Randomized controlled trial of general practitioner intervention in women with excessive alcohol consumption. Brief Intervention for Medical Inpatients with Unhealthy Alcohol Use The Effect of Screening and Brief Intervention for Risky Drinking on Health Care Utilization in Managed Care Organizations Evaluation of a controlled drinking minimal intervention for problem drinkers in general practice (the DRAMS scheme). Health Care Utilization by Older Alcohol-Using Veterans: Effects of a Brief Intervention to Reduce At-Risk Drinking Brief physician advice for alcohol problems in older adults: a randomized community-based trial. Brief alcohol intervention and alcohol assessment do not influence alcohol use in injured patients treated in the emergency department: a randomized controlled clinical trial. Analyzing the Costs and Benefits of Brief Intervention Treatment of problem alcohol use in women of childbearing age: results of a brief intervention trial. The effectiveness of a tailored intervention for excessive alcohol consumption prior to elective surgery. The long-term effectiveness of brief interventions for unsafe alcohol consumption: a 10-year follow-up. The Cost-Effectiveness and Cost-Benefit of Screening and Brief Intervention for Unhealthy Alcohol Use in Medical Settings Identification and intervention of heavy drinking in middle-aged men: results and follow-up of 24-60 months of long-term study with randomized controls. Brief Physician Advice For High-Risk Drinking Among Young Adults Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Brief physician advice for problem drinking among older adults: an economic analysis of costs and benefits. Benefit-cost analysis of brief physician advice with problem drinkers in primary care settings. Brief intervention in a primary care setting for hazardous drinkers. Screening for problem drinking and counseling by the primary care physician-nurse team. Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices. Brief physician advice for problem drinkers: long-term efficacy and benefit-cost analysis. The effect of general practitioners' advice to heavy drinking men. Screening and brief intervention for hazardous drinking in an HMO: Effects on medical care utilization Effectiveness of nurse-led brief alcohol intervention: a cluster randomized controlled trial. Cost-effectiveness of screening and referral to an alcohol health worker in alcohol misusing patients attending an accident and emergency department: a decision-making approach. Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial
Seventy two women drinking 21 units ( 210 g ) or more of alcohol per week were recruited from an opportunistic screening programme in eight English general practice s. The women were r and omized into control and treatment groups . Women in the treatment group received ten minutes advice from their general practitioner to reduce alcohol consumption .  At one year follow-up , when analyzed by intention to treat , women in the treatment group had reduced their alcohol consumption from an average of 35 - 24 units per week . Similar reductions were found in the control group ( from 37 - 27 units per week ) . The lack of evidence for a treatment effect may be explained by contamination of the control group by informal interventions Context Brief interventions reduce alcohol use in out patients who drink unhealthy amounts but are not alcohol-dependent . Their effect in medical in patients is unknown . Contribution The authors screened all adult medical in patients at an urban teaching hospital and r and omly assigned 341 risky drinkers to a 30-minute motivational counseling intervention followed gy treatment planning or to usual care . By 3 months , the same proportion of patients from both groups had received alcohol assistance , and both groups had reduced their drinking to the same degree . Caution s Three quarters of the participants met Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , criteria for alcohol dependence . Implication s In this well-done study , brief intervention did not affect alcohol-related outcomes in persons who drank unhealthy amounts . The Editors Professional organizations recommend that clinicians screen their patients for unhealthy alcohol use ( that is , the spectrum from drinking risky amounts to dependence ) and conduct a brief intervention when indicated ( 1 , 2 ) . Despite this recommendation and the existence of brief , valid screening tools ( 35 ) , patients with unhealthy alcohol use often are not identified and do not receive timely care . Although widely recommended , brief intervention has proven efficacy in decreasing alcohol consumption and related consequences only in unhealthy drinkers without alcohol dependence and in outpatient setting s ( 6 ) . Its efficacy among other population s ( for example , persons with alcohol dependence ) and in inpatient setting s remains unclear ( 7 ) . Evidence suggests , however , that medical in patients a group with a high prevalence of alcohol-related problemsmay benefit from brief intervention . Some studies have demonstrated the efficacy of brief intervention in setting s similar to medical services in which alcohol-related problems are common and their related consequences are severe ( 8 , 9 ) . Further , brief interventions are well suited to medical services . Patients who otherwise might not seek care are accessible and have time for an intervention . Persons admitted because of an alcohol-related problem may recognize the link between drinking and hospitalization , thus providing a teachable moment ( 10 ) . Also , busy staff might implement a brief intervention because of its brevity and flexibility . The unmet need for alcohol screening and intervention and opportunities for implementation underscore the importance of determining the efficacy of brief intervention in medical in patients with unhealthy alcohol use . In addition , evaluating its effectiveness and practicality in real-world setting s is critical to help clinicians make informed decisions when treating their patients ( 11 ) . Therefore , we conducted a r and omized , controlled trial to examine whether screening followed by brief intervention would improve alcohol-related outcomes in typical medical in patients ( that is , a racially diverse group with a range of unhealthy alcohol use , comorbid conditions , and readiness to change ) . We hypothesized that screening and brief intervention would lead to the following : receipt of alcohol assistance ( for example , specialty treatment ) among persons with alcohol dependence and , among all persons decreased alcohol consumption , alcohol-related problems , and health care utilization and improved readiness to change and health-related quality of life . Methods Patients As previously described , we recruited patients from the inpatient medical service of a large , urban teaching hospital ( 12 ) . Trained research associates approached all patients who were age 18 years or older and whose physicians did not decline patient contact . Patients fluent in English or Spanish who gave verbal consent were asked to complete a screening interview to determine eligibility : currently ( past month ) drinking risky amounts ( defined for eligibility as > 14 st and ard drinks/wk or 5 drinks/occasion for men and > 11 drinks/wk or 4 drinks/occasion for women and persons 66 years ) ; 2 contacts to assist with follow-up ; no plans to move from the area in the next year ; and a Mini-Mental State Examination score of 21 or greater ( 13 , 14 ) . Research associates assessed demographic characteristics and administered the  Alcohol Use Disorders Identification Test ( AUDIT )  ( 15 ) by interview . To better characterize current alcohol use , they assessed the average numbers of drinking-days per week and drinks consumed on a typical day , and the maximum number of drinks consumed per occasion ( 16 , 17 ) . For the first 7 months of the study , research associates asked these additional questions only to patients with an AUDIT score of 8 or greater ( a recommended cutoff for screening ) ( 18 ) . For the remaining 22 months , research associates asked the additional questions to anyone who drank in the past 12 months to maximize identification of drinkers of risky amounts . Lastly , the research associates asked all patients who were drinking risky amounts to describe their readiness to change by using a visual analog scale ranging from 0 to 10 ( 19 ) . Enrolled patients provided written informed consent and were compensated for each completed interview . The institutional review board at Boston University Medical Center approved this study . We secured additional privacy protection with a certificate of confidentiality from the National Institute on Alcohol Abuse and Alcoholism . Assessment at Enrollment Research associates interviewed patients before r and omization to assess the characteristics shown in Table 1 . One author review ed the medical records to determine medical diagnoses ( 29 ) . Diagnoses of alcohol use disorders were based on the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( 30 ) , and were determined with the Composite International Diagnostic Interview ( CIDI ) Alcohol Module ( 31 , 32 ) . Table 1 . Characteristics at Enrollment of All Study Patients and of the Subgroup with Alcohol Dependence * R and omization and Intervention An off-site data management group generated assignments to control and intervention groups by using a permuted block ( size 8) r and omization procedure stratified by AUDIT score ( < 12 vs. 12 ) and provided us the assignments in sealed opaque envelopes . We used the AUDIT score to stratify because we could not score the CIDI before r and omization . After each baseline assessment , research associates opened an envelope and informed the patient of his or her assignment . Patients in the control group received usual care ( that is , they were told the screening results and that they could discuss their drinking with their physicians ) . Specialists were available by referral . Systematic alcohol screening and brief intervention were not routine at this hospital . We assigned patients in the intervention group to a 30-minute session of brief motivational counseling ( 19 , 33 ) conducted by counseling and clinical psychology doctoral students whom we trained and supervised . Sessions were audiotaped and included feedback , an open discussion , and construction of a change plan ( Appendix ) . Outcomes and Measurements The first primary outcome was self-reported receipt of alcohol assistance in the past 3 months by patients with CIDI-determined alcohol dependence . This outcome was measured at the 3-month follow-up visit with a st and ardized interview based on the Treatment Services Review ( 34 ) and Form 90 ( 35 ) . Assistance included residential treatment , outpatient treatment ( for example , specialty counseling or therapy ) , medications , employee assistance programs , or mutual-help groups ( for example , Alcoholics Anonymous ) . The other primary outcome was the change in the number of mean drinks per day in the past 30 days from enrollment to 12 months among all patients . We determined consumption with the Timeline Follow-back method ( 36 ) . Five secondary consumption outcomes ( past 30 days ) included changes from enrollment to 12 months in the numbers of heavy drinking episodes ( 5 drinks/occasion for men and 4 drinks/occasion for women and for persons 66 y ) and days abstinent ; and the proportions of patients drinking risky amounts ( > 14 drinks/wk or 5 drinks/occasion for men and > 7 drinks/wk or 4 drinks/occasion for women and persons 66 y ) ( 37 ) , having 1 or more heavy drinking episodes , and abstaining for all 30 days . Other secondary outcomes included the changes at 12 months in readiness to change ( Taking Steps scale on the Stages of Change Readiness and Treatment Eagerness Scale ) ( 38 ) , alcohol problems ( total score on the Short Inventory of Problems ) ( 39 ) , physical and mental health-related quality of life ( Physical and Mental Component Summary scale scores on the Short-Form Health Survey ) ( 40 ) , and emergency department visits and days of medical hospitalization ( both determined by a st and ardized interview based on the Treatment Services Review and Form 90 ) ( 34 , 35 ) . Follow-up Procedures Research associates conducted follow-up visits , which included re assessment of most domains covered at enrollment , usually in person and at 3 and 12 months ( 10 % and 13 % , respectively , by telephone ; similar by r and omized group ) . They performed  alcohol breath tests  at in-person follow-up visits ( 41 ) . Although they were involved in the r and omization assignment , research associates were not involved in the intervention . Further , 64 % of patients at 3-month follow-up and 85 % of patients at 12-month follow-up were interviewed by a different research associate than at baseline . Statistical Analysis We analyzed all patients in the groups to which they were r and omly assigned . Reported P values are 2-tailed and are considered statistically significant if they were less than 0.05 . We analyzed data with SAS/STAT software , versions 8.2 and 9.1.3 ( SAS Institute , Inc. , Cary , North Carolina ) . To describe the study sample and to compare groups , we used the chi-square test , Fisher exact test , 2- sample t test , and Wilcoxon rank-sum test , as appropriate . For the primary analyses , we used logistic and Objective : We sought to estimate the effect of screening and brief intervention ( SBI ) for risky alcohol use on