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Cited by 168Substance Abuse Treatment and OutcomesAlcohol Consumption and Health EffectsHealth Policy Implementation Science

Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials: SBI and referral to treatment

Open access
Glass, Joseph E., Hamilton, Ashley M., Powell, Byron J., Perron, Brian E., Brown, Randall T., Ilgen, Mark A.·2015·Addiction
DOI 10.1111/add.12950PMC PMC4753046
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Abstract

BACKGROUND AND AIMS: Brief alcohol interventions in medical settings are efficacious in improving self-reported alcohol consumption among those with low-severity alcohol problems. Screening, Brief Intervention and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated. We estimated main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral-specific component, in increasing the utilization of alcohol-related care. METHODS: A systematic review of English language papers published in electronic databases to 2013. We included randomized controlled trials (RCTs) of brief alcohol interventions in general health-care settings with adult and adolescent samples. We excluded studies that lacked alcohol services utilization data. Extractions of study characteristics and outcomes were standardized and conducted independently. The primary outcome was post-treatment alcohol services utilization assessed by self-report or administrative data, which we compared across intervention and control groups. RESULTS: Thirteen RCTs met inclusion criteria and nine were meta-analyzed (n = 993 and n = 937 intervention and control group participants, respectively). In our main analyses the pooled risk ratio (RR) was = 1.08, 95% confidence interval (CI) = 0.92-1.28. Five studies compared referral-specific interventions with a control condition without such interventions (pooled RR = 1.08, 95% CI = 0.81-1.43). Other subgroup analyses of studies with common characteristics (e.g. age, setting, severity, risk of bias) yielded non-statistically significant results. CONCLUSIONS: There is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol-related services.

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Registry

Crossref · 10.1111/add.12950

Cites

83 of 83 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 138 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Subgroup analyses that pooled trials by age, setting, severity, and treatment intensity produced risk ratios that were not statistically significant.

    “Other subgroup analyses of studies with common characteristics (e.g., age, setting, severity, risk of bias) yielded non-statistically significant results.”
    • Also stated in: § Meta-analysis · plain
      “Other subgroup analyses, which pooled results of multiple studies with similar characteristics (i.e., by age, setting, severity, and treatment intensity), also yielded non-statistically significant risk ratios”
    Quote in the paperNot a substantial claim
  • Findingown data

    Removing trials with risk of bias in more than two areas did not change the findings.

    “Excluding studies that had a risk of bias in more than two areas of risk did not alter the results.”
    Quote in the paperNot a substantial claim
  • Findingown data

    No included trial analyzed the association between treatment use and clinical outcomes.

    “Although rates of specialty treatment utilization following brief intervention ranged from 2–56%, no studies analyzed an association between treatment utilization and clinical outcomes.”
    Quote in the paperSubstantial claim
  • Findingown data

    Only two trials measured self-reported alcohol treatment use with validated instruments.

    “just two studies assessed self-reports of alcohol treatment utilization with validated instruments (33,58).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [33] Saitz, 2007, Brief intervention for medical inpatients with unhealthy alcohol use: a randomized, controlled trial, Ann Intern Med source

      Not checked in the free run.

    • cites [58] Field, 2010, The effectiveness of brief intervention among injured patients with alcohol dependence: who benefits from brief interventions?, Drug Alcohol Depend source

      Not checked in the free run.

  • Findingown data

    Specialty treatment use after brief intervention ranged from 2% to 56%.

    “Although rates of specialty treatment utilization following brief intervention ranged from 2–56%, no studies analyzed an association between treatment utilization and clinical outcomes.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 22
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 21

  • May combine two claims.

    Findingown data

    Across nine trials with 993 intervention and 937 control participants, brief intervention was not significantly linked to later alcohol treatment initiation; the random-effects pooled risk ratio was 1.08 (95% CI 0.92-1.28).

    “In these nine studies, there were n = 993 and n = 937 intervention and control group participants, respectively. Receipt of brief intervention was not significantly associated with subsequent alcohol treatment initiation. The random-effects pooled risk ratio was RR=1.08 (95% CI=0.92–1.28)”
    • Also stated in: § Results · plain
      “In our main analyses the pooled risk ratio was RR=1.08 (95% CI=0.92–1.28).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In five trials that compared referral-specific interventions with a control condition lacking such interventions, the pooled risk ratio was 1.08 (95% CI 0.81-1.43), a non-significant result.

