title: A randomized controlled trial of motivational enhancement therapy (MET) for mild to moderate alcohol dependence. Randomized controlled trial of general practitioner intervention in women with excessive alcohol consumption. Results of a Social Norm Intervention to Prevent Binge Drinking Among First-year Residential College Students Controlled evaluation of a general practice-based brief intervention for excessive drinking. Reducing alcohol consumption. Comparing three brief methods in family practice. Evaluation of a controlled drinking minimal intervention for problem drinkers in general practice (the DRAMS scheme). Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. Moderating drinking by correspondence: an evaluation of a new method of intervention. Brief physician advice for alcohol problems in older adults: a randomized community-based trial. Effectiveness of advice to reduce alcohol consumption in hypertensive patients. Brief interventions for at-risk drinking: patient outcomes and cost-effectiveness in managed care organizations. Relative efficacy of a brief motivational intervention for college student drinkers. Disease Management for Depression and At-Risk Drinking Via Telephone in an Older Population of Veterans Reducing Alcohol Use in College Students: A Controlled Trial of Two Brief Interventions Treatment of problem alcohol use in women of childbearing age: results of a brief intervention trial. Maritally distressed women with alcohol problems: the impact of a short-term alcohol-focused intervention on drinking behaviour and marital satisfaction. Examining mechanisms of action in 12-Step community outpatient treatment. Acceptability of various brief intervention approaches for hazardous drinking among university students. Provider training for patient-centered alcohol counseling in a primary care setting. The long-term effectiveness of brief interventions for unsafe alcohol consumption: a 10-year follow-up. Brief physician and nurse practitioner-delivered counseling for high-risk drinking Assisting problem drinkers to change on their own: effect of specific and non-specific advice. Effectiveness of a self-control manual for problem drinkers with and without therapist contact. Identification and intervention of heavy drinking in middle-aged men: results and follow-up of 24-60 months of long-term study with randomized controls. Screening and brief intervention for high-risk college student drinkers: results from a 2-year follow-up assessment. The efficacy of single-session motivational interviewing in reducing drug consumption and perceptions of drug-related risk and harm among young people: results from a multi-site cluster randomized trial. Matching alcoholism treatments to client heterogeneity: Project MATCH three-year drinking outcomes. The Tromsø Study: identification of and a controlled intervention on a population of early-stage risk drinkers. A comparison of personalized feedback for college student drinkers delivered with and without a motivational interview. A randomized study of secondary prevention of early stage problem drinkers in primary health care. Community-based alcohol counselling: a randomized clinical trial. Detection of patients with high alcohol intake by general practitioners. Brief intervention in a primary care setting for hazardous drinkers. Promoting brief alcohol intervention by nurses in primary care: a cluster randomised controlled trial. Training in controlled drinking for early-stage problem drinkers. Relative effectiveness of bibliotherapy, individual and group self-control training in the treatment of problem drinkers. Screening for problem drinking and counseling by the primary care physician-nurse team. A comparison of brief advice and conjoint therapy in the treatment of alcohol abuse: the results of the Marital Systems Study. Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices. Evaluating a brief alcohol intervention with fraternities. Serum-gamma-glutamyltransferase in screening and continuous control of heavy drinking in middle-aged men. Intervention in alcohol abuse among macrocytic patients in general practice. Prevention of alcohol-related deaths in middle-aged heavy drinkers. Excessive drinking--brief intervention by a primary health care nurse. A randomized controlled trial. Effects of two types of brief intervention and readiness to change on alcohol use in hazardous drinkers. Attempted referral as intervention for problem drinking in the general hospital. Screening and brief intervention for hazardous drinking in an HMO: Effects on medical care utilization Assisted natural recovery from alcohol problems: effects of a self-help manual with and without supplementary telephone contact. Addressing Alcohol Problems in Primary Care: A Cluster Randomized, Controlled Trial of a Systems Intervention: The Screening and Intervention in Primary Care (SIP) Study A ten-year follow-up of older former problem drinkers: risk of relapse and implications of successfully sustained remission. Early intervention in patients with excessive consumption of alcohol: a controlled study. A self-help approach for high-risk drinking: effect of an initial assessment. Brief physician- and nurse practitioner-delivered counseling for high-risk drinkers: does it work?
