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Evidence summaries

Brief Interventions for Heavy Alcohol Users

Brief interventions to heavy alcohol users appear to be effective for reduction in alcohol consumption admitted to primary care or general hospital wards. Brief interventions may be effective for reduction in death rates for male patients admitted to general hospital wards. Level of evidence: "B"

Comment: The quality of evidence is downgraded by study limitations (allocation concealment, sequence generation, incomplete outcome data).

Brief intervention is recommended for heavy alcohol users admitted to primary care or general hospital wards.

Summary

A Cochrane review [Abstract] 1 included 14 studies with a total of 4041 mainly male participants (16 years or older) admitted to general inpatient hospital care for any reason other than specifically for alcohol treatment. Patients receiving brief interventions (1 to 3 sessions) had a greater reduction in alcohol consumption compared to those in control groups at 6 month (MD in grams per week -69.43, 95% CI -128.14 to -10.72; 4 trials, n=453) and 9 months follow up (MD in grams per week -182.88, 95% CI -360.00 to -5.76; 1 trial, n=479) but this was not maintained at one year (MD in grams per week -33.62, 95% CI -82.27 to 15.03; 4 trials, n=1073). In addition there were significantly fewer deaths in the groups receiving brief interventions than in control groups at 6 months (RR 0.42, 95% CI 0.19 to 0.94; 4 trials, n=1166) and one year follow up (RR 0.60, 95% CI 0.40 to 0.91; 7 trials, n=2396). In one high-quality trial, heavy drinking episodes were decreased at 4, 9 and 12 months (MD -0.56, 95% CI -1.02 to -0.10; MD -0.78, 95% CI -1.32 to -0.24; MD -0.71, 95% CI -1.26 to -0.16 days per week respectively; n=616).

A Cochrane review [Abstract] 2 included 69 studies with a total of 33 642 subjects. Most interventions were delivered in general practice or emergency care settings. Participants receiving brief intervention reduced their alcohol consumption compared to the control group (mean difference: -20 grams/week, 95% CI -28.36 to -11.81 g/week; 34 trials, n=15 197). Sub-group analysis confirmed the benefit of brief intervention both in men and in women. Extended intervention when compared with brief intervention had no greater reduction in alcohol consumption although findings were imprecise (MD 2 g/week, 95% CI -42 to 45; 3 studies, n=552).

Secondary outcome data from a three-arm randomized controlled trial 3 with 6-, 12-, 18- and 24-month follow-ups included 960 patients (18-64 years) with at-risk alcohol use identified through systematic screening on 13 hospital wards. Self-reported number of sick days in the past 6 months was assessed at all time-points. In comparison to assessment only, in-person counselling (OR 2.18, p = 0.047) and computer-generated written feedback (OR = 2.08, p = 0.047) resulted in statistically significant increased odds of reporting no sick days 24 months later.

Clinical comments

Note

Date of latest search: 2 April 2018

    References

    • McQueen J, Howe TE, Allan L et al. Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database Syst Rev 2011;(8):CD005191. [PubMed]
    • Kaner EF, Beyer FR, Muirhead C et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018;(2):CD004148. [PubMed]
    • Freyer-Adam J, Baumann S, Bischof G et al. Sick days in general hospital patients two years after brief alcohol intervention: Secondary outcomes from a randomized controlled trial. Prev Med 2020;(139):106106. [PubMed]

Primary/Secondary Keywords