Table 2.
More than one session patient-centered counseling – no active comparator
| Study | Intervention | Patients | Follow-up times | Outcomes reported | Key findings |
|---|---|---|---|---|---|
| Aalto et al46 2000, Finland | 1. BI sessions at 0, 2, 6, 12, 18, 24, and 30 months (10–20 minutes based on FRAMES) 2. BI sessions at 0, 12, and 24 months 3. Control: patients were advised to reduce drinking and contact GP in the event of health problems |
• N=118 • Female patients consecutively attending four primary care health clinics and one occupational health care clinic • Heavy drinker with self-reported alcohol consumption ≥190 g of absolute ethanol per week • And/or ≥2 affirmative answers on CAGE |
36 months | • Drinking amount per week • Drinking frequency per week • Drinking amount per occasion • CDT • GGT |
• No differences between or within groups at 3 years in alcohol consumption variables • Significant reductions within all groups in MCV • GGT decreased in intervention groups, while not in the control group (difference not statistically significant) |
| Aalto et al47 2001, Finland | 1. BI sessions at 0, 2, 6, 12, 18, 24, and 30 months (10–20 minutes based on FRAMES) 2. BI sessions at 0, 12, and 24 months 3. Control: patients were advised to reduce drinking and contact GP in the event of health problems |
• N=296 • Male patients • Heavy drinker with self-reported alcohol consumption ≥280 g of absolute ethanol per week • And/or ≥3 affirmative answers on CAGE |
36 months | • Drinking amount per week • Drinking frequency per week • Drinking amount per occasion • CDT • GGT |
Grams of alcohol per week: • Intervention groups decreased from 270 (251) and 284 (262) to 272 (302) and 290 (273), respectively; control group decreased from 308 (337) to 338 (371). Differences not significant Drinking frequency per week: • Intervention groups increased from 2.0 (1.6) and 2.4 (1.6) to 2.0 (1.8) and 2.6 (1.8), respectively; control group increased from 2.3 (1.8) to 2.4 (1.9). Differences not significant Usual drinking amount per occasion in grams: • Intervention groups decreased from 154 (86) and 131 (80) to 151 (89) and 125 (76), respectively. Control group increased from 130 (83) to 137 (82). Differences not significant Significant decreases within groups for all groups in MCV: • Intervention groups from 94.5 (4.2) and 94.2 (4.2) to 93.7 (4.1) and 93.2 (4.2); control group from 94.5 (4.0) to 93.2 (3.9) |
| Allen et al48 2011, Russia | 1. MI up to four sessions 2. Control |
• N=441 • Male patients aged 25–54 years recruited from a longitudinal observational study (the Izhevsk Family Study II) • Criteria for hazardous and harmful drinking were: ○ Zapoi in the last year (behavior resulting in ≥2 days of continuous drunkenness) ○ Drinking surrogates (nonbeverage alcohols) in the last year ○ Hangover and/or excessive drunkenness and/or going to sleep clothed due to being drunk twice or more per week on average over the past year ○ Weekly consumption of 250 mL or more of ethanol (from beverages) over the past year |
3 months | • Self-report of hazardous and harmful drinking |
Hazardous drinking over previous month: • Intervention group decreased from 70.5% to 47.5%, control group reduced from 73.8% to 54.0%. Differences not significant (AOR 0.64, 95% CI 0.39–1.06) |
| Beich et al49 2007, Denmark | 1. BI (10-minute session and follow-up session with GP) 2. Control – no intervention |
• N=906 • Listed patients aged 18–64 years, scheduled to see their GP • AUDIT score ≥8 |
12–14 months | • Drinking frequency • Drinking diary • Binge drinking • AUDIT score • Compliance |
Units of alcohol per week: • Intervention group increased from 12.8 (8.7) to 13.5 (11.1); control group increased from 12.9 (9.0) to 13.6 (11.7) • Differences not significant |
| Brown et al50 2007, USA | 1. Male intervention MI (six sessions) 2. Male control 3. Female intervention MI (six sessions) 4. Female control |