abstract: OBJECTIVE This study was design ed to conduct a r and omized controlled trial of motivational enhancement therapy ( MET ) with two control conditions : nondirective reflective listening ( NDRL ) and no further counseling ( NFC ) ; and to conduct this study in a sample of patients with a primary diagnosis of mild to moderate alcohol dependence , in a " real-life " clinical setting . METHOD Patients with mild to moderate alcohol dependence were recruited , assessed and treated at the Community Alcohol and Drug Service of Christchurch , New Zeal and . All patients received a feedback/education session before r and omization to either four sessions of MET , four sessions of NDRL , or NFC . Outcome data on 122 subjects ( 57.4 % men ) were obtained 6 months following the end of treatment , by an interviewer who was blind to the treatment condition . The primary drinking outcome was unequivocal heavy drinking , defined as drinking 10 or more st and ard drinks six or more times in the follow-up period . Global assessment scale ( GAS ) measured general personal/social functioning . RESULTS Of patients treated with MET , 42.9 % showed unequivocal heavy drinking compared with 62.5 % of the NDRL and 65.0 % of the NFC groups ( p = .04 ) . No significant differences were found for GAS score according to treatment condition . CONCLUSIONS In patients with mild to moderate alcohol dependence , MET is more effective for reducing unequivocal heavy drinking than either a feedback/education session alone or four sessions of NDRL . MET can be considered an effective " value added " counseling intervention in a real-life clinical setting . In patients with mild to moderate alcohol dependence , nondirective reflective listening provides no additional advantage over a feedback/education session alone Seventy two women drinking 21 units ( 210 g ) or more of alcohol per week were recruited from an opportunistic screening programme in eight English general practice s. The women were r and omized into control and treatment groups . Women in the treatment group received ten minutes advice from their general practitioner to reduce alcohol consumption .  At one year follow-up , when analyzed by intention to treat , women in the treatment group had reduced their alcohol consumption from an average of 35 - 24 units per week . Similar reductions were found in the control group ( from 37 - 27 units per week ) . The lack of evidence for a treatment effect may be explained by contamination of the control group by informal interventions Abstract The effects of a primary prevention social norm intervention on  binge drinking among 1st-year residential college students were examined . Six hundred thirty-four students attending a medium-sized public university in the South were r and omly assigned to receive a two-phase social norm intervention or the st and ard campus psychoeducational prevention program . At posttest , no differences were found between intervention and control group students on any of the alcohol use and alcohol-use risk factor measures . Significant subgroup differences were found by stage of initiating binge drinking behaviors , for frequency of alcohol use , F(3 , 507 ) = 3.69 , p = .01 ; quantity of alcohol use , F(3 , 507 ) = 2.51 , p = .05 ; and social norms , F(3 , 505 ) = 2.53 , p = .05 . These findings suggest the need for tailoring social norm binge drinking interventions to students ' stage of initiating heavy drinking and carefully monitoring for potential negative , as well as positive , effects of norm-based prevention messages In a controlled evaluation of general practitioner (GP)-based brief intervention , 378 excessive drinkers identified opportunistically by screening in 40 group practice s in metropolitan Sydney were assigned to groups receiving : ( i ) a five-session intervention by the GP ( the Alcoholscreen Program ) ; ( ii ) a single session of 5 minutes ' advice by the GP plus a self-help manual ( minimal intervention ) ; ( iii ) an alcohol-related assessment but no intervention ; ( iv ) neither intervention nor assessment . Among all patients allocated to receive it , the Alcoholscreen Program did not result in a significantly greater reduction in consumption at follow-up than control conditions but patients offered Alcoholscreen reported a significantly greater reduction in alcohol-related problems in the period to 6 months follow-up . A greater proportion of patients who returned for the second Alcoholscreen visit were drinking below recommended levels at follow-up than in the remainder of the sample . There was no evidence that minimal intervention or alcohol-related assessment were effective in reducing alcohol consumption or problems . Implication s for further research into GP-based brief interventions are discussed OBJECTIVE To compare the effects of three brief methods of reducing alcohol consumption among family practice patients . DESIGN Patients r and omly assigned to one of three interventions were assessed initially and at 3- , 6- , and 12-month follow-up appointments . SETTING Family practice clinic composed of 12 primary care physicians seeing approximately 6000 adults monthly in a small urban community , population 40,000 . PARTICIPANTS Through a screening question naire , 134 men and 131 women were identified as hazardous drinkers ( five or more drinks at least once monthly ) during an 11-month screening of 1420 patients . Of 265 patients approached , 180 agreed to participate and 159 ( 83 men and 76 women ) actually participated in the study . INTERVENTIONS Three interventions were studied : brief physician advice ( 5 minutes ) , two 30-minute sessions with a physician using cognitive behavioural strategies or two 30-minute sessions with a nurse practitioner using identical strategies . MAIN OUTCOME MEASURES Quantity and frequency ( QF ) of drinking were used to assess reduction in hazardous drinking and problems related to drinking