Brief physician- and nurse practitioner-delivered counseling for high-riskdrinkers - Does it work?

Background: There is a need for primary care providers to have brief effect ive methods to intervene with highrisk drinkers during a regular outpatient visit. Objective: To determine whether brief physician- and nurse practitioner-del ivered counseling intervention is efficacious as part of routine primary ca re in reducing alcohol consumption by high-risk drinkers. Methods: Academic medical center-affiliated primary care practice sites wer e randomized to special intervention or to usual care. From a screened popu lation of 9772 patients seeking routine medical care with their primary car e providers, 530 high-risk drinkers were entered into the study. Special in tervention included training providers in a brief (5- to 10-minute) patient -centered counseling intervention, and an office support system that screen ed patients, cued providers to intervene, and made patient education materi als available. The primary outcome measures were change in alcohol use from baseline to 6 months as measured by weekly alcohol consumption and frequen cy of binge drinking episodes. Results: Participants in the special intervention and usual care groups wer e similar on important background variables and potential confounders excep t that special intervention participants had significantly higher baseline levels of alcohol usage (P = .01). At 6-month follow-up, in the 91% of the cohort who provided follow-up information, alcohol consumption was signific antly reduced when adjusted for age, sex, and baseline alcohol usage (speci al intervention, -5.8 drinks per week; usual care, -3.4 drinks per week; P = .001). Conclusions: This study provides evidence that screening and very brief (5- to 10-minute) advice and counseling delivered by a physician or nurse prac titioner as part of routine primary care significantly reduces alcohol cons umption by high-risk drinkers.