    “Five studies compared referral-specific interventions with a control condition without such interventions (pooled RR=1.08, 95% CI=0.81–1.43).”
    • Also stated in: § Meta-analysis · plain
      “Pooled results of studies that isolated referral to treatment to one study arm (n = 5) did not achieve statistical significance (RR=1.08, 95% CI=0.81–1.43).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Adding back the trial with high risk of bias in four of six domains, the only trial with a significant effect, did not change the findings; the pooled result for all 10 trials was 1.22 (95% CI 0.94-1.58).

    “Moreover, we note that including the study with a risk of bias in four of six domains, which was the only study that achieved statistical significance, also did not alter the results (e.g., pooled results for all 10 studies was RR=1.22, 95% CI=0.94–1.58).”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingcitation

    Many included trials described referral processes poorly or only gave participants lists of local alcohol treatment agencies.

    “many of the identified studies were limited in their description of referral processes (56–58,64,65)”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [56] Copeland, 2003, Health care utilization by older alcohol-using veterans: effects of a brief intervention to reduce at-risk drinking, Health Educ Behav source

      Not checked in the free run.

    • cites [57] Wutzke, 2002, The long-term effectiveness of brief interventions for unsafe alcohol consumption: a 10-year follow-up, Addiction source

      Not checked in the free run.

    • cites [58] Field, 2010, The effectiveness of brief intervention among injured patients with alcohol dependence: who benefits from brief interventions?, Drug Alcohol Depend source

      Not checked in the free run.

    • cites [64] Monti, 2007, Motivational interviewing versus feedback only in emergency care for young adult problem drinking, Addiction source

      Not checked in the free run.

    • cites [65] Monti, 1999, Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department, J Consult Clin Psychol source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In 11 of 13 trials, treatment use meant receiving at least one specialty addiction treatment session; the other two trials counted specialty addiction treatment visits.

    “In 11 of 13 studies, the presence of treatment utilization was defined as receiving one or more sessions of specialty addiction treatment (33,54,55,58–65), whereas the remaining two studies analyzed counts of specialty addiction treatment visits (56,57).”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [33] Saitz, 2007, Brief intervention for medical inpatients with unhealthy alcohol use: a randomized, controlled trial, Ann Intern Med source

      Not checked in the free run.

    • cites [54] Kuchipudi, 1990, Failure of a 2-hour motivational intervention to alter recurrent drinking behavior in alcoholics with gastrointestinal disease, J Stud Alcohol source

      Not checked in the free run.

    • cites [55] Bischof, 2008, Evaluation of a telephone-based stepped care intervention for alcohol-related disorders: a randomized controlled trial, Drug Alcohol Depend source

      Not checked in the free run.

    • cites [58] Field, 2010, The effectiveness of brief intervention among injured patients with alcohol dependence: who benefits from brief interventions?, Drug Alcohol Depend source

      Not checked in the free run.

    • cites [59] Cherpitel, 2010, Screening, brief intervention, and referral to treatment (SBIRT): 12-month outcomes of a randomized controlled clinical trial in a Polish emergency department, Alcohol Clin Exp Res source

      Not checked in the free run.

    • cites [60] Batel, 1995, Prompting alcoholics to be referred to an alcohol clinic: the effectiveness of a simple letter, Addiction source

      Not checked in the free run.

    • cites [61] Bernstein, 2010, A brief motivational interview in a pediatric emergency department, plus 10-day telephone follow-up, increases attempts to quit drinking among youth and young adults who screen positive for problematic drinking, Acad Emerg Med source

      Not checked in the free run.

    • cites [62] Gentilello, 1999, Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence, Ann Surg source

      Not checked in the free run.

    • cites [63] Crawford, 2004, Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial, Lancet source

      Not checked in the free run.

    • cites [64] Monti, 2007, Motivational interviewing versus feedback only in emergency care for young adult problem drinking, Addiction source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Trials in inpatient settings or with high-severity samples tended to have the highest post-intervention alcohol treatment use, with 18.9-56.1% of intervention participants receiving treatment.