over 12 months of follow up . RESULTS No statistical difference between groups was found . The QF of monthly drinking was reduced overall by 66 % ( among men ) and 74 % ( among women ) for those reporting at least one hazardous drinking day weekly at assessment ( N = 96 ) . Men reported drinking significantly more than women . CONCLUSIONS These results indicated that offering brief , specific advice can motivate patients to reduce their alcohol intake . There was no difference in effect between brief advice from their own physician or brief intervention by a physician or a nurse Sixteen general practitioners participated in a controlled trial of the Scottish Health Education Group 's  DRAMS ( drinking reasonably and moderately with self-control ) scheme . The scheme was evaluated by r and omly assigning 104 heavy or problem drinkers to three groups - a group participating in the DRAMS scheme  ( n = 34 ) , a group given simple advice only ( n = 32 ) and a non-intervention control group ( n = 38 ) . Six month follow-up information was obtained for 91 subjects ( 87.5 % of initial sample ) . There were no significant differences between the groups in reduction in alcohol consumption , but patients in the DRAMS group showed a significantly greater reduction in a logarithmic measure of serum gamma-glutamyl-transpeptidase than patients in the group receiving advice only . Only 14 patients in the DRAMS group completed the full DRAMS procedure . For the sample as a whole , there was a significant reduction in alcohol consumption , a significant improvement on a measure of physical health and well-being , and significant reductions in the logarithmic measure of serum gamma-glutamyl transpeptidase and in mean corpuscular volume . The implication s of these findings for future research into controlled drinking minimal interventions in general practice are discussed OBJECTIVE : To determine effectiveness of advice from general practitioners to heavy drinkers to reduce their  excessive alcohol consumption ( 35 U or more a week for men , 21 U or more for women ) . DESIGN : R and omised , controlled double blind trial over 12 months with interim assessment at six months . SETTING : Group practice s ( n = 47 ; list size averaging 10,000 ) recruited from Medical Research Council 's general practice research framework , mostly in rural or small urban setting s. PATIENTS : Patients recruited after question naire survey . Of total of 2571 ( 61.2 % ) of 4203 patients invited for interview who attended , 909 ( 35.4 % ) stated that in past seven days they had drunk above the limits set for study and had not received advice ; they were r and omised to control and treatment groups . INTERVENTIONS : Patients in treatment group were interviewed by general practitioner ( who had had a training session ) and received advice and information about how to reduce consumption and also given a drinking diary . END POINT : Study aim ed at detecting a reduction in proportion of men with excessive alcohol consumption of 30 % in treatment group and 20 % in control group ( for women 40 % and 20 % , respectively ) with a power of 90 % at 5 % level of significance . In addition , corroborative measures such as estimation of gamma-glutamyltransferase activity were included . MEASUREMENTS AND MAIN RESULTS : At one year a mean reduction in consumption of alcohol of 18.2 ( SE 1.5 ) U/week had occurred in treated men compared with a reduction of 8.1 ( 1.6 ) U/week in controls ( p less than 0.001 ) . The proportion of men with excessive consumption at interview had dropped by 43.7 % in the treatment group compared with 25.5 % in controls ( p less than 0.001 ) . A mean reduction in weekly consumption of 11.5 ( 1.6 ) U occurred in treated women compared with 6.3 ( 2.0 ) U in controls ( p less than 0.05 ) , with proportionate reductions of excessive drinkers in treatment and control groups of 47.7 % and 29.2 % respectively . Reduction in consumption increased significantly with number of general practitioner interventions . At one year the mean value for gamma-glutamyltransferase activity had dropped significantly more in treated men ( -2.4 (0.9)IU/l ) than in controls ( + 1.1(1.0)IU/l ; t = 2.7 , p less than 0.01 ) . Reduction in gamma-glutamyltransferase activity tended to increase with number of intervention sessions in men . Changes in gamma-glutamyltransferase activity in women and changes in other indicators in both sexes did not differ significantly between treatment and control groups . CONCLUSIONS : If the results of this study were applied to the United Kingdom intervention by general practitioners could each year reduce to moderate levels the alcohol consumption of some 250000 men and 67500 women who currently drink to excess . General practitioners and other members of the primary health care team should therefore be encouraged to include counselling about alcohol consumption in their preventive activities Recognizing the need to offer alternative methods of brief interventions , this study developed correspondence treatments for low-dependent problem drinkers and evaluated their impact . One hundred and twenty-one problem drinkers were recruited by media advertisements and were r and omly allocated to a full cognitive-behavioural treatment programme ( CBT ) or to a minimal intervention condition ( MI ) that gave information regarding alcohol misuse and instructions to record drinking++ . As predicted , CBT was more effective than MI in reducing alcohol consumption over the 4-month controlled trial period . CBT produced a 50 % fall in consumption , bringing the average intake