Evelyn P. Whitlock, MD, MPH; Michael R. Polen, MA; Carla A. Green, PhD, MPH; Tracy Orleans, PhD; Jonathan Klein, MD, MPH
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Acknowledgments: Shannon Sanner, MPH, contributed invaluable assistance in the conduct of this review and preparation of its results. Al Berg, MD, MPH, and Al Siu, MD, MSPH, provided critical oversight and assistance for the USPSTF. David Atkins, MD, MPH, and Eve Shapiro, Managing Editor of the USPSTF, provided insightful editorial assistance. Elizabeth Haney, MD; Jae Douglas, PhD; and Nancy Perrin, PhD, provided outcome summary and statistical assistance, and Martha Swain provided editorial support.
Grant Support: This study was conducted by the Oregon Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality, Rockville, Maryland (contract 290-97-0018, task order no. 2).
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Evelyn P. Whitlock, MD, MPH, Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227-1110.
Current Author Addresses: Dr. Whitlock and Mr. Polen: Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227-1110.
Dr. Green: Department of Public Health & Preventive Medicine, Oregon Health & Science University, CB669, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098.
Dr. Orleans: The Robert Wood Johnson Foundation, Route 1 and College Road East, Princeton, NJ 08543.
Dr. Klein: Department of Adolescent Medicine, University of Rochester, 601 Elmwood Avenue, Box 690, Rochester, NY 14642.
Primary health care visits offer opportunities to identify and intervene with risky or harmful drinkers to reduce alcohol consumption.
To systematically review evidence for the efficacy of brief behavioral counseling interventions in primary care settings to reduce risky and harmful alcohol consumption.
Cochrane Database of Systematic Reviews, Database of Research Effectiveness (DARE), MEDLINE, Cochrane Controlled Clinical Trials, PsycINFO, HealthSTAR, CINAHL databases, bibliographies of reviews and included trials from 1994 through April 2002; update search through February 2003.
An inclusive search strategy (alcohol* or drink*) identified English-language systematic reviews or trials of primary care interventions to reduce risky/harmful alcohol use. Twelve controlled trials with general adult patients met our quality and relevance inclusion criteria.
Investigators abstracted study design and setting, participant characteristics, screening and assessment procedures, intervention components, alcohol consumption and other outcomes, and quality-related study details.
Six to 12 months after good-quality, brief, multicontact behavioral counseling interventions (those with up to 15 minutes of initial contact and at least 1 follow-up), participants reduced the average number of drinks per week by 13% to 34% more than controls did, and the proportion of participants drinking at moderate or safe levels was 10% to 19% greater compared with controls. One study reported maintenance of improved drinking patterns for 48 months.
Behavioral counseling interventions for risky/harmful alcohol use among adult primary care patients could provide an effective component of a public health approach to reducing risky/harmful alcohol use. Future research should focus on implementation strategies to facilitate adoption of these practices into routine health care.
Do behavioral counseling interventions in primary care reduce risky or harmful alcohol use? What are elements of effective interventions? Do such interventions improve health outcomes?
What methods were used to identify risky/harmful drinkers for behavioral counseling interventions in primary care?
What adverse effects are associated with interventions addressing risky/harmful drinkers in primary care?
What health care system influences are present in effective interventions for risky and harmful drinkers in primary care?
Analytic framework and key questions (KQs).
Literature search and retrieval results.
Risky/harmful alcohol use: quality recheck instrument.
Table 1. Criteria for Grading the Internal Validity of Individual Studies
Appendix Table 1. Literature Search Terms
Appendix Table 2. Excluded Studies and Reasons for Exclusion
Advice to reduce current drinking and/or about guidelines for low-risk use.
Feedback about current drinking patterns, problem indicators (such as laboratory results), or medical consequences of current use patterns.
Explicit goal-setting, usually for moderation and not abstinence.
Assistance in achieving the goal, including providing a menu of options for change, helping patients develop skills for managing high-risk drinking situations (for example, recognizing antecedents, planning ahead, pacing drinking), coping with problems without drinking, and providing self-help materials.
Providing follow-up in the form of telephone calls, repeat visits, or repeated monitoring of laboratory test results, physical examinations, and the like.
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Whitlock EP, Polen MR, Green CA, Orleans T, Klein J. Behavioral Counseling Interventions in Primary Care To Reduce Risky/Harmful Alcohol Use by Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. ;140:557–568. doi: 10.7326/0003-4819-140-7-200404060-00017
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Published: Ann Intern Med. 2004;140(7):557-568.
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