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Screening, Counseling Helps Reduce Risky Drinking

RESEARCH TRIANGLE PARK, N.C. – Screening adults aged 18 and older, including pregnant women, for alcohol misuse and offering brief behavioral counseling interventions can help adults with risky or hazardous drinking reduce their alcohol intake, according to a new draft recommendation statement posted by the United States Preventive Services Task Force. 

The Task Force’s draft recommendation is based on an evidence report by researchers from the RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center.

Alcohol misuse is a leading cause of preventable mortality in the United States and contributes to a variety of health conditions including hypertension, liver problems, anxiety, depression, breast cancer, insomnia, injuries and more.

The report, published in the Sept. 25, 2012, issue of Annals of Internal Medicine, is based on a systematic review of 23 controlled trials that evaluated the effectiveness of behavioral counseling interventions for adults whose alcohol misuse was identified through screening in primary care settings.

The studies included in the report generally evaluated counseling interventions for individuals with risky or hazardous drinking, defined as drinking above recommended amounts. To limit risks for alcohol-related consequences, the National Institute on Alcohol Abuse and Alcoholism recommends no more than three drinks per day and seven drinks per week for women and for anyone older than 65 years of age, and no more than four drinks per day and 14 drinks per week for men.

“Behavioral interventions for unhealthy alcohol use generally aim to moderate an individual’s alcohol consumption to sensible levels and to eliminate risky drinking practices, rather than to achieve complete abstinence,” said Dan Jonas, M.D., M.P.H, co-director of the RTI-UNC Evidence-based Practice Center and lead author of the study.

The researchers found that adults receiving behavioral counseling were less likely to engage in heavy, or binge, drinking than those who did not receive counseling (12 percent reduction). Participants who received counseling also averaged 3.6 fewer drinks per week than those who did not receive counseling and were more likely to limit drinking to the recommended drinking levels over a one-year period (showed an 11 percent increase).

“Long-term outcomes revealed that participants who received behavioral counseling maintained reductions in consumption or continued to reduce consumption further for up to 48 months,” said Janice Brown, a research clinical psychologist at RTI International and one of the report’s co-authors.

Some evidence suggests that counseling also reduced the frequency of hospital stays, emergency room visits and primary care visits for those undergoing treatment.

However, for other alcohol-related health outcomes, such as mortality, quality of life, alcohol-related automobile accidents and alcohol-related liver problems, the report found insufficient evidence from randomized controlled trials to determine whether behavioral counseling made an impact.

According to the report, the most effective interventions were those that included multiple brief (10 to 15 minutes) contacts, conducted either in person or in person with telephone follow-ups. Very brief (up to five minutes) and brief single-contact interventions were found to be ineffective or less effective.

The authors caution that because most of the trials included in the report excluded or substantially limited subjects with alcohol dependence, the report’s findings are unlikely to be applicable to individuals with alcohol dependence, and that such individuals require different interventions, such as 12-step programs and medications.

The review was conducted by the RTI-UNC Evidence-based Practice Center, a collaboration between RTI and the five health professions schools and the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. The project was supported by the Agency for Healthcare Research and Quality (AHRQ).  This report informed the Task Force’s draft recommendation statement on screening and behavioral counseling for alcohol misuse, available for public comment at http://www.uspreventiveservicestaskforce.org/tfcomment.htm.