of subjects within recommended maximum levels . Treatment gains at 6 months were well maintained to 12 months . High levels of consumer satisfaction , a high representation of women and a substantial participation from isolated rural areas attested to the feasibility of the correspondence programme as an alternative treatment . However , some drinking occasions still involved high intake for a significant subgroup of subjects , and this issue will be addressed in future programmes . The results supported the use of correspondence delivery as a means of promoting early engagement and equity of access between city and country areas BACKGROUND Alcohol use in older adults is common . It is associated with depression , hypertension , diabetes , drug interactions , accidents , and increased rates of emergency department visits and hospitalizations . METHODS A controlled clinical trial ( Project GOAL --Guiding Older Adult Lifestyles ) tested the efficacy of brief physician advice in reducing the alcohol use and use of health care services of older adult problem drinkers . Twenty-four community-based primary care practice s in Wisconsin ( 43 family physicians and internists ) participated in the trial . Of the 6073 patients screened , 105 men and 53 women met inclusion criteria and were r and omized into a control group ( n = 71 ) or an intervention group ( n = 87 ) . Intervention group patients received two 10- to 15-minute physician-delivered counseling sessions that included advice , education , and contracting using a scripted workbook . A total of 146 patients ( 92.4 % ) participated in the 12-month follow-up procedure . RESULTS No significant differences were found between the control and intervention groups at baseline in alcohol use , age , socioeconomic status , depression , onset of alcohol use , smoking status , activity level , or use of mood-altering drugs . The older adults who received the physician intervention demonstrated a significant reduction in 7-day alcohol use , episodes of binge drinking , and frequency of excessive drinking ( P < .005 ) compared with the control group at 3 , 6 , and 12 months after the intervention . There was a 34 % reduction in 7-day alcohol use , 74 % reduction in mean number of binge-drinking episodes , and 62 % reduction in the percentage of older adults drinking more than 21 drinks per week in the intervention group compared with the control group . There were no significant changes in health status . Patterns of health care utilization were not extensively analyzed because of the small number of events . CONCLUSIONS This study provides the first direct evidence that brief physician advice can decrease alcohol use by older adults in community-based primary care practice The relation between alcohol consumption and blood pressure is well recognized , and advice to reduce alcohol plays an important part in the management of hypertensive patients . We have evaluated the effectiveness of this advice in a r and omized , controlled , single-blind clinical study . After a 2-week run-in period , hypertensive men regularly consuming more than 20 units/wk ( 1 unit = 10 g ) of alcohol  were r and omly assigned either to the " advice " or control group and were seen at 2-week intervals over an 8-week study period . The outcome measures were : reported alcohol consumption ( 1-week retrospective diary ) , markers of alcohol consumption ( serum gamma-glutamyl transpeptidase , aspartate aminotransferase , uric acid , mean corpuscular volume ) , and blood pressure ( sitting and st and ing ) . Over 18 months , 67 men who drank more than 20 units/wk of alcohol were seen . Twenty-six either were excluded , refused to participate , or dropped out due to nonattendance . Forty-one patients completed the study . After intervention , reported alcohol consumption fell from 60 units/wk to around 30 units/wk in the advice group , whereas it remained between 50 and 60 units/wk in the control group ( analysis of variance [ ANOVA ] F = 7.1 , p less than 0.05 ) . This was accompanied by falls in gamma-glutamyl transpeptidase ( 20.9 % ) and aspartate aminotransferase ( 18.1 % ) , but no significant changes were seen in the control group . St and ing diastolic blood pressure fell significantly in the advice group ( from 101.5 mm Hg to 96.3 mm Hg ) compared with the control group ( ANOVA F = 4.8 , p less than 0.05 ) . The results suggest that advice to reduce alcohol consumption is a useful form of treatment for hypertensive patients who drink excessively AIMS Evaluate effectiveness and costs of brief interventions for patients screening positive for at-risk drinking in managed health care organizations ( MCOs ) . METHODS A pre-post , quasi-experimental , multi-site evaluation conducted at 15 clinic sites within five MCO setting s. At-risk drinkers ( N = 1329 ) received either : ( i ) brief intervention delivered by licensed practitioners ; or ( ii ) brief intervention delivered by mid-level professional specialists ( nurses ) ; or ( iii ) usual care ( comparison condition ) . Clinics were r and omly assigned to three study conditions . Data were collected on the cost of screening and brief intervention . Follow-up interviews were conducted at 3 and 12 months . RESULTS Participants in all three study conditions were drinking significantly less at 3-month follow-up , but the decline was significantly greater in the two intervention groups than in the control group . There were no significant differences between the two intervention conditions . Of the patients in the intervention conditions 60 % reduced their alcohol consumption