the health care utilization  of risky drinkers in 4 managed care organizations . Research Design : A quasi-experimental group design was implemented in which 12 participating primary care clinics r and omly were assigned to 1 of 3 study conditions . In one condition , physicians , physician assistants , and nurse practitioners delivered the brief intervention . In another condition , midlevel professionals ( usually nurses ) performed the brief intervention . In the third condition , SBI was not performed . Using administrative cl aims data , we estimated the effect of SBI on individual-level annual days of total and inpatient health care utilization ; annual outpatient visits ; annual emergency room visits ; and annual visits related to alcohol , drug , or mental health conditions . Negative binomial regression models were used to control for other factors that may affect health care utilization . Results : Across all categories of care , the pre- to postintervention change in average health care utilization among risky drinkers in the intervention clinics was not significantly different from that of risky drinkers in the comparison clinics . Conclusions : Our findings suggest that there is no effect of  SBI  on the health care utilization of risky drinkers in the year following the intervention . Although SBI does not appear to reduce health care utilization , previous studies find that it significantly reduces the alcohol consumption of risky drinkers . Because these reductions presumably improve patients ’ overall health and well-being , managed care organizations may still find it beneficial to implement SBI on a broad scale Sixteen general practitioners participated in a controlled trial of the Scottish Health Education Group 's  DRAMS ( drinking reasonably and moderately with self-control ) scheme . The scheme was evaluated by r and omly assigning 104 heavy or problem drinkers to three groups - a group participating in the DRAMS scheme  ( n = 34 ) , a group given simple advice only ( n = 32 ) and a non-intervention control group ( n = 38 ) . Six month follow-up information was obtained for 91 subjects ( 87.5 % of initial sample ) . There were no significant differences between the groups in reduction in alcohol consumption , but patients in the DRAMS group showed a significantly greater reduction in a logarithmic measure of serum gamma-glutamyl-transpeptidase than patients in the group receiving advice only . Only 14 patients in the DRAMS group completed the full DRAMS procedure . For the sample as a whole , there was a significant reduction in alcohol consumption , a significant improvement on a measure of physical health and well-being , and significant reductions in the logarithmic measure of serum gamma-glutamyl transpeptidase and in mean corpuscular volume . The implication s of these findings for future research into controlled drinking minimal interventions in general practice are discussed The objective of the study was to estimate the effect of a brief alcohol-reduction intervention on health care use . Male veterans aged 55 years and older drinking more than guideline limits participated in an effective primary care-based r and omized clinical trial to reduce drinking . Repeated measures ANCOVA assessed short-term and long-term changes in both inpatient and outpatient utilization .  Stage of change ( SOC ) was assessed in a sub sample to test for interaction between SOC and the intervention . Veterans exposed to the intervention used more outpatient medical services in the short term . Long-term effects on inpatient/outpatient use were not observed . SOC did not moderate the effect of the intervention but was associated with differential use of health care services . A cost-effective brief intervention to reduce drinking may spur increased efforts to seek health care . Early detection and management of alcohol-related or other illnesses might be expected to accrue savings in later years BACKGROUND Alcohol use in older adults is common . It is associated with depression , hypertension , diabetes , drug interactions , accidents , and increased rates of emergency department visits and hospitalizations . METHODS A controlled clinical trial ( Project GOAL --Guiding Older Adult Lifestyles ) tested the efficacy of brief physician advice in reducing the alcohol use and use of health care services of older adult problem drinkers . Twenty-four community-based primary care practice s in Wisconsin ( 43 family physicians and internists ) participated in the trial . Of the 6073 patients screened , 105 men and 53 women met inclusion criteria and were r and omized into a control group ( n = 71 ) or an intervention group ( n = 87 ) . Intervention group patients received two 10- to 15-minute physician-delivered counseling sessions that included advice , education , and contracting using a scripted workbook . A total of 146 patients ( 92.4 % ) participated in the 12-month follow-up procedure . RESULTS No significant differences were found between the control and intervention groups at baseline in alcohol use , age , socioeconomic status , depression , onset of alcohol use , smoking status , activity level , or use of mood-altering drugs . The older adults who received the physician intervention demonstrated a significant reduction in 7-day alcohol use , episodes of binge drinking , and frequency of excessive drinking ( P < .005 ) compared with the control group at 3 , 6 , and 12 months after the intervention . There was a 34 % reduction in 7-day alcohol use , 74 % reduction in mean number of binge-drinking episodes , and 62 % reduction in the percentage of older adults drinking more than 21 drinks per week in the intervention group compared with the control group . There were no significant changes in health status . Patterns of health care utilization were not extensively analyzed because of the small number of events . CONCLUSIONS This study provides the first direct evidence that brief physician advice can decrease alcohol use by older adults in community-based primary care practice AIMS To evaluate the effectiveness of brief alcohol intervention ( BAI ) in reducing alcohol use among hazardous drinkers treated in the emergency department ( ED ) after an injury ; in addition it tests whether assessment of alcohol use without BAI is sufficient to reduce hazardous drinking . DESIGN R and omized controlled clinical trial with 12-month follow-up conducted between January 2003 and June 2005 . SETTING Urban academic emergency department ( ED ) of the Lausanne University Hospital , Lausanne , Switzerl and . PARTICIPANTS A total of 5136 consecutive patients attending ED after an injury completed a seven-item general and a three-item alcohol screen and 1472 ( 28.7 % ) were positive for hazardous drinking according to