    “Studies conducted in inpatient settings and/or with high severity samples tended to have the highest rates of post-intervention alcohol treatment utilization (18.9–56.1% in the intervention groups obtained alcohol treatment) (33,54,55).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [33] Saitz, 2007, Brief intervention for medical inpatients with unhealthy alcohol use: a randomized, controlled trial, Ann Intern Med source

      Not checked in the free run.

    • cites [54] Kuchipudi, 1990, Failure of a 2-hour motivational intervention to alter recurrent drinking behavior in alcoholics with gastrointestinal disease, J Stud Alcohol source

      Not checked in the free run.

    • cites [55] Bischof, 2008, Evaluation of a telephone-based stepped care intervention for alcohol-related disorders: a randomized controlled trial, Drug Alcohol Depend source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    There were not enough data, and no identified trials, to meta-analyze whether referral to treatment improved alcohol-related outcomes.

    “There were insufficient data (i.e., no identified studies) to meta-analyze whether or not alcohol-related outcomes improved as a result of referral to treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Trials in emergency departments or with mixed-severity samples had lower post-intervention alcohol treatment use, with 1.9-32.8% of intervention participants receiving treatment.

    “In comparison, studies conducted in emergency departments and/or with mixed severity samples had a lower range of post-intervention alcohol treatment utilization (1.9–32.8% in the intervention groups obtained alcohol treatment) (59–63,66).”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [59] Cherpitel, 2010, Screening, brief intervention, and referral to treatment (SBIRT): 12-month outcomes of a randomized controlled clinical trial in a Polish emergency department, Alcohol Clin Exp Res source

      Not checked in the free run.

    • cites [60] Batel, 1995, Prompting alcoholics to be referred to an alcohol clinic: the effectiveness of a simple letter, Addiction source

      Not checked in the free run.

    • cites [61] Bernstein, 2010, A brief motivational interview in a pediatric emergency department, plus 10-day telephone follow-up, increases attempts to quit drinking among youth and young adults who screen positive for problematic drinking, Acad Emerg Med source

      Not checked in the free run.

    • cites [62] Gentilello, 1999, Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence, Ann Surg source

      Not checked in the free run.

    • cites [63] Crawford, 2004, Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial, Lancet source

      Not checked in the free run.

    • cites [66] Barnett, 2007, Efficacy of counselor vs. computer-delivered intervention with mandated college students, Addict Behav source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Interventions took place in medical inpatient units, general healthcare settings, and emergency departments.

    “Interventions were delivered in medical inpatient units (33,54), general healthcare settings (55–57), and emergency departments (see Table 1) (58–65).”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [33] Saitz, 2007, Brief intervention for medical inpatients with unhealthy alcohol use: a randomized, controlled trial, Ann Intern Med source

      Not checked in the free run.

    • cites [54] Kuchipudi, 1990, Failure of a 2-hour motivational intervention to alter recurrent drinking behavior in alcoholics with gastrointestinal disease, J Stud Alcohol source

      Not checked in the free run.

    • cites [55] Bischof, 2008, Evaluation of a telephone-based stepped care intervention for alcohol-related disorders: a randomized controlled trial, Drug Alcohol Depend source

      Not checked in the free run.

    • cites [56] Copeland, 2003, Health care utilization by older alcohol-using veterans: effects of a brief intervention to reduce at-risk drinking, Health Educ Behav source

      Not checked in the free run.

    • cites [57] Wutzke, 2002, The long-term effectiveness of brief interventions for unsafe alcohol consumption: a 10-year follow-up, Addiction source

      Not checked in the free run.

    • cites [58] Field, 2010, The effectiveness of brief intervention among injured patients with alcohol dependence: who benefits from brief interventions?, Drug Alcohol Depend source

      Not checked in the free run.

    • cites [59] Cherpitel, 2010, Screening, brief intervention, and referral to treatment (SBIRT): 12-month outcomes of a randomized controlled clinical trial in a Polish emergency department, Alcohol Clin Exp Res source

      Not checked in the free run.

    • cites [60] Batel, 1995, Prompting alcoholics to be referred to an alcohol clinic: the effectiveness of a simple letter, Addiction source

      Not checked in the free run.

    • cites [61] Bernstein, 2010, A brief motivational interview in a pediatric emergency department, plus 10-day telephone follow-up, increases attempts to quit drinking among youth and young adults who screen positive for problematic drinking, Acad Emerg Med source

      Not checked in the free run.

