides with behaviors that risk serious injury and with mental health challenges,” Saitz says. “Taking alcohol out of the equation or moderating it could save young lives.”
The study was co-authored by Nicholas Parr of the US Department of Veterans Affairs Evidence Synthesis Program Coordinating Center, and Maria Schweer-Collins of the Counseling Psychology and Human Services Department at the University of Oregon at the time of the study.