Brief interventions are effective in primary health care settings in reducing hazardous and harmful alcohol consumption. Ten patients need to be advised for one patient to benefit. This compares favourably with brief advice from a general practitioner to cigarette smokers, where about 20 patients need to be offered advice to quit for one to benefit; the ratio improves to about 10 with the addition of pharmacotherapy. There is little evidence for a dose response effect and it does not seem that extended interventions are any more effective than brief interventions. The effectiveness is certainly maintained for up to one year and maybe be maintained for up to four years.
Brief interventions are effective in primary health care settings in reducing alcohol related problems amongst persons with harmful alcohol consumption, but without alcohol dependence. Eight patients need to be advised for one patient to benefit. Brief interventions are also effective in reducing mortality. 282 patients need to receive advice to prevent one death within one year.
Brief interventions appear to be to equally effective for men and women, and for young and old.They appear to be more effective for less serious problems. The evidence to date suggests that interventions during pregnancy are ineffective.
Very little is known about the effectiveness of the different components of the intervention. However, b ased on the contents of evaluated interventions, three essential elements of brief counselling have been proposed, including the giving of brief advice, the assessment and tailoring of the advice to stages of change and the offer of follow-up . There is mixed evidence to suggest that interventions with more than one session are any more effective than one session alone. Motivational interviewing appears to be an effective intervention technique.
1. Primary health care physicians and other primary health care professionals should offer a brief (10-15 minute) intervention to all patients identified with hazardous or harmful alcohol consumption.
2. Effective interventions to reduce hazardous and harmful alcohol consumption include an initial counselling session of about 15 minutes, feedback, advice, and goal-setting. Most also include further assistance and follow-up. Interventions can be described with reference to the 5-As behavioural counselling framework: assess alcohol consumption with a brief screening tool followed by clinical assessment as needed; advise patients to reduce alcohol consumption to moderate levels; agree on individual goals for reducing alcohol use or abstinence (if indicated); assist patients with acquiring the motivations, self-help skills, or supports needed for behaviour change; and arrange follow-up support and repeated counselling, including referring dependent drinkers for specialty treatment (US Preventive Services Task Force 2004).