BRIEF PHYSICIAN ADVICE FOR PROBLEM ALCOHOL DRINKERS - A RANDOMIZED CONTROLLED TRIAL IN COMMUNITY-BASED PRIMARY-CARE PRACTICES

Objective.-Project TrEAT (Trial for Early Alcohol Treatment) was desig ned to test the efficacy of brief physician advice in reducing alcohol use and health care utilization in problem drinkers. Design.-Randomiz ed controlled clinical trial with 12-month follow-up. Setting.-A total of 17 community-based primary care practices (64 physicians) located in 10 Wisconsin counties. Participants.-Of the 17 695 patients screene d for problem drinking, 482 men and 292 women met inclusion criteria a nd were randomized into a control (n=382) or an experimental (n=392) g roup. A total of 723 subjects (93%) participated in the 12-month follo w-up procedures. Intervention.-The intervention consisted of two 10- t o 15-minute counseling visits delivered by physicians using a scripted workbook that included advice, education, and contracting information . Main Outcome Measures.-Alcohol use measures, emergency department vi sits, and hospital days. Results.-There were no significant difference s between groups at baseline on alcohol use, age, socioeconomic status , smoking status, rates of depression or anxiety, frequency of conduct disorders, lifetime drug use, or health care utilization. At the time of the 12-month follow-up, there were significant reductions in 7-day alcohol use (mean number of drinks in previous 7 days decreased from 19.1 at baseline to 11.5 at 12 months for the experimental group vs 18 .9 at baseline to 15.5 at 12 months for controls; t=4.33; P<.001), epi sodes of binge drinking (mean number of binge drinking episodes during previous 30 days decreased from 5.7 at baseline to 3.1 at 12 months f or the experimental group vs 5.3 at baseline to 4.2 at 12 months for c ontrols; t=2.81; P<.001), and frequency of excessive drinking (percent age drinking excessively in previous 7 days decreased from 47.5% at ba seline to 17.8% at 12 months for the experimental group vs 48.1% at ba seline to 32.5% at 12 months for controls; t=4.53; P<.001). The chi(2) test of independence revealed a significant relationship between grou p status and length of hospitalization over the study period for men ( P<.01). Conclusions.-This study provides the first direct evidence tha t physician intervention with problem drinkers decreases alcohol use a nd health resource utilization in the US health care system.