Summary of the Evidence: Behavioral Counseling Interventions in Primary Care to Reduce Risky/Harmful Alcohol Use by Adults

You Are Here: AHRQ Home > Clinical Information > U.S. Preventive Services Task Force (USPSTF) > Guide to Clinical Preventive Services, 2001-2004 > Screening: Alcohol Misuse > Summary of the Evidence

Table 2. Components of Interventions and Alcohol Outcomes among Adult Alcohol Intervention Trials, by Intervention Intensity^a

Intervention Condition^b	Study	Population	Setting/Duration	Intervention	Outcomes	Study Quality
Very brief intervention conditions	Richmond et al.⁶¹ ^c	378 adults age 18-70 y; baseline mean alcohol consumption: 38.5 drinks/wk	40 Australian primary care practices (119 physicians) Outcomes assessed at 12 mo	Group 1: alcohol assessment placed on chart before visit (n= 93) Group 2: Same as group 1 plus 5-min physician advice and self-help manual (n= 96)	Group 1 Mean drinks/wk:^d 21.5 (women); 36.2 (men) Not bingeing: NR Moderate/safe drinking: 21.5% Group 2 Mean drinks/wk: 24.2 (women); 39.3 (men) Not bingeing: NR Moderate/safe drinking: 22.9% (P=NS)	Fair: nonrandom assignment, control follow-up not assessed, contamination between interventions, baseline differences not controlled for in all analyses
Very brief intervention conditions	WHO Brief Intervention Study⁵⁸ ^e (group 1)	1559 adults age 18-70 y; baseline alcohol consumption: NR	Various outpatient medical settings in 8 countries, including United States Outcomes assessed at an average of 9 mo	Group 1: 5-min clinician advice	Group 1 Mean drinks/wk: NR Not bingeing: NR Moderate/safe drinking: 43% (women), 43% (men) Control group Mean drinks/wk: NR Not bingeing: NR Moderate/safe drinking: 35% (women) (P=NS), 35% (men) (P < 0.05)	Fair: possible noncomparable groups at baseline and follow-up, potential contamination across intervention conditions
Brief intervention conditions	Anderson and Scott⁵⁴	154 men age 17-69 y; baseline mean alcohol consumption: 52 drinks/wk	8 primary care group practices in United Kingdom Outcomes assessed at 12 mo	10-min clinician advice	Intervention group Change in mean drinks/wk: -15.7 Not bingeing: 77.50% Moderate/safe drinking: 17.50% Control group Change in mean drinks/wk: -9.2 (P= 0.06) Not bingeing: 60.81% (P< 0.05) Moderate/safe drinking: 5.41% (P< 0.05)	Good: relatively high attrition levels (31% and 39%), but baseline-forward-replacement of missing values analysis reported
	Maisto et al.⁶⁰ ^e (group 1)	301 adults age = 21 y; baseline alcohol consumption: 5.5 drinks/drinking day	12 primary care clinics in the United States Outcomes assessed at 12 mo	Group 1: 10- to 15-min advice from research staff	Group 1 Change in mean drinks/drinking day: -0.79 Change in mean drinks/wk: -8.3 Not bingeing: NR Moderate/safe drinking: NR Control group Change in mean drinks/drinking day: -0.85 (P= NS) Change in mean drinks/week: -3.6 (P= NS) Not bingeing: NR Moderate/safe drinking: NR	Fair: high attrition (23%) without addressing loss to follow-up, unclear blinding, potential contamination between groups
	Nilssen⁵⁷ ^d,e (group 1)	338 participants age 12-62 y (mean, 42 y); baseline alcohol consumption: NR	Residents of Tromso, Norway Outcomes assessed at 12 mo	Feedback given about biological assay results at study-initiated visit.	Group 1 Mean alcohol consumption, g/d: 15.6 Not bingeing: NR Moderate/safe drinking: NR Control group Mean alcohol consumption, g/d: 39.2 (P< 0.001) Not bingeing: NR Moderate/safe drinking: NR	Fair: unclear allocation concealment, blinding of outcome assessment, possible non-comparable groups at baseline and follow-up
	Scott and Anderson⁵⁹	72 women age 17-69 y; baseline mean alcohol consumption: 35.3 drinks/wk	8 primary care group practices in United Kingdom Outcomes assessed at 12 mo	10-min clinician advice	Intervention group Change in mean drinks/wk: -11.6 Not bingeing: 87.9% Moderate/safe drinking: 27% Control group Change in mean drinks/wk: -10.0 (P= NS) Not bingeing: 84.6% (P= NS) Moderate/safe drinking: 26% (P=NS)	Fair: noncomparable groups at baseline, unclear allocation concealment, possible contamination of controls, inadequate power
	Senft et al.⁵⁶	516 adults age ≥21 y; mean baseline alcohol consumption: 16.5 drinks/wk	3 primary care clinics in an HMO in the United States	30-sec clinician advice plus 15-min motivational interview with study counselor	Intervention group Mean drinks/wk: 13.1 Not bingeing: 77% Moderate/safe drinking: 80% Control group Mean drinks/wk: 14.9 (P= NS) Not bingeing: 77% (P=NS) Moderate/safe drinking: 73.1% (P= 0.07)	Good: although high attrition (20%) (and differentially greater in intervention group), baseline-forward-replacement of missing values showed no effect on results
