EFFECTIVENESS OF PHYSICIAN-BASED INTERVENTIONS WITH PROBLEM DRINKERS - A REVIEW

Objective: To review the results of randomized controlled trials on th e effectiveness of brief physician interventions with problem drinkers . Data sources: The MEDLINE and EMBASE databases were searched for art icles published from 1966 and 1972 respectively, with the terms blem/c ontrolled/responsible/moderate/risk/drink''; ''advice/drink''; ''physi cian, nurse, general practitioner''; and ''random.'' Forty-three artic les were identified in the EMBASE search and 112 articles in the MEDLI NE search. Study selection: All trials examining the effectiveness of interventions by physicians in reducing alcohol consumption among prob lem drinkers attending a health-care facility were reviewed. Trials in volving subjects attending an alcohol treatment clinic and those invol ving interventions delivered solely by nonphysicians were excluded. El even trials met the final selection criteria. Data extraction: For eac h article, two of the authors independently assigned a score from 0 to 2 on a number of criteria for validity and generalizability. Data syn thesis: The four trials with the highest validity scores showed that m en in the intervention groups reduced their weekly alcohol consumption by five to seven standard drinks more than the men in the control gro ups. Results for women were inconsistent. No convincing evidence of de clines in alcohol-related morbidity among men or women was found. Conc lusions: The trials support the use of brief interventions by physicia ns for patients with drinking problems. Although further studies are n eeded to determine their effect on morbidity and mortality, the public health impact of such interventions is potentially enormous. Further research is needed to determine which patients are best suited for bri ef interventions, the optimal intensity of treatment and which compone nts of brief interventions are most effective. Research is also needed to establish which strategies are effective in inducing physicians to use brief interventions.