by > or = 1 drink per week , compared with 53 % of those in the control condition . No differences were found on a measure of the quality of life . Differential reductions in weekly alcohol consumption between intervention and control groups were significant at 12-month follow-up . Average incremental costs of the interventions were 4.16 US dollar per patient using licensed practitioners and 2.82 US dollar using mid-level specialists . CONCLUSION Alcohol screening and brief intervention when implemented in managed care organizations produces modest , statistically significant reductions in at-risk drinking . Interventions delivered to a common protocol by mid-level specialists are as effective as those delivered by licensed practitioners at about two-thirds the cost The authors evaluated the efficacy of Brief Alcohol Screening and Intervention for College Students ( BASICS - L. A. Dimeff , J. S. Baer , D. R. Kivlahan , & G. A. Marlatt , 1999 ) , a single session of drinking-related feedback intended to reduce heavy drinking and related harm .  College student drinkers ( N = 99 ) were assigned to BASICS , an educational intervention , or an assessment -only control group . At 3 months postintervention . there were no overall significant group differences , but heavier drinking BASICS participants showed greater reductions in weekly alcohol consumption and binge drinking than did heavier drinking control and education participants . At 9 months , heavier drinking BASICS participants again showed the largest effect sizes . BASICS participants evaluated the intervention more favorably than did education participants . This study suggests that BASICS may be more efficacious than educational interventions for heavier drinking college students Objectives The purpose of this study was to explore the efficacy in a primary care setting of a telephone-based disease management program for the acute management of depression and /or at-risk drinking . Material s and Methods Veterans ( N = 97 ) with depression and /or at-risk drinking were identified by systematic screening and assessment . Eligible subjects received either telephone disease management ( TDM ) program or usual care based on r and om assignment of their clinician . The TDM program consisted of regular contacts with each subject by a behavioral health specialist ( BHS ) to assist in assessment , education , support , and treatment planning . Symptomatic outcomes were assessed at 4 months . Results Overall response rates favored those assigned to TDM compared with those assigned to usual care ( 39.1 % responded vs. 17.6 % , p = 0.022 ) . Response rates within the separate diagnostic groups also favored TDM , but this was only significant for depressive disorders . Conclusions Although the sample size was modest and the sample was limited to veterans , findings strongly suggest that a telephone-based disease management program can improve outcomes for patients with a behavioral health problem . Findings also suggest that a health specialist can focus and manage patients with different diagnoses , thus exp and ing the role beyond just depression care . TDM may be a viable , low-cost , model for primary care clinicians to deliver manual guideline -adherent behavioral health care , especially in a VA clinical setting This study tested two forms of alcohol reduction programming for college students . Thirty-seven moderate to heavy drinkers completed measures of quantity/frequency , drinking consequences , and attitude question naires . Participants were r and omly assigned to one of three groups : 1 ) a two-hour information and motivation session plus mailed personal feedback on their drinking ; 2 ) mailed feedback only ; or 3 ) no treatment . At a 6-week follow-up session , the feedback-only group decreased drinks per month as compared to control . No other differences were statistically significant , though decreases favored the treatment conditions about equally over control . Implication s for research and treatment are discussed BACKGROUND Studies suggest that 14 % of women age 18 to 40 drink alcohol above recommended limits . Of special concern is the increasing use of alcohol by women during pregnancy . This article reports 48 month follow-up data from a sub analysis of a trial for early alcohol treatment ( Project TrEAT ) focused on women of childbearing age . METHODS Project TrEAT was conducted in the offices of 64 primary care , community-based physicians from 10 Wisconsin counties . Of 5979 female patients ages 18 to 40 who were screened for problem drinking , 205 were r and omized into an experimental group ( n = 103 ) or control group ( n = 102 ) . The intervention consisted of two 15 min , physician-delivered counseling visits that included advice , education , and contracting by using a scripted workbook . A total of 174 subjects ( 85 % ) completed the 48 month follow-up procedures . RESULTS No significant differences were found between the experimental and control groups at baseline for alcohol use , age , socioeconomic status , smoking , depression or anxiety , conduct disorder , lifetime drug use , or health care utilization . The trial found a significant treatment effect in reducing both 7 day alcohol use ( p = 0.0039 ) and binge drinking episodes ( p = 0.0021 ) over the 48 month follow-up period . Women in the experimental group who became pregnant during the follow-up period had the most dramatic decreases in alcohol use . A logistic regression model based on a 20 % or greater reduction in drinking found an odds ratio of 1.93 ( confidence interval 1.07 - 3.46 ) in