    • cites [62] Gentilello, 1999, Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence, Ann Surg source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Follow-up lasted from three to 18 months, except for one trial with a 10-year follow-up.

    “Follow-up periods ranged from three to 18 months, except for one study (57) that had a 10-year follow-up.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] Wutzke, 2002, The long-term effectiveness of brief interventions for unsafe alcohol consumption: a 10-year follow-up, Addiction source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    All trials discussed randomization, but only one reported off-site assignment or sequential assignment of sealed opaque cards to conceal randomization.

    “Although all studies discussed aspects of randomization, just one reported off-site assignment (33) or sequential assignment of sealed opaque cards to ensure concealment of randomization.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Saitz, 2007, Brief intervention for medical inpatients with unhealthy alcohol use: a randomized, controlled trial, Ann Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The trial with high risk of bias in four of six domains was also the only trial with significant effects on treatment use.

    “The study that had a high risk of bias in four of six domains was also the only study that found significant effects on treatment utilization (60).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [60] Batel, 1995, Prompting alcoholics to be referred to an alcohol clinic: the effectiveness of a simple letter, Addiction source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Four trials used treatment agency or state administrative records to measure treatment use, while the remaining trials used self-report.

    “Four studies used treatment agency or state administrative data to assess treatment utilization (54,56,60,61) and the rest used self-report.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [54] Kuchipudi, 1990, Failure of a 2-hour motivational intervention to alter recurrent drinking behavior in alcoholics with gastrointestinal disease, J Stud Alcohol source

      Not checked in the free run.

    • cites [56] Copeland, 2003, Health care utilization by older alcohol-using veterans: effects of a brief intervention to reduce at-risk drinking, Health Educ Behav source

      Not checked in the free run.

    • cites [60] Batel, 1995, Prompting alcoholics to be referred to an alcohol clinic: the effectiveness of a simple letter, Addiction source

      Not checked in the free run.

    • cites [61] Bernstein, 2010, A brief motivational interview in a pediatric emergency department, plus 10-day telephone follow-up, increases attempts to quit drinking among youth and young adults who screen positive for problematic drinking, Acad Emerg Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Four trials were conducted outside the United States, in France, Germany, Poland, and Australia.

    “Four RCTs were conducted outside of the United States, including France, Germany, Poland, and Australia (55,57,59,60).”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [55] Bischof, 2008, Evaluation of a telephone-based stepped care intervention for alcohol-related disorders: a randomized controlled trial, Drug Alcohol Depend source

      Not checked in the free run.

    • cites [57] Wutzke, 2002, The long-term effectiveness of brief interventions for unsafe alcohol consumption: a 10-year follow-up, Addiction source

      Not checked in the free run.

    • cites [59] Cherpitel, 2010, Screening, brief intervention, and referral to treatment (SBIRT): 12-month outcomes of a randomized controlled clinical trial in a Polish emergency department, Alcohol Clin Exp Res source

      Not checked in the free run.

    • cites [60] Batel, 1995, Prompting alcoholics to be referred to an alcohol clinic: the effectiveness of a simple letter, Addiction source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Six of the eight trials with referral-specific efforts kept those efforts in the intervention group only, while two gave the same information to the control group.

    “In total, six of the eight studies with referral-specific efforts isolated these referral-specific efforts to the intervention group (54,59–63). The other two of studies only provided information about treatment options as the referral-specific effort, but provided the same information to the control group (64,65).”
    Quote in the paperNot a substantial claim0 of 8 sources checked
    • cites [54] Kuchipudi, 1990, Failure of a 2-hour motivational intervention to alter recurrent drinking behavior in alcoholics with gastrointestinal disease, J Stud Alcohol source

      Not checked in the free run.

    • cites [59] Cherpitel, 2010, Screening, brief intervention, and referral to treatment (SBIRT): 12-month outcomes of a randomized controlled clinical trial in a Polish emergency department, Alcohol Clin Exp Res source

      Not checked in the free run.

    • cites [60] Batel, 1995, Prompting alcoholics to be referred to an alcohol clinic: the effectiveness of a simple letter, Addiction source

      Not checked in the free run.

    • cites [61] Bernstein, 2010, A brief motivational interview in a pediatric emergency department, plus 10-day telephone follow-up, increases attempts to quit drinking among youth and young adults who screen positive for problematic drinking, Acad Emerg Med source

      Not checked in the free run.

