Brief physician interventions have impact on problem drinking

Newswise — Five minutes of straight talk between doctors and problem drinkers could help reduce the toll of alcohol-related injuries, violence and accidents.

Doctors have long questioned whether a single, short discussion with patients about their drinking could have significant effects on alcohol-related problems, despite dozens of studies supporting such “brief interventions.” However, a new review should lay those doubts to rest.

Results showed that brief interventions reduced alcohol consumption by an average of four drinks per week. The study included 21 randomized controlled trials with 7,286 participants.

“The study confirms that relatively short and simple interventions can be quite significant in terms of reducing drinking in the general population,” said lead review author Eileen Kaner, Ph.D., a senior lecturer in public health at Newcastle University in England.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Although many physicians have dismissed brief interventions as applicable only to artificial research settings, Kaner found that “the studies in general are biased towards real practice” and there was no difference in the strength of the effects for studies conducted in research settings compared to those done in primary care doctors’ offices or emergency rooms.

“These interventions, often as brief as five minutes, are very effective in a larger population sense at reducing alcohol consumption and are easily accomplished even within a busy primary care practice,” said Fred Rotgers, Psy.D., associate professor of psychology at the Philadelphia College of Osteopathic Medicine.

Brief interventions target patients whose drinking has been found to be above safe levels — either because they have disclosed this on screening forms or because a test or injury has revealed possible alcohol-related problems.

During interventions, doctors tell patients about the harms associated with heavy drinking and the personal risk they face. They talk about specific amounts of alcohol and describe what low-risk drinking really means. They note the benefits of cutting back — as well as strategies for reducing consumption. They keep their tone nonjudgmental and matter-of-fact.

While some of the studies included more than one session, more sessions were not associated with significantly greater reductions in drinking.

Although most treatment resources target alcoholics specifically, the vast majority of alcohol-related harms such as injuries or accidents involve people who drink heavily but who are not alcoholics, such as underage binge drinkers. The development of brief interventions acknowledges and addresses this much larger group of drinkers.

Rotgers said that most people who receive these interventions are not even aware that their drinking is harmful, so they are not highly motivated to change before the conversation with their health care provider.

“Less-dependent drinkers are more likely to benefit, but more severely dependent drinkers, especially those not yet aware of the medical impact of their drinking, will also benefit,” Rotgers said.

He said that many heavy drinkers — even alcoholics — quit drinking without treatment when they become aware that it is harmful, so brief interventions could help catch drinking problems early and prevent them from becoming more severe.

Although there was no statistically significant difference in the results for men and women, women are the subjects of fewer studies and therefore the review could not confirm that brief interventions are effective for women.

Previous research has shown that women are more likely to drink heavily to self-medicate psychiatric conditions like depression than men are, so it is possible that brief interventions will not work if they do not occur in conjunction with treatment for these other disorders. “Brief interventions focus completely on drinking, and thus may miss the root cause of alcohol use for women.” Rotgers said.

“There is really no reason for doctors not to act on this now, especially with men,” Kaner said.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

Kaner EFS, et al. Effectiveness of brief alcohol interventions in primary care populations (Review). The Cochrane Database of Systematic Reviews 2007, Issue 2.