the sample exposed to physician intervention . Age , smoking , depression , conduct disorder , antisocial personality disorder , and illicit drug use did not reduce drinking significantly . No significant differences were found in health care utilization and health status between groups . CONCLUSIONS This trial provides the first direct evidence that brief intervention is associated with sustained reductions in alcohol consumption by women of childbearing age . The results have enormous implication s for the U.S. health care system AIM To evaluate the efficacy of a short-term alcohol-focused intervention for maritally distressed women , and to explore changes in relationship functioning . DESIGN Participants were assigned r and omly to an alcohol-focused treatment or to a waiting-list control group . The waiting-list control group began the intervention at 1-month follow-up . SETTING The intervention took place at a research and training centre offering outpatient psychology services to the community . PARTICIPANTS A sample of 32 women with alcohol and marital problems were recruited through the media . Participants reported protracted alcohol problems , moderate to severe impact of alcohol on social and occupational functioning , and moderate to severe marital distress . MEASUREMENTS Measures of average alcohol consumption , marital distress , relational efficacy and depression were administered at pre- and post-therapy , and at 1 , 6 and 12-month follow-up . INTERVENTION The intervention involved six 1-hour sessions , consisting of clinical assessment , motivational interviewing , cognitive-behavioural strategies and relapse prevention . RESULTS At 1-month follow-up , the intervention was associated with statistically significant improvements in alcohol consumption , marital satisfaction , relational efficacy and depression , and these effects were sustained at 12-month follow-up . CONCLUSIONS At 1-month follow-up the intervention was associated with decreased alcohol consumption and depression , and increased marital satisfaction and relational efficacy , with evidence of maintained effects at 12-month follow-up . However , it is unlikely that reduced problem drinking and improved confidence in resolving problems were the only factors producing low marital quality in these couples . Further research is needed to identify those individuals who might benefit from marital interventions Twelve-step theory hypothesizes that changes in specific cognitions and behaviors , including adoption of disease model beliefs and involvement in self-help programs , lead to symptom reduction . We examined the role of self-help affiliation in treatment outcome using causal chain analysis . Baseline , end-treatment and follow-up self-help affiliation  and substance use were assessed in 252 drug and alcohol abusers attending a community program . Participants were r and omly assigned to one of three cognitive-behavioral or 12-Step oriented individual counseling conditions . Participants also were assigned , based on problem severity , to one of three treatment setting s ( partial hospitalization ; intensive outpatient ; st and ard outpatient ) that varied according to intensity of additional 12-Step programming . Repeated- measures ANOVA indicated that self-help affiliation increased overall during treatment , particularly in the 12-Step counseling condition ( versus cognitive-behavioral ) , and the partial hospitalization setting ( versus st and ard outpatient ) . Multiple regression indicated that self-help affiliation was negatively associated with substance use 6 months post-treatment , and that this was not moderated by condition . Self-help affiliation predicted outcome most strongly in the partial hospitalization setting and not at all in outpatient ; however , this effect was accounted for by participants ' initial problem severity : high-severity patients had poorer outcomes if they failed to increase self-help affiliation , relative to those who increased affiliation and to low-severity patients regardless of affiliation . Results indicate that , in this community-based program , self-help affiliation increased as a function of exposure to 12-Step oriented treatment programming , and significantly predicted better outcome among patients with high levels of problem severity . Implication s for future treatment process and dissemination research are discussed AIMS To determine the acceptability to university students of practitioner-delivered screening and brief intervention ( SBI ) versus a novel approach-web-based SBI ( e-SBI ) . METHODS A r and om sample of 1910 university students was invited to indicate their preferences for various brief intervention approaches in an internet survey . RESULTS e-SBI was the most popular intervention . It was favoured by 81 % of all students and 82 % of hazardous drinkers . CONCLUSIONS e-SBI is a promising approach for the reduction of hazardous drinking among young people OBJECTIVE To assess the impact of a brief training program on primary care providers '  skills , attitudes , and knowledge regarding high-risk and problem drinking . DESIGN Training plus pretesting and posttesting for program efficacy . SETTING Ambulatory primary care clinic ; academic medical center . PARTICIPANTS Fourteen attending physicians , 12 residents , and 5 nurse practitioners were r and omized by clinical team affiliation to a Special Intervention or usual care condition of a larger study . We report the results of the training program for the Special Intervention providers . INTERVENTION Providers received a 2-hour group training