the National Institute on Alcohol Abuse and Addiction definition ; of these 987 ( 67.1 % ) were r and omized into a BAI group ( n = 310 ) or a control group with screening and assessment ( n = 342 ) or a control group with screening only ( n = 335 ) and then a total of 770 patients ( 78.0 % ) completed the 12-month follow-up procedures . INTERVENTION A single 10 - 15-minute session of st and ardized BAI conducted by a trained research assistant . MEASUREMENTS Percentage of participants who have changed to low-risk drinking at follow-up . FINDINGS Data obtained at 12 months indicated that similar proportions were low-risk drinkers in BAI versus control groups with and without assessment ( 35.6 % , 34.0 % , 37.0 % , respectively , P = 0.71 ) . Data also indicated similar reductions in drinking frequency , quantity , binge drinking frequency and Alcohol Use Disorders Identification Test ( AUDIT ) scores across groups . All groups reported similar numbers of days hospitalized and numbers of medical consults in the last 12 months . A model including age groups , gender , AUDIT and injury severity scores indicated that BAI had no influence on the main alcohol use outcome . CONCLUSIONS This study provides the evidence that a 10 - 15-minute BAI does not decrease alcohol use and health re source utilization in hazardous drinkers treated in the ED , and demonstrates that commonly found decreases in hazardous alcohol use in control groups can not be attributed to the baseline alcohol assessment The Trial for Early Alcohol Treatment , Project TrEAT , was a r and omized controlled trial of screening and brief intervention in primary care clinics . One of the few such trials to be analyzed in terms of cost-effectiveness , Project TrEAT was examined from two perspectives . The analysis from the perspective of medical care providers focused on clinic and hospital costs , contrasting the benefits that directly reduced medical expenditures with the costs to providers . The analysis from the societal perspective took all of the intervention ’s costs and benefits into account . Both components of this study revealed that Project TrEAT led to a reduction in alcohol consumption  by high-risk drinkers and a corresponding reduction in medical and societal costs . Overall , this study supported the cost-effectiveness of Project TrEAT , concluding that its costs were outweighed by its benefits BACKGROUND Studies suggest that 14 % of women age 18 to 40 drink alcohol above recommended limits . Of special concern is the increasing use of alcohol by women during pregnancy . This article reports 48 month follow-up data from a sub analysis of a trial for early alcohol treatment ( Project TrEAT ) focused on women of childbearing age . METHODS Project TrEAT was conducted in the offices of 64 primary care , community-based physicians from 10 Wisconsin counties . Of 5979 female patients ages 18 to 40 who were screened for problem drinking , 205 were r and omized into an experimental group ( n = 103 ) or control group ( n = 102 ) . The intervention consisted of two 15 min , physician-delivered counseling visits that included advice , education , and contracting by using a scripted workbook . A total of 174 subjects ( 85 % ) completed the 48 month follow-up procedures . RESULTS No significant differences were found between the experimental and control groups at baseline for alcohol use , age , socioeconomic status , smoking , depression or anxiety , conduct disorder , lifetime drug use , or health care utilization . The trial found a significant treatment effect in reducing both 7 day alcohol use ( p = 0.0039 ) and binge drinking episodes ( p = 0.0021 ) over the 48 month follow-up period . Women in the experimental group who became pregnant during the follow-up period had the most dramatic decreases in alcohol use . A logistic regression model based on a 20 % or greater reduction in drinking found an odds ratio of 1.93 ( confidence interval 1.07 - 3.46 ) in the sample exposed to physician intervention . Age , smoking , depression , conduct disorder , antisocial personality disorder , and illicit drug use did not reduce drinking significantly . No significant differences were found in health care utilization and health status between groups . CONCLUSIONS This trial provides the first direct evidence that brief intervention is associated with sustained reductions in alcohol consumption by women of childbearing age . The results have enormous implication s for the U.S. health care system AIM To assess the effectiveness of a tailored pre-operative intervention for excessive alcohol consumption in reducing post-operative complications and alcohol consumption thereafter . METHODS Patients scheduled for elective surgery requiring at least overnight hospitalisation were screened for alcohol misuse . Consenting , eligible participants with > or = 7 days to surgery at the time of screening were offered an intervention and those with < 7 days to surgery were provided usual care . RESULTS Over a period of 2 years and 10 months , 3139 patients were screened to recruit 136 participants . Baseline analysis revealed a mean age of 53 ( + /-15.8 ) years and a mean consumption of 71 g/day ( + /-48.1 ) . The intervention group ( n = 45 ) did not differ significantly from controls ( n = 91 ) in age , consumption , and number of current smokers , but there were significantly more women in the control group . There was no difference between the groups in major or minor complications experienced , or length of stay after controlling for age , gender , and baseline consumption . At 6-month follow-up there was a significant reduction in drinking for the entire study population . CONCLUSION The study did not demonstrate any beneficial effect of the pre-operative intervention on post-operative complications . The relatively short time to surgery , intervention by a non-member of the surgical team , challenges to recruitment and reduced consumption in the control group may have limited the ability of the study to detect a significant effect of the intervention AIMS To examine the long-term impact of brief and early interventions for hazardous and harmful alcohol consumption . DESIGN A 9-month and 10-year follow-up of subjects recruited into a r and omized controlled trial of a range of alcohol-related brief interventions . SETTING General practice s , the outpatient or acute care services of a major city hospital , and a privately run health screening programmeme . PARTICIPANTS The cohort of 554 ( non-dependent ) hazardous and harmful drinkers recruited into the Australian arm of the Phase II World Health Organization collaborative project on identification and treatment of persons with harmful alcohol consumption . INTERVENTION The effectiveness of three forms of intervention , ranging from 5 to 60 minutes in duration , were compared with a no-treatment control condition . MEASUREMENTS Included drinking behaviour and biological markers of alcohol use . In addition , at 10 years subjects were asked about symptoms of diagnosable alcohol use disorders and their experience of alcohol-related psychological , social and physical harm . Mortality was also assessed . FINDINGS Results provide further evidence for the short-term effectiveness of alcohol-related brief interventions . In comparison to controls , subjects offered intervention : ( 1 ) report significantly lower consumption ; and ( 2 ) less unsafe drinking at 9-month follow-up . The intensity of intervention was not related to the amount of change in drinking behaviour . Analysis at 10 years failed to find any differences in outcomes between intervention and control groups in median consumption , mean reduction in consumption from baseline to follow-up , mortality and ICD-10 diagnoses of alcohol dependence or harmful alcohol use . CONCLUSIONS This study failed to find evidence that brief advice and counselling without regular follow-up and reinforcement can sustain significant long-term reductions in drinking behaviour at 10-year follow-up SUMMARY Economic evaluation can be a valuable tool for assessing the efficiency and value of health care programs . To examine the literature on the economic evaluation of  alcohol screening and brief intervention in medical setting s , relevant studies were identified in the MEDLINE data base ( 1966 through November 2006 ) and by h and - search ing the references of identified articles and relevant journals . The 15 identified studies used a range of economic evaluation methods , including cost analysis , cost-benefit , cost-effectiveness , and cost-utility . Nearly all of the studies supported the use of alcohol screening and brief intervention . The studies that prospect ively collected cost and effect data and /or conformed closely to method ological guidelines demonstrated a strong economic benefit of alcohol screening and brief intervention when compared to usual care . Overall , the review ed studies support alcohol SBI in medical setting s as a wise use of health care re sources and illustrate the usefulness of economic evaluation for assessing alcohol prevention and treatment programs In a continuing screening and intervention programme in Malmó , elevated serum-gamma-glutamyltransferase ( GGT ) values were used for selection of heavy drinkers . The study population consisted of 585 individuals born 1926 - 1933 with two consecutive GGT values in the upper decile of the GGT distribution , r and omly allocated either to an intervention group of to a control group . The subjects in the intervention group were further investigated and 75 % of them were judged to have elevated GGT values caused by alcohol consumption . These individuals were repeatedly encouraged to lower their overall alcohol consumption and  GGT  measurements were used as biofeedback method in the treatment program . The controls were informed by letter to be restrictive with their alcohol consumption and that they should receive new invitations for measurements of their liver enzymes  after 2 , 4 , and 6 years . The intervention and control groups were well matched and followed over a 2 - 6-year period . Two and 4 years after the screening investigation , the GGT values in both groups were significantly decreased . There were differences , however , between the two groups with regard to sick absenteeism , hospitalization , and mortality . A significant reduction was found in sick absence during 4 years by 80 % , in hospital days during 5 years by 60 % , and in mortality during 6 years by 50 % in the intervention group compared with the control group . Thus , the intervention program was effective in preventing medico-social consequences of heavy drinking BACKGROUND High-risk alcohol use in persons 18 to 30 years of age is a critical public health problem . It is the number 1 cause of death in this population . This article reports the results of a sub analysis of young adults ( aged 18 to 30 years ) who participated in Project TrEAT ( Trial of Early Alcohol Treatment ) conducted in the offices of 64 primary care physicians located in 10 counties in southern Wisconsin . METHODS Project TrEAT was a r and omized clinical trial design ed to test the efficacy of a brief intervention protocol to reduce alcohol use , improve health status , and decrease health care utilization . A total of 226 young adults were r and omly assigned to either a usual care or brief intervention group . RESULTS There were no significant differences between the 2 groups at baseline on a number of potential confounders . During the 4-year follow-up period , there were significant reductions in number of persons drinking more than 3 drinks per day , average 7-day alcohol use , number of persons drinking 6 or more drinks per occasion , and number of binge drinking episodes in the previous 30 days ( P < .01 to P < .001 ) . There were also significant differences ( P < .05 ) in emergency department visits ( 103 vs 177 ) , motor vehicle crashes ( 9 vs 20 ) , total motor vehicle events ( 114 vs 149 ) , and arrests for controlled substance or liquor violation ( 0 vs 8) . CONCLUSION In this 4-year sub analysis of young adults who participated in Project TrEAT , we found long-term reductions in high-risk drinking behaviors and consequences . The findings of this study support more widespread implementation of brief interventions in primary care setting OBJECTIVE Alcoholism is the leading risk factor for injury . The authors hypothesized that providing brief alcohol interventions as a routine component of trauma care would significantly reduce alcohol consumption and would decrease the rate of trauma recidivism . METHODS This study was a r and omized , prospect i ve controlled trial in a level 1 trauma center . Patients were screened using a blood alcohol concentration , gamma glutamyl transpeptidase level , and short Michigan Alcoholism Screening Test ( SMAST ) . Those with positive results were r and omized to a brief intervention or control group .  