METAANALYSIS OF RANDOMIZED CONTROL TRIALS ADDRESSING BRIEF INTERVENTIONS IN HEAVY ALCOHOL DRINKERS

OBJECTIVE: To assess the effectiveness of brief interventions in heavy drinkers by analyzing the outcome data and methodologic quality. DESI GN: (1) Qualitative analysis of randomized control trials (RCTs) using criteria from Chalmers' scoring system: (2) calculating and combining odds ratios (ORs) of RCTs using the One-Step (Peto) and the Mantel-Ha enszel methods. STUDY SELECTION AND DATA ANALYSIS: A MEDLINE and PsycL IT search identified RCTs testing brief interventions in heavy alcohol drinkers. Brief interventions were less than 1 hour and incorporated simple motivational counseling techniques much like outpatient smoking cessation programs. By a single-reviewer, nonblinded format, eligible studies were selected for adult subjects, sample sizes greater than 3 0, a randomized control design, and incorporation of brief alcohol int erventions. Methodologic quality was assessed using an established sco ring system developed by Chalmers and colleagues. Outcome data were co mbined by the One-Step (Peto) method; confidence limits and chi(2) tes t for heterogeneity were calculated. RESULTS: Twelve RCTs met all incl usion criteria, with an average quality score of 0.49 +/- 0.17. This w as comparable to published average scores in other areas of research ( 0.42 +/- 0.16). Outcome data from RCTs were pooled, and a combined OR was close to 2 (1.91; 95% confidence interval 1.61-2.27) in favor of b rief alcohol interventions over no intervention. This was consistent a cross gender, intensity of intervention, type of clinical setting, and higher-quality clinical trials. CONCLUSIONS: Heavy drinkers who recei ved a brief intervention were twice as likely to moderate their drinki ng 6 to 12 months after an intervention when compared with heavy drink ers who received no intervention. Brief intervention is a low-cost, ef fective preventive measure for heavy drinkers in outpatient settings.