Brief alcohol interventions questioned

By Caroline Price, Senior medwireNews Reporter

UK researchers report finding no extra benefit from giving patients in primary care brief advice or brief lifestyle counseling about alcohol misuse, as compared with simply offering written information.

Patients who received feedback and the brief advice or counseling after undergoing screening were no more likely, at either of two follow-up points, to self-report a reduction in hazardous or harmful drinking than those receiving leaflets.

"The current study strongly suggests that screening followed by simple feedback and written information may be the most appropriate strategy to reduce hazardous and harmful drinking in primary care," write Eileen Kaner (Newcastle University) and team in the BMJ.

Their study was conducted at primary care practices in the north east and south east of England, and London. Of 2991 patients screened using the fast alcohol screening test or Modified-Single Alcohol Screening Question, 900 (30.1%) were identified as hazardous or harmful drinkers; of these, 756 consented to take part in the trial.

All of the participants received feedback on screening and a patient information leaflet, and 250 (99%) of those allocated to each of the other interventions received the brief advice (5 minutes of structured advice from practice staff). However, only 143 (57%) patients allocated to the brief lifestyle counseling returned for the 20-minute counseling session, a condensed form of motivational interviewing.

At baseline, 611 (82%) participants scored 8 or higher, out of a total of 40, on the alcohol use disorders identification test (AUDIT; average score 12.7), indicating hazardous or harmful drinking.

At both 6 and 12 months of follow-up, there were no significant differences among the three groups in the proportion of patients achieving a score of 8 or lower (negative AUDIT).

At both follow-ups, however, patients receiving the brief lifestyle counseling were more likely to show a greater readiness to change than those in the leaflet group, and they also reported greater satisfaction in terms of general communication and the interpersonal manner of the clinician delivering the intervention.

The authors say that the significant "patient attrition" in the brief lifestyle counseling group supports giving feedback straight after screening, rather than delaying until a subsequent visit.

"Nevertheless, in patients who returned to a subsequent consultation for brief lifestyle counseling, there were significant positive changes in motivation to reduce drinking and in patient satisfaction levels," they write.

"Consequently, it is possible that whereas most hazardous and harmful drinkers in primary care require minimal input after screening, there may be a group of patients who would value and benefit from additional support."

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