Reinjury was detected by a computerized search of emergency department and statewide hospital discharge records , and 6- and 12-month interviews were conducted to assess alcohol use . RESULTS A total of 2524 patients were screened ; 1153 screened positive ( 46 % ) . Three hundred sixty-six were r and omized to the intervention group , and 396 to controls . At 12 months , the intervention group decreased alcohol consumption by 21.8+/-3.7 drinks per week ; in the control group , the decrease was 6.7+/-5.8 ( p = 0.03 ) . The reduction was most apparent in patients with mild to moderate alcohol problems ( SMAST score 3 to 8) ; they had 21.6+/-4.2 fewer drinks per week , compared to an increase of 2.3+/-8.3 drinks per week in controls ( p < 0.01 ) . There was a 47 % reduction in injuries requiring either emergency department or trauma center admission ( hazard ratio 0.53 , 95 % confidence interval 0.26 to 1.07 , p = 0.07 ) and a 48 % reduction in injuries requiring hospital admission ( 3 years follow-up ) . CONCLUSION Alcohol interventions are associated with a reduction in alcohol intake and a reduced risk of trauma recidivism . Given the prevalence of alcohol problems in trauma centers , screening , intervention , and counseling for alcohol problems should be routine OBJECTIVE Problem alcohol use among elderly persons can have a variety of health-related consequences , complicating management of chronic illnesses and increasing health care utilization and costs . This study evaluates the economic cost and benefits of brief intervention for at-risk drinking older adults . METHOD A controlled clinical trial with 24-month follow-up tested effectiveness of brief physician advice in reducing alcohol use , health care utilization and other consequences among older ( age 65 or older ) adult problem drinkers . Of 6,073 patients screened for problem drinking in 24 community-based primary care practice s in Wisconsin , 158 patients met inclusion criteria and were r and omized into control ( n = 71 ) or intervention ( n = 87 ) groups . Intervention group patients received two 10- to 15-minute physician-delivered counseling sessions including professional advice , education and contracting using scripted workbooks . RESULTS The intervention group demonstrated significant reductions in alcohol use ( p = 0.001 ) and frequency of excessive drinking ( p = 0.03 ) compared with the control group over 24 months , but no significant differences emerged in economic outcomes , including hospital days , emergency department visits , office visits , medications , lab and x-ray procedures , injuries , legal events or mortality . CONCLUSIONS Although the clinical benefits of brief alcohol interventions with older adults are clear , the economic results in this age group are less certain . Older adult problem drinkers may require more intensive and costly interventions to achieve economic benefits similar to those seen in younger adult problem drinkers . Method ological issues , such as statistical power , outcome measures , outlier cases and follow-up periods , are identified for future evaluations BACKGROUND Few studies have estimated the economic costs and benefits of brief physician advice in managed care setting s. OBJECTIVE To conduct a benefit-cost analysis of brief physician advice regarding problem drinking . DESIGN Patient and health care costs associated with brief advice were compared with economic benefits associated with changes in health care utilization , legal events , and motor vehicle accidents using 6- and 12-month follow-up data from Project TrEAT ( Trial for Early Alcohol Treatment ) , a r and omized controlled clinical trial . SUBJECTS 482 men and 292 women who reported drinking above a threshold limit were r and omized into control ( n = 382 ) or intervention ( n = 392 ) groups . MEASURES Outcomes included alcohol use , emergency department visits , hospital days , legal events , and motor vehicle accidents . RESULTS No significant differences between control and intervention subjects were present for baseline alcohol use , age , socioeconomic status , smoking , depression or anxiety , conduct disorders , drug use , crimes , motor vehicle accidents , or health care utilization . The total economic benefit of the brief intervention was $ 423,519 ( 95 % CI : $ 35,947 , $ 884,848 ) , composed of $ 195,448 ( 95 % CI : $ 36,734 , $ 389,160 ) in savings in emergency department and hospital use and $ 228,071 ( 95 % CI : -$191,419 , $ 757,303 ) in avoided costs of crime and motor vehicle accidents . The average ( per subject ) benefit was $ 1,151 ( 95 % CI : $ 92 , $ 2,257 ) . The estimated total economic cost of the intervention was $ 80,210 , or $ 205 per subject . The benefit-cost ratio was 5.6:1 ( 95 % CI : 0.4 , 11.0 ) , or $ 56,263 in total benefit for every $ 10,000 invested . CONCLUSIONS These results offer the first quantitative evidence that implementation of a brief intervention for problem drinkers can generate positive net benefit for patients , the health care system , and society INTRODUCTION The study was design ed to test a brief intervention for reducing alcohol consumption among moderate to heavy ( hazardous ) drinkers in a busy HMO primary care setting . METHODS In a r and omized controlled trial , hazardous drinkers ( n = 516 ) were identified by the AUDIT screening question naire . Intervention included brief clinician advice ( 30 seconds ) , a 15-minute motivational session by counselors , and printed material s. RESULTS At six-month follow-up , intervention subjects reported fewer total st and ard drinks in the past three months ( 176 versus 216 , P = .04 , one-tailed ) and fewer drinking days per week ( 2.8 versus 3.3 , P = .02 ) than controls , but similar drinks per drinking day ( 3.3 versus 3.5 ; P = .13 ) . At 12 months , intervention subjects again reported fewer drinking days per week ( 2.7 versus 3.1 ; P = .04 ) than controls , but similar numbers of st and ard drinks ( 157 versus 179 ; P = .13 ) and drinks per drinking day ( 3.6 versus 3.3 ; P = .20 ) . Intervention subjects were somewhat more likely than controls to report drinking within daily recommended limits ( < or = 3 for men , < or = 2 for women ) at both six months ( 79 % versus 71 % ; P = .06 ) and 12 months ( 80 % versus 73 % ; P = .07 ) , but did not differ significantly from controls on other drinking outcomes ( percent abstinent , frequency of drinking > or = 6 drinks per drinking occasion , estimated peak blood alcohol concentration ) , or use of medical care in the year following intervention . CONCLUSIONS A one-time , brief motivational intervention using minimal clinician time supplemented by trained counselors result ed in a modest reduction in frequency of alcohol consumption in a busy primary care population . Future research should focus on strengthening and maintaining intervention effects Present methods to screen for alcohol abuse are generally obtrusive and result in referral to services that deal mainly with alcoholics . These factors deter physicians from identifying alcohol abuse patients at an early stage . In the present study , 81 % of all primary care physicians of a single city evaluated ( i ) the efficiency and the acceptability of a nonobtrusive screening method for the identification of problem drinkers and ( ii ) the effectiveness of brief cognitive behavioral counseling given by a nurse in a lifestyle