	WHO Brief Intervention Study⁵⁸ ^d,e (group 2)	1559 adults age 18-70 y; baseline consumption: NR	Various outpatient medical settings in 8 countries, including United States Outcomes assessed at an average of 9 mo	Group 2: 15-min advice from health care provider	Group 2 Mean drinks/wk: NR Mean cL alcohol/d: males, 5.18; females, 3.39 Not bingeing: NR Moderate/safe drinking: males, 43%; females: 39% Control group Mean drinks/wk: NR Mean cL alcohol/d: males, 6.29 (P< 0.001); females, 3.80 (P= NS) Not bingeing: NR Moderate/safe drinking: Males, 35% (P< 0.05); females, 35% (P= NS)	Fair: possible noncomparable groups at baseline and follow-up, potential contamination across intervention conditions
Brief multicontact intervention conditions	Curry et al.⁵⁰	307 adults; mean age, 48.2 y; baseline alcohol consumption: 14.9 drinks/wk	Patients of 23 clinicians in an HMO in the United States Outcomes assessed at 12 mo, adjusted for missing data	<5-min motivational clinician message, self-help manual, and up to 3 phone calls from research health educator	Intervention group Mean drinks/wk: 10.6 Not bingeing: 86% Moderate/safe drinking: 57% Control group Mean drinks/wk: 10.6 (P > 0.2) Not bingeing: 81% (P > 0.2) Moderate/safe drinking: 43 (P= 0.048)	Good: high, differential attrition (34% and 22%) addressed by multiple imputation procedure
	Fleming et al.⁵³	774 adults age 18-65 y; mean baseline alcohol consumption: 19.1 drinks/wk	17 primary care practices in the United States Outcomes assessed at 12 mo	2 brief clinician visits, each followed by phone call from nurse	Intervention group Mean drinks/wk: 11.5 Not bingeing: 52% Moderate/safe drinking: 84.7% Control group Mean drinks/wk: 15.5 (P < 0 .001) Not bingeing: 31.7% (P < 0.001) Moderate/safe drinking: 68.9% (P< 0.001)	Good: low attrition (10%, slightly differential between groups), baseline-forward-replacement of missing values
	Fleming et al.⁵¹	158 adults age 65 y; mean baseline alcohol consumption: 16 drinks/wk	24 primary care practices in the United States Outcomes assessed at 12 mo	Two 10- to 15-min clinician visits, each followed by phone call from nurse	Intervention group Mean drinks/wk: 9.9 Not bingeing: 69.2% Moderate/safe drinking: 84.6% Control group Mean drinks/wk: 16.3 (P<0.001) Not bingeing: 50.8% (P< 0.025) Moderate/safe drinking: 65.7% (P< 0.005)	Good: all criteria met
	Maisto et al.⁶⁰ ^e (group 2)	301 adults age = 21 y; baseline alcohol consumption: 5.5 drinks/drinking day	12 primary care clinics in the United States Outcomes assessed at 12 mo	30- to 45-min motivational session with research interventionist plus two 15- to 20-min booster sessions	Group 2 Change in mean drinks/drinking day: -0.64 Change in mean drinks/wk: -5.5 Not bingeing: NR Moderate/safe drinking: NR Control group Change in mean drinks/drinking day: -0.85 (P= NS) Change in mean drinks/wk: -3.6 (P= NS) Not bingeing: NR Moderate/safe drinking: NR	Fair: high attrition (23%) without addressing loss to follow-up, unclear blinding, potential contamination between groups
	Nilssen⁵⁷ ^e,f (group 2)	338 participants age 12-62 y (mean, 42 y); baseline alcohol consumption: NR	Residents of Tromso, Norway Outcomes assessed at 12 mo	Feedback given about biological assay results at study-initiated visit; participants invited to repeat visits with laboratory tests until gamma-glutamyltransferase level normalized	Group 2 Mean alcohol consumption, g/d: 13.5 Not bingeing: NR Moderate/safe drinking: NR Control group Mean alcohol consumption, g/d: 39.2 (P < 0.001) Not bingeing: NR Moderate/safe drinking: NR	Fair: unclear allocation concealment, blinding of outcome assessment, possible noncomparable groups at baseline and follow-up
	Ockene⁵²	530 adults age 21-70 y; mean baseline alcohol consumption: 18.9 drinks/wk	4 primary care sites (93 clinicians) in the United States Outcomes assessed at 6 mo	5- to 10-min tailored consultation with clinician plus follow-up visit	Intervention group Change in mean drinks/week: -6.0 Not bingeing: 31% Not bingeing and moderate/safe drinking: 38.7% Control group Change in mean drinks/wk: -3.1 (P = 0.003) Not bingeing: 26% (P = NS) Not bingeing and moderate/safe drinking: 28.3% (P< 0.05)	Good: met all criteria
	Wallace et al.⁵⁵ ^d	909 adults age 17-69 y; mean baseline alcohol consumption: 35.1 (females) and 62.2 (males) drinks/wk	47 group practices in England and Scotland	1 or 2 visits with clinician with up to 5 visits as needed	Intervention group Mean drinks/week: females, 23.6; males, 44.0 Binge/heavy episodes: NR Moderate/safe drinking: females, 47.7%; males, 43.7% Control group Mean drinks/wk: females, 30.4 (P < 0.05); males: 55.6 (P<0.001) Binge/heavy episodes: NR Moderate/safe drinking: females, 29.2% (P <0.05); males, 25.5% (P< 0.001)	Good: met all criteria

