Alcohol screening and brief intervention in primary care: Absence of evidence for efficacy in people with dependence or very heavy drinking
Open accessAbstract
Issues. Although screening and brief intervention (BI) in the primary‐care setting reduces unhealthy alcohol use, its efficacy among patients with dependence has not been established. This systematic review sought to determine whether evidence exists for BI efficacy among patients with alcohol dependence identified by screening in primary‐care settings. Approach. We included randomised controlled trials (RCTs) extracted from eight systematic reviews and electronic database searches published through September 2009. These RCTs compared outcomes among adults with unhealthy alcohol use identified by screening who received BI in a primary‐care setting with those who received no intervention. Key Findings. Sixteen RCTs, including 6839 patients, met the inclusion criteria. Of these, 14 excluded some or all persons with very heavy alcohol use or dependence; one in which 35% of 175 patients had dependence found no difference in an alcohol severity score between groups; and one in which 58% of 24 female patients had dependence showed no efficacy. Conclusion and Implications. Alcohol screening and BI has efficacy in primary care for patients with unhealthy alcohol use, but there is no evidence for efficacy among those with very heavy use or dependence. As alcohol screening identifies both dependent and non‐dependent unhealthy use, the absence of evidence for the efficacy of BI among primary‐care patients with screening‐identified alcohol dependence raises questions regarding the efficiency of screening and BI, particularly in settings where dependence is common. The finding also highlights the need to develop new approaches to help such patients, particularly if screening and BI are to be disseminated widely.[Saitz R. Alcohol screening and brief intervention in primary care: Absence of evidence for efficacy in people with dependence or very heavy drinking. Drug Alcohol Rev 2010;29;631–640]
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Prior reviews have not provided enough evidence to determine whether brief alcohol interventions increase later treatment use.
“Overall, reviews have produced insufficient evidence to evaluate whether or not brief alcohol interventions actually increase subsequent treatment utilization.”
Prior reviews have evaluated SBI evidence separately by age, clinical setting, and alcohol use severity.
“The evidence for SBI has been evaluated separately in several reviews based on other study characteristics, such as age (adolescent versus adult) (28,36), clinical setting (37,38), and alcohol use severity (30), which we also considered in subgroup analyses.”
Many randomized controlled trials of brief interventions exclude participants who could benefit from specialty care, such as those with DSM-IV dependence.
“Many RCTs of brief interventions have been conducted, but most do not assess treatment utilization, and many exclude participants who would benefit from specialty care (e.g., those with DSM-IV dependence) (30).”
A 2010 systematic review of randomized trials of SBI in primary care that included alcohol-dependent drinkers found no trials that examined linkage to alcohol treatment as an outcome.
“A systematic review in 2010 of randomized controlled trials (RCTs) of SBI in primary care settings that included drinkers with alcohol dependence found no studies that examined linkage to alcohol treatment as a study outcome (30).”
Most randomized controlled trials of brief interventions do not measure treatment utilization.
“Many RCTs of brief interventions have been conducted, but most do not assess treatment utilization, and many exclude participants who would benefit from specialty care (e.g., those with DSM-IV dependence) (30).”
Encouraging people to use alcohol treatment is difficult.
“As has been noted by prior reviews, this highlights the fact that it is difficult to encourage people to utilize alcohol treatment (30).”
Findings from brief intervention trials have been mixed, with supportive findings for unhealthy alcohol use but a lack of evidence for unhealthy drug use.
“Findings from BI trials have been mixed, with supportive findings for unhealthy alcohol use, 10 -13 but currently lack evidence for unhealthy drug use. 11,14 -16”
From Efficacy of Brief Intervention for Unhealthy Drug Use in Outpatient Medical Care: a Systematic Review and Meta-analysis (2022) · cites this paper as [14]
The lack of actual diagnoses hampers any attempt to use the available data to test the common view that self-help interventions are particularly suited to people with less serious alcohol problems, but less appropriate for those with alcohol dependence.
“This lack of actual diagnoses also hampers any attempt to use the available data to test the common view that self-help interventions are particularly suited to people with less serious alcohol problems, but less appropriate for those with alcohol dependence [3], [80].”
From Effectiveness of Guided and Unguided Low-Intensity Internet Interventions for Adult Alcohol Misuse: A Meta-Analysis (2014) · cites this paper as [80]
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Carneiro, A. P. L., & Souza-Formigoni, M. L. O. (2018) · Substance Abuse · doi:10.1080/08897077.2017.1365801 · Cited by 7 · see citing works
- Authors
- SAITZ, R.
- Affiliations
- Boston University (US)
- Corresponding author
- SAITZ, RICHARD
- ORCID
- SAITZ, RICHARD
- Venue
- Drug and Alcohol Review
- Publisher
- Wiley
- Published
- 2010-10-26
- Volume
- 29
- Issue
- 6
- Pages
- 631-640
- ISSN
- 0959-5236 (ISSN-L)
- 1465-3362
- PMC
- PMC2966031
- OpenAlex
- W1649156037
- Cited by
- 241
- References
- 65
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 7 · 2023: 7 · 2022: 14 · 2021: 18 · 2020: 12 · 2019: 15 · 2018: 21 · 2017: 15 · 2016: 17 · 2015: 30 · 2014: 20 · 2013: 23 · 2012: 20
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Review (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (R01AA010870, R01AA10019)
- National Institute on Drug Abuse (R01DA025068, R01DA010019)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- alcohol screening, brief intervention, alcoholism, primary care, treatment efficacy, unhealthy alcohol use
- MeSH terms
- Adolescent, Adult, Aged, Alcohol Drinking, Ethanol, Alcoholism, Counseling, Female, Humans, Male, Mass Screening, Middle Aged, Primary Health Care, Randomized Controlled Trials as Topic, Treatment Outcome, Young Adult
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