Article

Most studies support the idea of the “J-shaped curve” in which moderate consumption of alcohol reduces mortality because of the reduction in some forms of cardiovascular disease.¹ This effect is seen in people >50 years of age and means that reductions in moderately heavy drinking towards “safe” levels may have disproportionate health gains in this group.

The study by Fleming et al targets an appropriate group of people. All are well over 50 years of age and the selection criteria require that they are all drinking “not much too much”. In this sample, the least severely affected are drinking within “safe” limits, and many of them will be the “pre-problem drinkers” who we should be targeting. The sample is heterogeneous, which is an advantage because it covers most types of potentially harmful drinking.

The intervention is simple, brief, and translatable to the “real world”. The results at 1 year are worthwhile. The control group shows that general health advice does not translate into changes in drinking behavior and specific advice is necessary. Furthermore, in the control group some evidence showed that “untreated” problem drinking worsened.

This study should encourage primary care workers and community mental health workers to make screening for alcohol use and brief intervention part of the normal package of care.