context . Patients ( n = 15,686 ) attending the private practice s of 42 primary -care physicians were asked four alcohol-neutral trauma questions in the reception area . Physicians asked about alcohol use and alcohol-related problems only to patients with previous trauma . Problem drinkers by defined criteria were offered an appointment with a nurse who , by r and om assignment , gave either 3-hr of cognitive behavioral counseling over 1 year or simply advised patients to reduce their alcohol intake . The screening method identified 62 - 85 % of expected number of problem drinkers in this population . Following the application of exclusion criteria , 105 problem drinkers were entered in the intervention part of the study . After 1 year , patients who received counseling showed significant reductions in reported alcohol consumption ( -70 % ; p < 0.001 ) , psychosocial problems ( -85 % ; p < 0.001 ) and serum gamma glutamyl transferase ( -32 % to -58 % ; p < 0.02 ) . Physician visits were reduced ( -34 % ; p < 0.02 ) following counseling . Patients receiving only advice showed neither reductions in psychosocial problems nor in serum gamma glutamyl transferase or physician visits , but reported a 46 % reduction ( p < 0.01 ) in alcohol consumption . Data indicate that asking patients about recent trauma is efficient and is well accepted as the first screening instrument in the identification of the problem drinker . Cost of screening per patient is under one dollar . Counseling of 3 hr given by a nurse is markedly superior ( p < 0.05 ) to simple advice in reducing alcohol consumption , objective indicators of alcohol-related morbidity , and the frequency of physician visits OBJECTIVE Project TrEAT ( Trial for Early Alcohol Treatment ) was design ed to test the efficacy of brief physician advice in reducing alcohol use and health care utilization  in problem drinkers . DESIGN R and omized controlled clinical trial with 12-month follow-up . SETTING A total of 17 community-based primary care practice s ( 64 physicians ) located in 10 Wisconsin counties . PARTICIPANTS Of the 17695 patients screened for problem drinking , 482 men and 292 women met inclusion criteria and were r and omized into a control ( n=382 ) or an experimental ( n=392 ) group . A total of 723 subjects ( 93 % ) participated in the 12-month follow-up procedures . INTERVENTION The intervention consisted of two 10- to 15-minute counseling visits delivered by physicians using a scripted workbook that included advice , education , and contracting information . MAIN OUTCOME MEASURES Alcohol use measures , emergency department visits , and hospital days . RESULTS There were no significant differences between groups at baseline on alcohol use , age , socioeconomic status , smoking status , rates of depression or anxiety , frequency of conduct disorders , lifetime drug use , or health care utilization . At the time of the 12-month follow-up , there were significant reductions in 7-day alcohol use ( mean number of drinks in previous 7 days decreased from 19.1 at baseline to 11.5 at 12 months for the experimental group vs 18.9 at baseline to 15.5 at 12 months for controls ; t=4.33 ; P<.001 ) , episodes of binge drinking ( mean number of binge drinking episodes during previous 30 days decreased from 5.7 at baseline to 3.1 at 12 months for the experimental group vs 5.3 at baseline to 4.2 at 12 months for controls ; t=2.81 ; P<.001 ) , and frequency of excessive drinking ( percentage drinking excessively in previous 7 days decreased from 47.5 % at baseline to 17.8 % at 12 months for the experimental group vs 48.1 % at baseline to 32.5 % at 12 months for controls ; t=4.53 ; P<.001 ) . The chi2 test of independence revealed a significant relationship between group status and length of hospitalization over the study period for men ( P<.01 ) . CONCLUSIONS This study provides the first direct evidence that physician intervention with problem drinkers decreases alcohol use and health re source utilization in the US health care system BACKGROUND This report describes the 48-month efficacy and benefit-cost analysis of Project TrEAT ( Trial for Early Alcohol Treatment ) , a r and omized controlled trial of brief physician advice for the treatment of problem drinking . METHODS Four hundred eighty-two men and 292 women , ages 18 - 65 , were r and omly assigned to a control ( n = 382 ) or intervention ( n = 392 ) group . The intervention consisted of two physician visits and two nurse follow-up phone calls . Intervention components included a review of normative drinking , patient-specific alcohol effects , a worksheet on drinking cues , drinking diary cards , and a drinking agreement in the form of a prescription . RESULTS Subjects in the treatment group exhibited significant reductions ( p < 0.01 ) in 7-day alcohol use , number of binge drinking episodes , and frequency of excessive drinking as compared with the control group . The effect occurred within 6 months of the intervention and was maintained over the 48-month follow-up period . The treatment sample also experienced fewer days of hospitalization ( p = 0.05 ) and fewer emergency department visits ( p = 0.08 ) . Seven deaths occurred in the control group and three in the treatment group . The benefit-cost analysis suggests a 43,000 dollars reduction in future health care costs for every 10,000 dollars invested in early intervention . The benefit-cost ratio increases when including the societal benefits of fewer motor vehicle events and crimes . CONCLUSIONS The long-term follow-up of Project TrEAT provides the first direct evidence that brief physician advice is associated with sustained reductions in alcohol use , health care utilization , motor vehicle events , and associated costs . The report suggests that a patient 's personal physician can successfully treat alcohol problems and endorses the implementation of alcohol screening and brief intervention in the US health care system The objective of the study was to determine the effectiveness of  advice from general practitioners to heavy drinking men ( consuming 350 - 1050 grams of alcohol per week ) to reduce their alcohol consumption .  