Graphic of 4 step screening and assessment process
Step 1: Ask: quantity and frequency, binge, CAGE, and AUDIT
Step 2: Assess: Academic, Social, Behavioral, and Medical
Step 3: Advise Appropriate Action: Iterative process of Brief Intervention, Motivational Interview, and Referral
Step 3: Follow-Up Supportive Care: Iterative process of Brief Intervention, Motivational Interview, and Referral
Public Health Paradigm
The primary goal of brief intervention is to:
Reduce alcohol use to low-risk levels
Encourage abstinence in persons who are alcohol-dependent
Brief Intervention or Brief Talk Therapy
Commonly used by clinicians to talk to patients about health issues or medication compliance
Not unique to the alcohol field
Designed for use in busy clinical settings
Generally 5-10 minute duration
Includes motivational interviewing and Cognitive Behavioral Therapy (CBT) techniques
More clinician-centered than client-centered therapy
Clinician shares concerns with student and tries to convince student to decrease alcohol use
Uses an empathic, non-confrontational style
Offers patient choices
Emphasizes patient responsibility
Conveys confidence in patient's ability to change
Conduct an assessment:
“Tell me about your drinking.” “What do you think about your drinking?”
Provide direct clear feedback:
"As your doctor/therapist, I am concerned about how much you drink and how it is affecting your health."
Establish a treatment contract through negotiation and goal setting:
“You need to reduce your drinking. What do you think about cutting down to three drinks 2-3 times per week?”
Apply behavioral modification techniques:
“Here is a list of situations when students drink and sometimes lose control of their drinking.”
Ask patients to review a self-help booklet and complete diary cards:
“I would like you to review this booklet and bring it with you at your next visit. I’d also like you to write down how much you drink on these diary cards.”
Set up a continuing care plan for nurse reinforcement phone calls and clinic visits.
Brief Intervention Studies in College Students
Source: Marlatt et. al. 1998
348 heavy drinking college freshmen recruited at the University of Washington
Recruitment occurred via self-report questionnaire completed by incoming students
Intervention delivered by research staff
No involvement of primary care clinicians
Follow up at 6, 12 and 24 months
Intervention consisted of
self-monitoring
personalized feedback at year 1
mail feedback at year 2
Experimental group drank significantly less and had fewer self-reported consequences than the control group
Brief Intervention Trials Conducted in Young Adults
Monte et. al. 1999
94 persons age 18 -19 recruited from hospital emergency departments based on an alcohol-related accident
Subjects randomized to brief motivational interview or standard care
Intervention consisted of a 30-60 minute motivational interviewing session with a counselor
Outcome - subjects randomized to the intervention group had fewer negative consequences, reduced drunk driving arrests, and fewer traffic violations
Project TrEAT Fleming, 2002
Trial of Early Alcohol Treatment
64 physicians, 17 sites
17,695 screened
1,705 assessed
774 enrolled (n=225 persons 18-30 years old)
392 experimental
382 control
Follow-up:
12 months 723 (93.4%)
48 months 643 (83.1%)
Percent Drinking Excessively in Past Week
Excessive is more than 13 drinks for a woman and more than 20 for a man.
Line chart with two items.
Item 1: The Experimental Group showed a decrease, over the 48 months, in weekly excessive drinking from approximatley 50 percent to approximately 20 percent.
Item 2: The Control Group showed a decrease, over the 48 months, in weekly excessive drinking from approximatley 50 percent to approximately 25 percent.
Mean Number of Drinks in Past 7 Days
Line chart with two items.
Item 1: The Experimental Group showed a decrease, over the 48 months, in the mean number of drinks consumed in the past 7 days from approximately 19 drinks to approximately 13 drinks.
Item 2: The Control Group showed a decrease, over the 48 months, in the mean number of drinks consumed in the past 7 days from approximately 19 drinks to approximately 14 drinks.
Number of Binge Drinking Episodes Past 30 days
Line chart with two items.
Item 1: The Experimental Group showed a fluctuation over 48 months, starting at approximately 5.5 moving to a low of 3 episodes then rising to just over 4 episodes in the past 30 days.
Item 2: The Control Group showed a fluctuation over 48 months, starting at approximately 5.5 moving to a low of 4 episodes then rising to a high of 6 then declining to approximately 5.5 episodes in the past 30 days.
Percent Doing Any Binge Drinking in Past Month
Binge drinking is defined as more than 4 drinks on single occasion for a woman or more than 5 drinks on single occasion for a man.
Line chart with two items
Item:1 The Experimental Group showed a decrease, over 48 months, from approximately 87 percent doing binge drinking in past month to approximatley 65 percent doing binge drinking in past month.
Item:2 The Control Group showed a decrease, over 48 months, from approximately 87 percent doing binge drinking in past month to approximatley 70 percent doing binge drinking in past month.
48-Month TrEAT Data: Benefit-Cost Analysis
Tabular data for Treatment(n=392) and Control(n=382) Groups
Medical Use: Emergency department visits, Treatment is 420, Control is 664 (Adjusted to equate patient-years).
Medical Use: Days of hospitalization, Treatment is 302, Control is 376 (Adjusted to equate patient-years).
Motor Vehicle Events: Crash with fatalities, Treatment is 0, Control is 2.
Motor Vehicle Events: Crash with non-fatal injuries, Treatment is 20, Control is 31.
Motor Vehicle Events: Crash with property damage only, Treatment is 67, Control is 72.
Motor Vehicle Events: Operating while intoxicated, Treatment is 25, Control is 25.
Motor Vehicle Events: Other moving violations, Treatment is 169, Control is 177.
Legal Events: Assault/battery/child abuse, Treatment is 8 , Control is 11.
Legal Events: Resist/obstruct officer/disorderly, Treatment is 8 , Control is 6.
Legal Events: Controlled substance/liquor violation, Treatment is 2 , Control is 11.
Legal Events: Criminal damage/property damage, Treatment is 2 , Control is 1.
Legal Events: Theft/robbery, Treatment is 3 , Control is 3.
Legal Events: Other arrests, Treatment is 5 , Control is 9.