• N=897 • Patients (21–59 years) who exceeded recommendations on low-risk drinking • DSM-IV criteria for alcohol abuse or dependence • No alcohol treatment in the past 3 months • Men who exceeded 56 standard drinks in 28 days and men who had >4 standard drinks in any 1 day • Women who exceeded 44 drinks in 28 days and women who had >3 drinks in any 1 day |
3 months | • Number of drinks per month • Risky drinking days per month |
Men in the intervention group: • 17.3% decrease in 28-day alcohol consumption in standard drinks (from 69.4 to 57.4; P<0.001) • 30% decrease in number of risky drinking days (from 6.2 to 4.3; P<0.001) Men in the control group: • 12.9% decrease in 28-day alcohol consumption in standard drinks (from 82.1 to 71.5; P=0.002) • 8.3% decrease in number of risky drinking days (from 7.2 to 6.6; P=0.009) • Decreases in the intervention group significantly larger Women in the intervention group: • 15.7% decrease in 28-day alcohol consumption in standard drinks (from 50.4 to 42.5; P<0.001) • 20.7% decrease in number of risky drinking days (from 5.8 to 4.6; P<0.001) Women in the control group: • 13.5% decrease in 28-day alcohol consumption in standard drinks (P<0.001) • 15.4% decrease in number of risky drinking days (P<0.001) • No differences between groups |
| Curry et al51 2003, USA | 1. BI 2. Control |
• N=307 • Outpatients visiting their primary care provider • Consuming an average of ≥2 alcoholic drinks per day in the past month (chronic drinking) • ≥2 episodes of binge drinking (defined as consuming ≥5 drinks on a single occasion) in the past month • ≥1 episode of driving after consuming ≥3 drinks |
12 months | • Prevalence of at-risk drinking practices and weekly alcohol consumption |
Any at risk drinking pattern reported at 12 months: • Intervention group 57%, control group 43% (P=0.003) Drinks per week: • Intervention group reduced from 14.93 (0.82) to 9.3; control group reduced from 13.56 (0.83) to 9.5. Differences not statistically significant (P=0.40) |
| D’Onofrio et al52 2012, USA | 1. BNI 2. BNI + booster phone call at 1 month 3. Standard care (screening with health questionnaire) |
• N=889 | 12 months | • Past 7-day alcohol consumption • Number of binge-drinking episodes in the past 28 days (>4 drinks per occasion for men and >3 drinks per occasion for women) |
Mean number of drinks in the past 7 days: • Intervention groups reduced from 20.4 (18.8–22.0) and 19.8 (18.3–21.4) to 13.0 (10.5–15.5) and 14.3 (11.9–16.8); control group reduced from 20.9 (18.7–23.2) to 17.6 (14.1–21.2). Differences statistically significant (P=0.045) Mean number of binge days in past 28 days: • Intervention groups reduced from 7.5 (6.8–8.2) and 7.2 (6.5–7.9) to 4.7 (3.9–5.6) and 5.1 (4.2–5.9); control group reduced from 7.2 (6.2–8.2) to 5.8 (4.6–7.0) • Differences statistically significant (P=0.03) |
| Hermansson et al53 2010, Sweden | 1. Comprehensive intervention: patients were offered ≤3 sessions (BI + TLFB + drinking diary over 4 weeks) 2. BI (one 15-minute session) 3. Control: no feedback on screening or verbal counseling |
• N=194 • Adults presenting to an ED |
12 months | • Change in percentage of patients with AUDIT positive |
Change in AUDIT status: • Overall, 51.3% of patients tested positive at baseline, and 22.8% at follow-up (−56% reduction, P<0.0001) • No significant differences between groups intervention groups reduced 1.55 (2.47) and 1.11 (1.95) points, respectively; controls reduced 1.11 (2.12) points (P=0.57) |
| Longabaugh et al54 2001, USA | 1. BI (40 minutes in ED) + booster MI session 2. BI (single 40-minute session) 3. Standard care |
• N=539 • Adults attending an ED • Assessed as a hazardous or harmful drinker; defined by one of three criteria ○ Breath alcohol positive (BAC >0.003 mg/dL) ○ Reported having ingested alcohol in the 6 hours prior to their injury ○ AUDIT score ≥8 |
12 months | • Number of heavy drinking days • Negative consequences from drinking (DrInC) • Alcohol-related injuries (IBC-R) |