session plus a 10- to 20-minute individual tutorial session 2 to 6 weeks after the group session . The training focused on teaching providers how to perform patient-centered counseling for high-risk and problem drinkers . MAIN OUTCOME MEASURES Alcohol counseling skills ; attitudes regarding preparedness to intervene and perceived importance and usefulness of intervening with high-risk and problem drinkers ; and knowledge of the nature , prevalence , and appropriate treatment of alcohol abuse in primary care population s. RESULTS After training , providers scored significantly higher on measures of counseling skills , preparedness to intervene , perceived usefulness and importance of intervening , and knowledge . CONCLUSION A group training program plus brief individual feedback can significantly improve primary care providers '  counseling skills , attitudes , and knowledge regarding high-risk and problem drinkers AIMS To examine the long-term impact of brief and early interventions for hazardous and harmful alcohol consumption . DESIGN A 9-month and 10-year follow-up of subjects recruited into a r and omized controlled trial of a range of alcohol-related brief interventions . SETTING General practice s , the outpatient or acute care services of a major city hospital , and a privately run health screening programmeme . PARTICIPANTS The cohort of 554 ( non-dependent ) hazardous and harmful drinkers recruited into the Australian arm of the Phase II World Health Organization collaborative project on identification and treatment of persons with harmful alcohol consumption . INTERVENTION The effectiveness of three forms of intervention , ranging from 5 to 60 minutes in duration , were compared with a no-treatment control condition . MEASUREMENTS Included drinking behaviour and biological markers of alcohol use . In addition , at 10 years subjects were asked about symptoms of diagnosable alcohol use disorders and their experience of alcohol-related psychological , social and physical harm . Mortality was also assessed . FINDINGS Results provide further evidence for the short-term effectiveness of alcohol-related brief interventions . In comparison to controls , subjects offered intervention : ( 1 ) report significantly lower consumption ; and ( 2 ) less unsafe drinking at 9-month follow-up . The intensity of intervention was not related to the amount of change in drinking behaviour . Analysis at 10 years failed to find any differences in outcomes between intervention and control groups in median consumption , mean reduction in consumption from baseline to follow-up , mortality and ICD-10 diagnoses of alcohol dependence or harmful alcohol use . CONCLUSIONS This study failed to find evidence that brief advice and counselling without regular follow-up and reinforcement can sustain significant long-term reductions in drinking behaviour at 10-year follow-up BACKGROUND : The objective of this study was to determine the effects of a brief primary care provider-delivered counseling intervention on the reduction of alcohol consumption by high-risk drinkers . The intervention was implemented as part of routine primary care medical practice . METHODS : We performed a controlled clinical trial with 6- and 12-month follow-up . Three primary care practice s affiliated with an academic medical center were r and omly assigned to special intervention ( SI ) or usual care ( UC ) . A total of 9,772 primary care patients were screened for high-risk drinking . A fourth site was added later . From the group that was screened , 530 high-risk drinkers entered into the study , with 447 providing follow-up at 12 months . The intervention consisted of brief ( 5–10 minute ) patient-centered counseling plus an office system that cued providers to intervene and provided patient educational material s. RESULTS : At 12-month follow-up , after controlling for baseline differences in alcohol consumption , SI participants had significantly larger changes ( P=.03 ) in weekly alcohol intake compared to UC ( SI=−5.7 drinks per week ; UC=−3.1 drinks per week ) , and of those who changed to safe drinking at 6 months more SI participants maintained that change at 12 months than UC . CONCLUSIONS : Project Health provides evidence that screening and very brief ( 5–10 minute ) advice and counseling delivered by a patient ’s personal physician or nurse practitioner as a routine part of a primary care visit can reduce alcohol consumption by high-risk drinkers Problem drinkers ( 99 males , 41 females ) wishing to quit or cut down without professional help received a 60-minute session during which they were assessed and given at r and om one of these material s : Guidelines , a two-page pamphlet outlining specific methods for achieving abstinence or moderate drinking ; Manual , a 30-page booklet describing the methods in the Guidelines ; or General Information , a package about alcohol effects . At 12 months follow-up , subjects in the Guidelines and Manual conditions showed significantly greater reductions of heavy days ( of 5 + drinks ) than subjects in General Information ( 70 % vs. 24 % ) ; in addition , significantly fewer subjects in the Guidelines and the Manual conditions expressed need for professional assistance with their drinking ( 25 % vs. 46 % in General Information ) . No main effect of condition or gender was observed on rates of moderate drinkers . At 12 months follow-up , 31 % of the men and 43 % of the women were rated as moderate drinkers . It was concluded that drinkers intending to cut down on their own derive greater benefit ( in terms of their alcohol use ) from