    • cites [62] Gentilello, 1999, Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence, Ann Surg source

      Not checked in the free run.

    • cites [63] Crawford, 2004, Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial, Lancet source

      Not checked in the free run.

    • cites [64] Monti, 2007, Motivational interviewing versus feedback only in emergency care for young adult problem drinking, Addiction source

      Not checked in the free run.

    • cites [65] Monti, 1999, Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department, J Consult Clin Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Most interventions used brief advice or a motivational interview; some added counseling or booster sessions; one had no in-person contact and mailed a letter asking participants to book an appointment with a specialist.

    “The majority of interventions involved brief advice or a motivational interview (33,54,58,59,61,62,64–66), several offered additional counseling or booster intervention sessions (55,57,61,66), and one intervention had no in-person contact and simply mailed a letter to participants requesting they make an appointment with a specialist (60).”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [33] Saitz, 2007, Brief intervention for medical inpatients with unhealthy alcohol use: a randomized, controlled trial, Ann Intern Med source

      Not checked in the free run.

    • cites [54] Kuchipudi, 1990, Failure of a 2-hour motivational intervention to alter recurrent drinking behavior in alcoholics with gastrointestinal disease, J Stud Alcohol source

      Not checked in the free run.

    • cites [58] Field, 2010, The effectiveness of brief intervention among injured patients with alcohol dependence: who benefits from brief interventions?, Drug Alcohol Depend source

      Not checked in the free run.

    • cites [59] Cherpitel, 2010, Screening, brief intervention, and referral to treatment (SBIRT): 12-month outcomes of a randomized controlled clinical trial in a Polish emergency department, Alcohol Clin Exp Res source

      Not checked in the free run.

    • cites [61] Bernstein, 2010, A brief motivational interview in a pediatric emergency department, plus 10-day telephone follow-up, increases attempts to quit drinking among youth and young adults who screen positive for problematic drinking, Acad Emerg Med source

      Not checked in the free run.

    • cites [62] Gentilello, 1999, Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence, Ann Surg source

      Not checked in the free run.

    • cites [64] Monti, 2007, Motivational interviewing versus feedback only in emergency care for young adult problem drinking, Addiction source

      Not checked in the free run.

    • cites [65] Monti, 1999, Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department, J Consult Clin Psychol source

      Not checked in the free run.

    • cites [66] Barnett, 2007, Efficacy of counselor vs. computer-delivered intervention with mandated college students, Addict Behav source

      Not checked in the free run.

    • cites [55] Bischof, 2008, Evaluation of a telephone-based stepped care intervention for alcohol-related disorders: a randomized controlled trial, Drug Alcohol Depend source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    All eight trials with a referral-specific intervention gave information about community alcohol treatment options, and three described more active efforts to encourage help seeking.

    “All of these eight studies provided information about alcohol treatment options in the community (54,59–65), and three of them described more active efforts to encourage help seeking.”
    Quote in the paperNot a substantial claim0 of 8 sources checked
    • cites [54] Kuchipudi, 1990, Failure of a 2-hour motivational intervention to alter recurrent drinking behavior in alcoholics with gastrointestinal disease, J Stud Alcohol source

      Not checked in the free run.

    • cites [59] Cherpitel, 2010, Screening, brief intervention, and referral to treatment (SBIRT): 12-month outcomes of a randomized controlled clinical trial in a Polish emergency department, Alcohol Clin Exp Res source

      Not checked in the free run.

    • cites [60] Batel, 1995, Prompting alcoholics to be referred to an alcohol clinic: the effectiveness of a simple letter, Addiction source

      Not checked in the free run.

    • cites [61] Bernstein, 2010, A brief motivational interview in a pediatric emergency department, plus 10-day telephone follow-up, increases attempts to quit drinking among youth and young adults who screen positive for problematic drinking, Acad Emerg Med source

      Not checked in the free run.

    • cites [62] Gentilello, 1999, Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence, Ann Surg source

      Not checked in the free run.

    • cites [63] Crawford, 2004, Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial, Lancet source

      Not checked in the free run.

    • cites [64] Monti, 2007, Motivational interviewing versus feedback only in emergency care for young adult problem drinking, Addiction source

      Not checked in the free run.