Number of heavy drinking days: • BI with booster session had a mean of 1.68 (1.15), BI of 1.72 (1.23) and standard care 1.70 (1.09) • Differences between groups not significant DrInC inventory: • BI with booster had the lowest score, with 2.24 (0.082). BI was 2.40 (0.078) and standard care was 2.52 (0.076) • Differences between groups statistically significant (P=0.005) |
| Maisto et al55 2001, USA | 1. MET (30–45 minutes session + two booster sessions) 2. BI (1×10–15 minutes session) 3. Standard care |
• N=301 • Adults attending a primary care clinic • AUDIT score ≥8 • Or ≥16 standard (0.6 oz ethanol) drinks per week for men and ≥12 drinks for women |
12 months | • Number of drinks in past 30 days • Drinks per drinking days, past 30 days • Number of days in the past month in which patients had between 1–6 drinks |
Days abstinent: • Motivational enhancement therapy group showed the greatest reduction in the difference between baseline to 12-month follow-up: −3.58 (−5.57, −1.58). BI reduced −2.54 (−4.56, −0.53), and standard care −1.16 (−2.67, −0.34) • Regression models showed no significant differences between either MET or BI vs SC Number of drinks: • Motivational enhancement therapy group showed a reduction in the difference between baseline to 12-month follow-up of 22 drinks (11.65, 32.32). BI reduced 33.20 (18.21, 48.19), and standard care reduced 14.24 (4.21, 24.26) • Regression models showed no significant differences between MET vs SC. BI showed a regression coefficient of −1.27 (P<0.05) Drinks per drinking day: • Motivational enhancement therapy group showed a reduction in the difference between baseline to 12-month follow-up of 1.30 (0.64, 1.96). BI reduced 1.55 (0.79, 2.32), and standard care 1.48 (0.85, 2.11) • Regression models showed no significant differences between either MET or BI vs SC |
| Mello et al56 2013, USA | 1. BMI 2. Standard care |
• N=285 • Patients attending the ED • ≥14 drinks/week for male subjects, ≥7 drinks/week for female subjects • Or ≥5 drinks/occasion for males, ≥4 drinks/occasion for females |
12 months | • Changes in AUDIT-C • Alcohol-related injuries • DrInC score |
AUDIT-C score AUDIT-1: • The intervention group decreased from 2.76 (0.89) to 2.33 (0.94); the control group decreased from 2.74 (0.83) to 2.31 (1.07). Differences at 12 months not statistically significant (P=0.87) AUDIT-2: • The intervention group decreased from 1.53 (1.14) to 1.15 (1.03); the control group decreased from 1.59 (1.12) to 1.16 (1.14). Differences at 12 months not statistically significant (P=0.0.97) AUDIT-3: • The intervention group decreased from 1.84 (1.16) to 1.41 (1.13); the control group decreased from 1.88 (1.01) to 1.51 (1.16). Differences at 12 months not statistically significant (P=0.52) Alcohol-related injuries: • Significant decrease favoring the intervention group (difference between baseline and 12-month: −0.33 (0.74) vs −0.16 (0.60); P=0.04) DrInC score: • Intervention group reduced from 3.54 (1.77) to 2.54 (1.72); the control group reduced from 3.38 (1.85) to 2.65 (1.86). Differences between baseline and 12-month score were −1.00 (1.50) for the intervention group and −0.74 (1.70) for the control group • Differences not statistically significant (P=0.09) |
| Monti et al57 2007, USA | 1. MI (30–40 minutes) + 2× telephone booster sessions 2. Feedback only |
• N=198 • Adults attending a level 1 trauma center • Blood alcohol concentration >0.01% • Reported drinking alcohol in the 6 hours prior to the event that caused their visit • Or AUDIT score ≥8 |
12 months | • Number of days drinking • Number of heavy drinking days • Average drinks per week |
