| Intervention Conditionb | 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 |
Fair: nonrandom assignment, control follow-up not assessed, contamination between interventions, baseline differences not controlled for in all analyses |
| 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 |
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: -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 Control group |
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 Control group |
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 Control group |
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 Control group |
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 Control group |
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 Control group |
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 Control group |
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 Control group |
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 Control group |
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 Control group |
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 Control group |
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 Control group |
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.