    • cites [65] Monti, 1999, Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department, J Consult Clin Psychol source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Five of the 13 trials did not describe any referral-specific process in the intervention group, while the other eight described a referral-specific intervention.

    “Although all studies conducted efforts that could potentially inspire help seeking (e.g., motivational sessions), five of the thirteen studies did not articulate any referral-specific processes in the intervention group (33,55–58) and the remaining eight studies described a referral-specific intervention.”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [33] Saitz, 2007, Brief intervention for medical inpatients with unhealthy alcohol use: a randomized, controlled trial, Ann Intern Med source

      Not checked in the free run.

    • cites [55] Bischof, 2008, Evaluation of a telephone-based stepped care intervention for alcohol-related disorders: a randomized controlled trial, Drug Alcohol Depend source

      Not checked in the free run.

    • cites [56] Copeland, 2003, Health care utilization by older alcohol-using veterans: effects of a brief intervention to reduce at-risk drinking, Health Educ Behav source

      Not checked in the free run.

    • cites [57] Wutzke, 2002, The long-term effectiveness of brief interventions for unsafe alcohol consumption: a 10-year follow-up, Addiction source

      Not checked in the free run.

    • cites [58] Field, 2010, The effectiveness of brief intervention among injured patients with alcohol dependence: who benefits from brief interventions?, Drug Alcohol Depend source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Outcome-level risk of bias focused on the validity of treatment utilization analyses, including instrument measurement properties and blinding of outcome assessment.

    “Outcome-level risk of bias focused on the validity of the treatment utilization analyses, including the measurement properties of the instruments (49,50) and blinding of outcome assessment (51).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [49] Glass, 2011, Concordance between self-reports and archival records of physician visits: a case-control study comparing individuals with and without alcohol use disorders in the community, Drug Alcohol Depend source

      Not checked in the free run.

    • cites [50] Killeen, 2004, Comparison of self-report versus agency records of service utilization in a community sample of individuals with alcohol use disorders, Drug Alcohol Depend source

      Not checked in the free run.

    • cites [51] Balk, 2002, Correlation of quality measures with estimates of treatment effect in meta-analyses of randomized controlled trials, JAMA source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The review followed PRISMA guidelines.

    “This review followed guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement (39).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Moher, 2009, G., PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, Ann Intern Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Several forms of alcohol treatment are cost-effective and improve clinical outcomes.

    “various forms of alcohol treatment are cost-effective and improve clinical outcomes (8–15).”
    Quote in the paperNot a substantial claim0 of 8 sources checked
    • cites [8] Dawson, 2005, Recovery from DSM-IV alcohol dependence: United States, 2001-2002, Addiction source

      Not checked in the free run.

    • cites [9] Dawson, 2006, Estimating the effect of help-seeking on achieving recovery from alcohol dependence, Addiction source

      Not checked in the free run.

    • cites [10] Ettner, 2006, Benefit-cost in the California treatment outcome project: does substance abuse treatment ‘pay for itself’?, Health Serv Res source

      Not checked in the free run.

    • cites [11] Finney, 2007 source

      Not checked in the free run.

    • cites [12] Fleming, 2000, Benefit-cost analysis of brief physician advice with problem drinkers in primary care settings, Med Care source

      Not checked in the free run.

    • cites [13] Miller, 2002, Mesa Grande: a methodological analysis of clinical trials of treatments for alcohol use disorders, Addiction source

      Not checked in the free run.

    • cites [14] Moos, 2006, Rates and predictors of relapse after natural and treated remission from alcohol use disorders, Addiction source

      Not checked in the free run.

    • cites [15] Zarkin, 2010, The effect of alcohol treatment on social costs of alcohol dependence: results from the COMBINE study, Med Care source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two authors independently extracted data, and extraction was standardized with forms and meetings to resolve disagreements.

    “Two authors independently reviewed articles identified by the literature search to extract data regarding outcomes, study characteristics, and risk of bias. Data extraction was standardized with forms and meetings were held to review study data and to identify and resolve discrepancies.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Study-level risk of bias was assessed using randomization concealment, loss to follow-up, standardization of intervention delivery, and intent-to-treat analysis.

