Brief intervention in primary care settings. A primary treatment method for at-risk, problem, and dependent drinkers

Abstract

Primary health care providers identify and treat many patients who are at risk for or are already experiencing alcohol-related problems. Brief interventions--counseling delivered by primary care providers in the context of several standard office visits--can be a successful treatment approach for many of these patients. Numerous trials involving a variety of patient populations have indicated that brief interventions can reduce patients' drinking levels, regardless of the patients' ages and gender. In clinical practice, brief interventions can help reduce the drinking levels of nondependent drinkers who drink more than the recommended limits, facilitate therapy and abstinence in patients receiving pharmacotherapy, and enhance the effectiveness of assessment and treatment referral in patients who do not respond to brief interventions alone. Despite the evidence for their usefulness, however, brief interventions for alcohol-related problems have not yet been widely implemented in primary care settings.

Figure 1

The relationship between alcohol use (grams [g] of alcohol per week) and mortality (deaths per 1,000), both from violence (blue bars) and from causes other than violence (yellow bars), in young men ages 18 to 19. The risk of violent death increases steadily with increasing alcohol consumption. Conversely, the risk of death from other causes remains relatively low at a consumption level less than 400 g alcohol (or 28 standard drinks) per week but increases substantially with a weekly alcohol consumption of more than 400 g. Source: Andreasson et al. 1988.

Figure 2

The relationship in men and women between alcohol use (i.e., grams of alcohol per day [g/day]) and the relative risk of developing liver cirrhosis. The lines represent the results of six different studies. In each of these studies, the risk for liver cirrhosis increased with increasing alcohol consumption. ¹Data for alcohol consumption greater than 70 g/day are not shown. f = female subjects; m = male subjects. NOTE: References for the six studies are as follows: Coates, R.A.; Halliday, M.L.; Rankin, J.G.; Feinman, S.V.; and Fisher, M.M. Risk of fatty infiltration or cirrhosis of the liver in relation to ethanol consumption: A case-control study. Clinical and Investigative Medicine—Medecine Clinique et Experimentale 9:26–32, 1986. Kagan, A.; Yano, K.; Roads, G.; and McGee, D.L. Alcohol and cardiovascular disease: The Hawaiian experience. Circulation 64(3):III27–31, 1981. Klatsky, A.L.; Friedman, G.D.; and Seigelaub, A.B. Alcohol and mortality: A ten-year Kaiser-Permanente experience. Annals of Internal Medicine 95:139–145, 1981. Kono, S.; Ikeda, M.; Tokudome, A.; Nishizumi, M.; and Kuratsune, M. Alcohol and mortality: A cohort study of male Japanese physicians. International Journal of Epidemiology 15:527–532, 1986. Pequinot, G.; Tuyns, A.J.; and Berta, J.L. Ascitic cirrhosis in relation to alcohol consumption. International Journal of Epidemiology 7:113–120, 1978. Tuyns, A.J., and Pequinot, G. Greater risk of ascitic cirrhosis in females in relation to alcohol consumption. International Journal of Epidemiology 14:53–57, 1984. SOURCE: Anderson et al. 1993.