4-2 BRIEF PHYSICIAN ADVICE FOR PROBLEM ALCOHOL DRINKERS
Testing for effective alcohol abuse prevention strategies has become an important national research priority.
This article presents the results from project TREAT ("Trial for Early Alcohol Treatment"), the first large US clinical trial conducted in community-based primary care practices to test the efficacy of brief physician advice in reducing alcohol use by problem drinkers.
Conclusion: Physician intervention decreased alcohol consumption.

STUDY

1. Randomized, controlled clinical trial in 17 community-based primary care practices entered over 700 problem drinkers.
2. Problem drinkers were defined as men who drank more than 14 drinks a week (>168 g of alcohol) and women who drank more than 11 drinks a week (>132 g alcohol). None had attended an alcohol treatment program in the previous year, drank more than 50 drinks per week, or had received advice from their physician in the previous 3 months to change their alcohol use.
3. Randomized to intervention and control groups:
   A. Those assigned to the intervention group received a work-book that contained feedback regarding current health behaviors, a review of the prevalence of problem drinking, a list of the adverse effects of alcohol, a worksheet on drinking cues, a drinking agreement in the form of a prescription, and drinking diary cards. Two 15-minute face-to-face visits were scheduled 1 month apart (brief intervention and reinforcement sessions).
   B. Those in the control group were told the trial focused on health behaviors, including alcohol use, smoking, exercise, and weight. None received the alcohol information or the face-to- face physician interventions.
4. Follow-up 12 months

RESULTS

1.

DISCUSSION

1. The study found significant reductions over 1 year in alcohol use and health care utilization among male subjects drinking over 14 drinks per week. Women benefited more from the intervention than men.
2. Binge drinking was also reduced.
3. These findings may be applicable to primary care practices throughout the US.
4. Only 13% of the control group received alcohol consumption advice during the 12-month follow-up.1
5. Two previous large scale trials, WHO and the Medical Research Council (UK) trial reported similar benefits from brief interventions.
6. The trial specifically excluded patients with alcohol dependence. The brief intervention was not tested in this population.
7. The reported reduction in alcohol use in the control group may be related to regression to the mean, historical changes in alcohol use, or the intervention effect of the research procedures. "It is our impression that research procedures can have a significant intervention effect. Each control subject was asked about his or her alcohol use 4 times over the 12-month period."

CONCLUSION
Brief advice protocols can provide a successful strategy for changing drinking behavior and improving health outcomes for at-risk and problem drinkers in primary care settings.
This study provides the first direct evidence that physician intervention with problem drinkers decreases alcohol use and health resource utilization in the US health care system.
JAMA April 2, 1997; 277: 1039-45 Original investigation, first author from Univ. Of Wisconsin Medical School, Madison

Comment:
Problem drinkers are poorly identified by primary care clinicians. Helping interventions are even less likely to be given.
The Physicians Guide to Helping Patients with Alcohol Problems can be obtained from the National Institute of Alcohol Abuse and Alcoholism—NIH Publication 95-3769.
All patients should be screened for alcohol use, including the youth and the elderly. (Perhaps especially the youth and the elderly.) Screening incurs no extra cost, no physical intervention, and has no adverse effects. As the authors suggest, screening and brief physician advice could have enormous implications for the US health care system.
An editorial (p 1079-80) comments that brief physician interventions can also achieve smoking cessation in some patients. RTJ

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