    “Study-level risk of bias was ascertained with the following characteristics: randomization concealment, proportion of participants lost to follow-up (48), standardization of intervention delivery (e.g., trained interventionists, followed treatment manuals), and presence of an intent to treat analysis (48).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [48] Sackett, 1979, Controversy in counting and attributing events in clinical trials, N Engl J Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Guidelines for SBI recommend referring people with severe unhealthy alcohol use, such as DSM-IV alcohol dependence, to more intensive services such as addiction specialist treatment.

    “SBI guidelines recommend that individuals with severe forms of unhealthy alcohol use such as DSM-IV alcohol dependence (20) be referred to more intensive services, such as treatments with addiction specialists (18,21,22).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [18] Babor, 2007, Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse, Subst Abuse source

      Not checked in the free run.

    • cites [21] National Institute on Alcohol Abuse and Alcoholism Helping Patients Who Drink Too Much: A Clinician's Guide [internet] 2005 http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/clinicians_guide.htm http://www.webcitation.org/6YWGq774x)

      Not checked in the free run.

    • cites [22] Moyer, 2013, A., Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. preventive services task force recommendation statement, Ann Intern Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Interpretationnone given

    More intensive linkage programs may be more effective for patients with more severe conditions.

    “Importantly, SBIRT has not been tested with more intensive linkage programs (79), which may be more effective with more severe patients.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [79] Scott, 2009, Results from two randomized clinical trials evaluating the impact of quarterly recovery management checkups with adult chronic substance users, Addiction source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Several included studies gave limited descriptions of the referral-specific components of the interventions in the treatment and control groups.

    “Several of the included studies were limited in their descriptions of referral-specific components of the interventions provided in the treatment and control groups, which highlights a need for better reporting in clinical trials.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Excluding non-English language articles may have caused the review to miss important studies.

    “Our exclusion of non-English language articles may have resulted in us missing some important studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    SBIRT extends SBI to people with more severe conditions, matching services to the level of need of all people with unhealthy alcohol use.

    “SBIRT extends SBI to those with more severe conditions, with services matched to the level of need of all individuals with unhealthy alcohol use (18).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Babor, 2007, Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse, Subst Abuse source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Connecting individuals to higher levels of care is a theoretically important part of SBIRT programs for providing effective treatment to people with severe alcohol problems.

    “Connecting individuals to higher levels of care is a theoretically important part of SBIRT programs to provide effective forms of treatment to persons with severe alcohol problems (18,21).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [18] Babor, 2007, Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse, Subst Abuse source

      Not checked in the free run.

    • cites [21] National Institute on Alcohol Abuse and Alcoholism Helping Patients Who Drink Too Much: A Clinician's Guide [internet] 2005 http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/clinicians_guide.htm http://www.webcitation.org/6YWGq774x)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A single trial reported that brief intervention raised treatment use for women and for adults younger than 44, despite non-significant main effects.

    “For instance, although their main effects were not statistically significant (33), one study found that brief intervention increased treatment utilization among women and adults under age 44 (77).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [33] Saitz, 2007, Brief intervention for medical inpatients with unhealthy alcohol use: a randomized, controlled trial, Ann Intern Med source

      Not checked in the free run.

    • cites [77] Saitz, 2009, Some medical inpatients with unhealthy alcohol use may benefit from brief intervention, J Stud Alcohol Drugs source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Conceptual frameworks describe brief alcohol intervention and referral as a low-intensity way to refer people to specialty care.

    “Conceptual frameworks have characterized brief alcohol intervention and referral as a low-intensity approach to referring individuals to specialty care, and suggest that more intensive efforts (e.g., telephone monitoring, continued contact, case management) may be necessary to provide effective linkages (34).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Cucciare, 2014, A conceptual model to facilitate transitions from primary care to specialty substance use disorder care: a review of the literature, Prim Health Care Res Dev

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The estimated relative risks ought not to be extended to every setting and population.

    “Although the heterogeneity statistic calculated by the meta-analysis was acceptable, the estimated relative risk ratios should not be generalized to all settings and populations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Two other systematic reviews examined the effect of brief interventions on later healthcare use, but neither specifically examined specialty alcohol treatment use.

    “Two other systematic reviews (including one meta-analysis) evaluated the effect of brief interventions on subsequent healthcare utilization (i.e. inpatient, outpatient, and emergency care), but neither specifically examined utilization of specialty alcohol treatments (31,32).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [31] Bray, 2011, A systematic review and meta-analysis of health care utilization outcomes in alcohol screening and brief intervention trials, Med Care source

      Not checked in the free run.