Number of days drinking in the last month: • The intervention group reduced from 8.27 (6.35) to 4.52 (5.70); the control group reduced from 7.31 (6.27) to 6.54 (6.24). Differences statistically significant in the treatment × time interaction (P<0.001) Number of heavy drinking days in the last month: • The intervention group reduced from 5.49 (5.94) to 2.72 (4.70); the control group reduced from 4.01 (4.48) to 3.53 (4.28). Differences statistically significant in the treatment × time interaction (P<0.01) Number of drinks per week in the last month: • The intervention group reduced from 13.07 (11.59) to 6.10 (8.33); the control group reduced from 10.77 (10.73) to 8.83 (9.67). Differences statistically significant in the treatment × time interaction (P<0.01) • No differences in RAPI scores at 12 months |
| Noknoy et al58 2010, Thailand | 1. MET (3×15-minute sessions) 2. Control: assessment only |
• N=117 • Consecutive primary care attenders • AUDIT score ≥8 • Patients with alcohol dependence excluded |
6 months | • Amount of alcohol consumption during previous week • Binge drinking episodes during previous week • GGT levels |
Drinks per drinking day in the last week: • The intervention group reduced from 5.19 (4.30) to 2.26 (2.70); the control group reduced from 4.31 (4.23) to 4.02 (4.00). Difference at 6 months statistically significant between groups (P=0.018) Drinks per week in the last week: • The intervention group reduced from 13.27 (15.40) to 4.72 (8.34); the control group reduced from 10.55 (16.96) to 11.24 (17.74). Difference at 6 months statistically significant between groups (P=0.04) Episodes of binge drinking in the last week: • The intervention group reduced from 1.00 (1.49) to 0.45 (1.38); the control group reduced from 0.88 (1.54) to 0.32 (0.72). Difference at 6 months not statistically significant between groups (P=0.139) |
| Sellman et al59 2001, New Zealand | 1. MET (four sessions) 2. NDRL (four sessions) 3. Control: received feedback at initial session |
• N=122 • Alcohol-dependent patients (according to DSM-IV criteria) of a community alcohol service |
6 months | • Abstinence • Heavy drinking (drinking ≥10 standard drinks ≥6 times in the 6-month follow-up period) |
• Abstinence: no differences between groups (MET 11.9%, NDRL 10%, control 7.5%; P=0.51) • Heavy drinking: MET 42.9%, NDRL 62.5%, control 65%; differences between groups significant (P=0.04) |
| Sommers et al60 2013, USA | 1. BI (2×20-minute sessions + one face to face in ED + one telephone visit) 2. Contact control group (20-minute assessment interview) 3. No-contact control group: patients were asked for contact information only and were not interviewed |
• N=476 • Young drivers (18–44 years) at a level I trauma center • Positive on two risky driving and two hazardous drinking items in a 3-minute screening |
12 months | • Self-reported risky driving behaviors • Alcohol consumption |
6 months period: • Absolute risk reduction for maximum number of drinks within a 6-hour period for intervention relative to control group of 0.81 (95% CI, 0.67–0.97). Intervention group decreased two drinks, control only one • Odds ratio for drinking >4 drinks in a day at 6 months for intervention relative to control group of 0.41 (95% CI, 0.17–0.98) • Significance lost at 12-month follow-up |
Notes: AUDIT-1, -2, or -3 refers to the first, second, or third AUDIT question; AUDIT-C is the short version of AUDIT.
Abbreviations: AOR, adjusted odds ratio; AUDIT, Alcohol Use Disorders Identification Test; BAC, blood alcohol content; BI, brief intervention; BMI, brief motivational interviewing; BNI, brief negotiated interview; CAGE, Cut down, Annoyed, Guilty, Eye-opener; CDT, carbohydrate deficient transferrin; CI, confidence interval; DrInC, Drinker Inventory of Consequences; DSM-IV, Diagnostic and statistical manual of mental disorders, fourth edition; FRAMES, Feedback, Responsibility, Advice, Menu, Empathy, Self-efficacy; ED, emergency department; GGT, gamma glutamil transpeptidase; GP, general practitioner; IBC-R, Injury behavior check-list; MCV, mean cell volume; MET, motivational enhancement therapy; MI, motivational interviewing; NDRL, nondirective reflective listening; RAPI, Rutgers alcohol problem index; SC, standard care; TLFB, time line follow back.