^aCG = control group; NR = outcome not reported; NS = reported as non--statistically significant in study; WHO = World Health Organization.

^bIncludes 15 intervention conditions from 12 studies. Multiple intervention groups from Maisto⁶⁰, Nilssen⁵⁷, and WHO⁵⁸ are further detailed in Appendix Table 3. Intervention definitions: "very brief" interventions include up to 5 minutes at initial contact with no follow-up contacts; "brief" interventions include up to 15 minutes at initial contact with no follow-up contact; "brief multi-contact" interventions include up to 15 minutes at initial contact with multiple follow-up contacts.

^cThis study contributed 2 minimal intervention conditions, designated here as group 1 and group 2.

^dMean drinks per week was reported as change scores from baseline for Ockene⁵², Anderson and Scott⁵⁴, Maisto⁶⁰, and Scott and Anderson⁵⁹. Two studies—Nilssen⁵⁷ and WHO⁵⁸—did not report mean drinks/wk but did report average daily consumption measures, with some statistically significant between-group differences (Appendix Table 3).

^eTrial results considered in 1996 U.S. Preventive Services Task Force recommendation for screening to detect problem drinking.

^fThis study reported 2 intervention conditions—designated here as group 1 and group 2—and 1 control.

Return to Document

Table 2. Components of Interventions and Alcohol Outcomes among Adult Alcohol Intervention Trials, by Intervention Intensitya

Table 2. Components of Interventions and Alcohol Outcomes among Adult Alcohol Intervention Trials, by Intervention Intensity^a