Behavioral counseling associated with reduced alcohol consumption in people with at-risk drinking

Brief counseling interventions are associated with improved behavioral outcomes for adults who engage in risky drinking, a study found.

To evaluate the benefits and harms of behavioral counseling interventions for adolescents and adults who misuse alcohol, researchers considered 23 controlled trials of at least six months that enrolled people who misused alcohol (as identified by screening in primary care settings). People with alcohol dependence were generally excluded from the studies. No studies randomly assigned patients, practices, or clinicians to screening and comparison groups, but all randomly assigned patients to treatment after they had positive screening results.

The study was published online Sept. 25 by Annals of Internal Medicine.

The best evidence was for 10- to 15-minute multicomponent interventions. In 10 trials of 4,332 patients, intervention reduced alcohol consumption by 3.6 drinks per week from baseline (95% CI, 2.4 to 4.8 drinks/week). Among seven trials of 2,737 patients, 12% fewer adults who received intervention reported heavy drinking episodes (risk difference, 0.12; 95% CI, 0.07 to 0.16), and among nine trials with 5,973 patients, 11% more adults reported drinking under the recommended limits (risk difference, 0.11; 95% CI, 0.08 to 0.13) over 12 months compared with control participants (a finding the reviewers labeled as having moderate strength of evidence).

Long-term outcomes from two studies revealed that participants in the intervention groups maintained reductions in consumption or continued to reduce consumption, but differences between intervention and control groups were no longer statistically significant by 48 months.

Evidence was insufficient to draw conclusions about effects on accidents, injuries or alcohol-related liver problems. Trials enrolling young adults or college students showed reduced consumption and fewer heavy drinking episodes (moderate strength of evidence). Little or no evidence of harms was found, such as impaired physician-patient relationship, except for opportunity costs from time spent on the interventions, which ranged from five minutes to two hours over several in-person or telephone visits.

Researchers estimated that positive screening results would require five to 10 minutes of follow-up to assess whether patients have alcohol abuse or dependence issues and should probably be referred for specialized treatment, instead of brief behavioral counseling interventions.

“Nevertheless, support systems are probably required for effective screening and intervention. In addition, most interventions required training providers or staff,” they wrote.