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Effectiveness of brief alcohol interventions in primary care populations
Abstract
BACKGROUND: Many trials reported that brief interventions are effective in reducing excessive drinking. However, some trials have been criticised for being clinically unrepresentative and unable to inform clinical practice. OBJECTIVES: To assess the effectiveness of brief intervention, delivered in general practice or based primary care, to reduce alcohol consumption SEARCH STRATEGY: We searched the Cochrane Drug and Alcohol Group specialised register (February 2006), MEDLINE (1966 to February 2006), EMBASE (1980 to February 2006), CINAHL (1982 to February 2006), PsycINFO (1840 to February 2006), Science Citation Index (1970 to February 2006), Social Science Citation Index (1970 to February 2006), Alcohol and Alcohol Problems Science Database (1972 to 2003), reference lists of articles. SELECTION CRITERIA: Randomised controlled trials, patients presenting to primary care not specifically for alcohol treatment; brief intervention of up to four sessions. DATA COLLECTION AND ANALYSIS: Two authors independently abstracted data and assessed trial quality. Random effects meta-analyses, sub-group, sensitivity analyses, and meta-regression were conducted. MAIN RESULTS: The meta-analysis included 21 RCTs (7,286 participants), showing that participants receiving brief intervention reduced their alcohol consumption compared to the control group (mean difference: -41 grams/week, 95% CI: -57 to -25), although there was substantial heterogeneity between trials (I2 = 52%). Sub-group analysis (8 studies, 2307 participants) confirmed the benefit of brief intervention in men (mean difference: -57 grams/week, 95% CI: -89 to -25, I2 = 56%), but not in women (mean difference: -10 grams/week, 95% CI: -48 to 29, I2 = 45%). Meta-regression showed a non-significant trend of an increased reduction in alcohol consumption of 1.1, 95%CI: -0.05 to 2.2 grams/week, p=0.06, for each extra minute of treatment exposure, but no relationship between the reduction in alcohol consumption and the efficacy score of the trial. Extended intervention when compared with brief intervention was associated with a non-significantly greater reduction in alcohol consumption (mean difference = -28, 95%CI: -62 to 6 grams/week, I2 = 0%) AUTHORS' CONCLUSIONS: Brief interventions consistently produced reductions in alcohol consumption. When data were available by gender, the effect was clear in men at one year of follow up, but unproven in women. Longer duration of counselling probably has little additional effect. The lack of differences in outcomes between efficacy and effectiveness trials suggests that the current literature had clear relevance to routine primary care. Future trials should focus on women and on delineating the most effective components of interventions.
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In the citing paper
“Screening and brief interventions are effective for reducing alcohol consumption in primary care patients in high-income countries (Kaner et al., 2007), including in young adults (Grossberg et al., 2004; Jonas et al., 2012).”
From Effectiveness of Nurse-Practitioner-Delivered Brief Motivational Intervention for Young Adult Alcohol and Drug Use in Primary Care in South Africa: A Randomized Clinical Trial (2014) · cites this paper as Kaner et al., 2007
In the citing paper
“Existing systematic reviews have found variability in effect by duration of intervention or number of visits, but this has not taken into account differences in content or provider.6–10”
In the citing paper
“The findings suggest that general practitioners may not be the most appropriate vehicle for delivering early intervention with at-risk drinkers.”
From Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice (2017) · cites this paper as [9]
In the citing paper
“Numbers needed to treat (NNT = 5) were comparable to those for face-to-face brief interventions in primary care settings [30].”
From Effectiveness of Guided and Unguided Low-Intensity Internet Interventions for Adult Alcohol Misuse: A Meta-Analysis (2014) · cites this paper as [30]
In the citing paper
“The latter include a Cochrane Collaboration systematic review of 29 primary care trials [30], which reported a significantly reduced weekly consumption of 38 grams at one-year follow-up (see also the study by Jonas and colleagues [15]).”
