Are Brief Alcohol Interventions Likely to be Effective in Routine Primary Care Practice?

A number of meta-analyses have demonstrated the modest efficacy of brief interventions (BI) for nondependent unhealthy alcohol use in primary care settings. Whether this level of efficacy can be expected when BIs are delivered outside of research studies in not known. This systematic review identified 22 randomized trials including over 5800 patients. Investigators classified the trials on a spectrum from tightly controlled (efficacy design) to real world (effectiveness design) studies. The scale considered whether patients presented to health care with a range of conditions, whether practices delivered a full range of medical services, whether practitioners routinely worked in the service rather than being funded by the trial, and whether the intervention could be delivered within standard visit times.

• Participants who received BI drank approximately 3 standard drinks per week less than those who did not.
• Longer duration of intervention was not significantly associated with a larger effect.
• The effect of BI on drinking was similar in studies regardless of whether they were tightly controlled or had more real world characteristics.

Comments by Michael Levy, PhD
This meta-analytic study showed the benefit of BI in reducing alcohol consumption in both controlled and real world primary care settings. It seems logical to assume similar results could be achieved in community treatment programs. Since BI in the studies reviewed was designed to achieve a reduction in alcohol consumption, treatment programs could consider implementing BI for patients who are not interested in achieving abstinence but who want to reduce their intake.