    • cites [32] Mdege, 2013, Interventions for reducing alcohol consumption among general hospital inpatient heavy alcohol users: a systematic review, Drug Alcohol Depend source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Integrated treatments use different transition practices and organizational resources and generally provide less intensive services than the specialty treatment programs that referrals target.

    “Integrated treatments use different transition practices (e.g., consults to providers in the same clinic) and require different organizational resources (e.g., embedded addiction specialists), yet they generally provide less intensive services than specialty treatment programs targeted by referrals (34).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Cucciare, 2014, A conceptual model to facilitate transitions from primary care to specialty substance use disorder care: a review of the literature, Prim Health Care Res Dev

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The hand search for grey literature could have missed unpublished reports.

    “Although there was no evidence for publication bias, our hand search to identify grey literature could have missed unpublished reports.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    More intensive efforts, such as telephone monitoring, continued contact, or case management, may be needed to create effective linkages.

    “Conceptual frameworks have characterized brief alcohol intervention and referral as a low-intensity approach to referring individuals to specialty care, and suggest that more intensive efforts (e.g., telephone monitoring, continued contact, case management) may be necessary to provide effective linkages (34).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Cucciare, 2014, A conceptual model to facilitate transitions from primary care to specialty substance use disorder care: a review of the literature, Prim Health Care Res Dev

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The purpose of referring people to treatment is to improve alcohol-related outcomes.

    “our secondary goal was to evaluate whether or not alcohol-related outcomes improved among those who were referred to higher levels of care, which is the purpose of referring people to treatment (34).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Cucciare, 2014, A conceptual model to facilitate transitions from primary care to specialty substance use disorder care: a review of the literature, Prim Health Care Res Dev

      Not checked in the free run.

37 of 37

  • The paper relies on this without support.

    SBIRT initiatives in the United States presume that brief alcohol interventions are efficacious in linking patients to higher levels of care.

    “Screening, Brief Intervention, and Referral to Treatment initiatives in the United States presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated.”

  • The authors state this as an assumption.

    Referral to treatment as part of SBI or SBIRT effectively links patients to higher levels of care for their alcohol problems.

    “This lack of evidence calls into question the assumption that referral to treatment as part of SBI or SBIRT effectively links patients to higher levels of care for their alcohol problems.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

1 retracted

Flagged first, then by citations

4 of the 87 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Whitlock, 2004, Behavioral Counseling Interventions in Primary Care to Reduce Risky/Harmful Alcohol Use
  2. 2011, Cochrane Handbook For Systematic Reviews Of Interventions [internet]
  3. StataCorp, 2013, Stata Statistical Software: Release 13
  4. Center for Substance Abuse Treatment, 1999, Brief Interventions and Brief Therapies for Substance Abuse

Cited by

Sorted by citations

Related

Authors
Glass, J. E., Hamilton, A. M., Powell, B. J., Perron, B. E., Brown, R. T., & Ilgen, M. A.
Affiliations
  • University of Wisconsin–Madison (US)
  • Chrysalis, Inc.; Madison WI USA
  • University of Pennsylvania (US)
  • University of Michigan (US)
Corresponding author
Glass, Joseph E.
ORCID
Venue
Addiction
Publisher
Wiley
Published
2015-06-03
Volume
110
Issue
9
Pages
1404-1415
ISSN
0965-2140 (ISSN-L)
DOI
10.1111/add.12950
PMC
PMC4753046
OpenAlex
W1876416398
Semantic Scholar
3da798d1882e8f34a248379b5c52718fa4a36a73
Cited by
168
References
87
Citations by year
2026: 6 · 2025: 11 · 2024: 16 · 2023: 13 · 2022: 20 · 2021: 11 · 2020: 17 · 2019: 20 · 2018: 15 · 2017: 17 · 2016: 13 · 2015: 9
FWCI
2.34
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 90 d)
Locations
  • Addiction (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
Funders
National Institute on Alcohol Abuse and Alcoholism (AA021034)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
brief alcohol intervention, referral to treatment, SBIRT, healthcare settings, linkage to care, alcohol consumption
MeSH terms
Counseling, Humans, Referral and Consultation, Randomized Controlled Trials as Topic, Substance-Related Disorders, Alcohol-Related Disorders

About these checks

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-05.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-05.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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