From Effectiveness of Guided and Unguided Low-Intensity Internet Interventions for Adult Alcohol Misuse: A Meta-Analysis (2014) · cites this paper as [30]
In the citing paper
“The reduction appears lower than those found in analyses of face-to-face brief interventions in primary care.”
From Effectiveness of Guided and Unguided Low-Intensity Internet Interventions for Adult Alcohol Misuse: A Meta-Analysis (2014) · cites this paper as [30]
In the citing paper
“Although the literature is somewhat inconclusive [75], it provides some confirmation for our current findings [30], [68], [76].”
From Effectiveness of Guided and Unguided Low-Intensity Internet Interventions for Adult Alcohol Misuse: A Meta-Analysis (2014) · cites this paper as [30]
In the citing paper
“The current overall effect also compares with meta-analyses of face-to-face primary care samples [3], [30], [67], [68] and of non-clinical samples performing postal self-help interventions based on bibliotherapy [69]–[71]. These studies all showed significant small to moderate effect sizes for curbing alcohol misuse.”
From Effectiveness of Guided and Unguided Low-Intensity Internet Interventions for Adult Alcohol Misuse: A Meta-Analysis (2014) · cites this paper as [30]
In the citing paper
“several studies on face-to-face alcohol interventions in primary care had reported that men were more likely to benefit than women [30], [67].”
From Effectiveness of Guided and Unguided Low-Intensity Internet Interventions for Adult Alcohol Misuse: A Meta-Analysis (2014) · cites this paper as [30]
In the citing paper
“Ample meta-analyses have shown face-to-face screening and brief interventions (SBIs) to be effective [5], particularly in primary care [6] and college settings [7].”
From Effectiveness of E-self-help interventions for curbing adult problem drinking: a meta-analysis (2011) · cites this paper as [6]
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Effectiveness of brief alcohol interventions in primary care populations
Kaner, E. F., Beyer, F. R., Muirhead, C., Campbell, F., Pienaar, E. D., Bertholet, N., Daeppen, J. B., Saunders, J. B., & Burnand, B. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004148.pub4 · Cited by 1,665
Self-citationGraham (2007) · doi:10.1097/01.hjr.0000277983.23934.c9 · Cited by 1,647
2016 European Guidelines on cardiovascular disease prevention in clinical practice
Authors/Task Force Members, Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., Cooney, M. T., Corrà, U., Cosyns, B., et al. (2016) · European Journal of Preventive Cardiology · doi:10.1177/2047487316653709 · Cited by 1,435
Metadata
- Authors
- Kaner, E. F. S., Dickinson, H. O., Beyer, F. R., Campbell, F., Schlesinger, C., Heather, N., Saunders, J. B., Burnand, B., & Pienaar, E. D.
- Affiliations
- Newcastle University (GB)
- University of Sheffield (GB)
- Prince Charles Hospital (AU)
- Northumbria University (GB)
- The University of Queensland (AU)
- Centre Hospitalier Universitaire Vaudois (CH)
- South African Medical Research Council (ZA)
- ORCID
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2007-04-18
- Issue
- 2
- Pages
- CD004148-CD004148
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- OpenAlex
- W3162772905
- Cited by
- 746
- References
- 89
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 9 · 2023: 9 · 2022: 15 · 2021: 21 · 2020: 27 · 2019: 39 · 2018: 55 · 2017: 65 · 2016: 64 · 2015: 77 · 2014: 56 · 2013: 56 · 2012: 74
- FWCI
- 4.74
- Type
- journal article
- Language
- en
- Update notices
- new_version (2018-02-24)
- Open access
- closed
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed (publishedVersion)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Keywords
- brief alcohol intervention, excessive drinking, alcohol consumption reduction, primary care, general practice, gender differences, trial heterogeneity, subgroup analysis, meta-regression, alcohol-related hospital admissions, alcohol-related accidents, alcohol-related crime
- MeSH terms
- Alcohol Drinking, Alcoholism, Emergencies, Family Practice, Humans, Randomized Controlled Trials as Topic
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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