One hundred and fifty-four men recruited from eight general practice s were allocated r and omly to treatment and control groups . Men in the treatment group received advice from their own general practitioner . At one year follow-up , when analyzed according to intention to treat , the treatment group had reduced their consumption by an excess of 65 grams of alcohol per week when compared with the control group ( p less than 0.05 ) . General practitioners should be recommended to screen for alcohol consumption amongst their patients and to give advice to those found to be at risk because of their drinking This study examined whether a brief intervention to reduce hazardous alcohol consumption among primary care patients reduced use of medical care . In a parent , r and omized controlled trial , at-risk drinkers identified in HMO outpatient waiting rooms were r and omly assigned to receive usual care or brief clinician advice plus a 15-minute motivational counseling session . The current study ( n=514 ) examined the groups ' use of outpatient and inpatient medical services during two years after intervention . Although the intervention reduced alcohol consumption at six-month follow-up , intervention and control groups made similar numbers of outpatient visits ( M=17.7 vs. 18.3 , respectively;p=.47 ) , were equally likely to be hospitalized ( 21.2 % vs. 22.0%;p=.81 ) , and , among those hospitalized , had similar lengths of stay ( 4.7 vs. 6.6 days;p=.37 ) . Although brief interventions to reduce hazardous drinking may potentially reduce medical care utilization , more evidence is needed to substantiate their practicality and cost-effectiveness AIM This paper reports an evaluation of the effectiveness and cost-effectiveness of nurse-led screening and brief intervention in reducing  excessive alcohol consumption among patients in primary health care . BACKGROUND Excessive alcohol consumption is a major source of social , economic and health problems . However , such consumption is responsive to brief alcohol intervention . To date , brief intervention research in primary health care has focused on general practitioner-led interventions , and there is only circumstantial evidence of effectiveness in nurse-led interventions . However , nurses are increasingly taking a lead in health promotion work in primary care . METHODS A pragmatic cluster-r and omized controlled trial was carried out between August 2000 and June 2003 to evaluate the effects of a brief intervention compared with st and ard advice ( control condition ) . A total of 40 general practice clusters ( intervention = 21 and control = 19 ) recruited 127 patients ( intervention = 67 and control = 60 ) to the trial . Excessive consumption was identified opportunistically via the Alcohol Use Disorders Identification Test . After baseline assessment , patients received either a 5 - 10 minutes brief intervention using the ' Drink-Less ' protocol or st and ard advice ( control condition ) . Follow-up occurred at 6 and 12 months postintervention . RESULTS Analysis of variance weighted for cluster size revealed no statistically significant differences between intervention and control patients at follow up . A majority of patients in both conditions reduced their alcohol consumption between assessment and subsequent measurement . Economic analysis suggested that the brief intervention led to no statistically significant changes in subsequent health service re source use relative to st and ard treatment . CONCLUSION The brief intervention evaluated in this trial had no effect over st and ard advice delivered by nurses in primary health care . However , there was a reduction in excessive drinking across both arms of the trial over time . Due to nurse drop-out , this trial was significantly underpowered . Future research should explore barriers to nurses ' involvement in research trials , particularly with an alcohol focus . A larger trial is required to evaluate the effectiveness of nurse-led screening and brief alcohol intervention in primary care We present the cost and cost-effectiveness of referral to an alcohol health worker ( AHW ) and information only control in alcohol misusing patients . The study was a pragmatic r and omised controlled trial conducted from April 2001 to March 2003 in an accident and emergency department ( AED ) in a general hospital in London , Engl and . A total of 599 adults identified as drinking hazardously according to the Paddington Alcohol Test were r and omised to referral to an alcohol health worker who delivered a brief intervention ( n = 287 ) or to an information only control ( n = 312 ) . Total societal costs , including health and social services costs , criminal justice costs and productivity losses , and clinical measures of alcohol consumption were measured . Levels of drinking were observably lower in those referred to an AHW at 12 months follow-up and statistically significantly lower at 6 months follow-up . Total costs were not significantly different at either follow-up . Referral to AHWs in an AED produces favourable clinical outcomes and does not generate a significant increase in cost . A decision-making approach revealed that there is at least a 65 % probability that referral to an AHW is more cost-effective than the information only control in reducing alcohol consumption among AED attendees with a hazardous level of drinking BACKGROUND Alcohol misuse is highly prevalent among people attending emergency departments , but the effect of intervention by staff working in these departments is unclear . We investigated the effect of screening and referral of patients found to be misusing alcohol while attending an emergency department . METHODS We undertook a single-blind pragmatic r and omised controlled trial . Patients received either an information leaflet or an information leaflet plus an appointment with an alcohol health worker . Outcome data were collected by patient interview and examination of hospital records at 6 and 12 months . FINDINGS 599 patients were r and omised over a 12-month period . At 6 months , those referred to an alcohol health worker were consuming a mean of 59.7 units of alcohol per week compared with 83.1 units in the control group ( t -2.4 , p=0.02 ) . At 12 months those referred were drinking 57.2 units per week compared with 70.8 in controls ( t -1.7 , p=0.09 ) . Those referred to the alcohol health worker had a mean of 0.5 fewer visits to the emergency department over the following 12 months ( 1.2 compared with 1.7 , t -2.0 , p=0.046 ) . Differences in quality of life were not found . INTERPRETATION Opportunistic identification and referral for alcohol misuse in an emergency department is feasible , associated with lower levels of alcohol consumption over the following 6 months , and reduces reattendance at the department . Short-term reductions in alcohol consumption associated with referral for brief intervention for alcohol misuse benefit patients and reduce dem and for accident and emergency department services
Objective : This systematic review and meta- analysis examines the effect of  screening and brief intervention ( SBI ) on outpatient , emergency department ( ED ) , and inpatient health care utilization outcomes .
Much of the current literature speculates that SBI provides cost savings through reduced health care utilization , but no systematic review or meta- analysis examines this assertion .