material s containing specific instructions to develop moderate drinking than from those providing general information on alcohol effects . Clinical and research implication s of the findings are discussed Thirty-one self-referred problem drinkers were r and omly assigned to one of two modalities for behavioral self-control training with a goal of moderation : ( 1 ) minimal therapist contact , in which clients worked only with a self-help manual ; and ( 2 ) therapist directed training , in which clients received self-help material s plus 10 individual treatment sessions . Both groups showed significant reductions in alcohol consumption and peak blood alcohol concentration . Contrary to expectations , there were no significant differences on outcome measures between groups . Results are interpreted within a self-control framework In a continuing screening and intervention programme in Malmó , elevated serum-gamma-glutamyltransferase ( GGT ) values were used for selection of heavy drinkers . The study population consisted of 585 individuals born 1926 - 1933 with two consecutive GGT values in the upper decile of the GGT distribution , r and omly allocated either to an intervention group of to a control group . The subjects in the intervention group were further investigated and 75 % of them were judged to have elevated GGT values caused by alcohol consumption . These individuals were repeatedly encouraged to lower their overall alcohol consumption and  GGT  measurements were used as biofeedback method in the treatment program . The controls were informed by letter to be restrictive with their alcohol consumption and that they should receive new invitations for measurements of their liver enzymes  after 2 , 4 , and 6 years . The intervention and control groups were well matched and followed over a 2 - 6-year period . Two and 4 years after the screening investigation , the GGT values in both groups were significantly decreased . There were differences , however , between the two groups with regard to sick absenteeism , hospitalization , and mortality . A significant reduction was found in sick absence during 4 years by 80 % , in hospital days during 5 years by 60 % , and in mortality during 6 years by 50 % in the intervention group compared with the control group . Thus , the intervention program was effective in preventing medico-social consequences of heavy drinking This r and omized controlled trial evaluated the efficacy of a brief intervention design ed to reduce the harmful consequences of heavy drinking among high-risk college students . Students screened for risk while in their senior year of high school ( 188 women and 160 men ) were r and omly assigned to receive an individualized motivational brief intervention in their freshman year of college or to a no-treatment control condition . A normative group selected from the entire screening pool provided a natural history comparison . Follow-up assessment s over a 2-year period showed significant reductions in both drinking rates and harmful consequences , favoring students receiving the intervention . Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period , most showed a decline in problems over time , suggesting a developmental maturational effect AIM To test whether a single session of motivational interviewing ( discussing alcohol , tobacco and illicit drug use ) would lead successfully to reduction in use of these drugs or in perceptions of drug-related risk and harm among young people . DESIGN Cluster r and omized trial , allocating 200 young people in the natural groups in which they were recruited to either motivational interviewing  ( n=105 ) or non-intervention education-as-usual control condition ( n=95 ) . SETTING Ten further education colleges across inner London . PARTICIPANTS Two hundred young people ( age range 16 - 20 years ) currently using illegal drugs , with whom contact was established through peers trained for the project . INTERVENTION The intervention was adapted from the literature on motivational interviewing in the form of a 1-hour single-session face-to-face interview structured by a series of topics . MEASUREMENTS Changes in self-reported cigarette , alcohol , cannabis and other drug use and in a range of drug-specific perceptions and other indicators of risk and harm . Measurement at recruitment and follow-up interview 3 months later . FINDINGS A good follow-up rate ( 89.5 % ; 179 of 200 ) was achieved . In comparison to the control group , those r and omized to motivational interviewing reduced their of use of cigarettes , alcohol and cannabis , mainly through moderation of ongoing drug use rather than cessation . Effect sizes were 0.37 ( 0.15 - 0.6 ) , 0.34 ( 0.09 - 0.59 ) and 0.75 ( 0.45 - 1.0 ) for reductions in the use of cigarettes , alcohol and cannabis , respectively . For both alcohol and cannabis , the effect was greater among heavier users of these drugs and among heavier cigarette smokers . The reduced cannabis use effect was also greater among youth usually considered vulnerable or high-risk according to other criteria . Change was also evident in various indicators of risk and harm , but not as widely as the changes in drug consumption . CONCLUSIONS This study provides the first substantial evidence of non-treatment benefit to be derived among young people involved in illegal drug use in receipt of motivational interviewing . The targeting of multiple drug use in a generic fashion among young people has also been supported This study reports 3-year outcomes for clients who had been treated in the five outpatient sites of Project MATCH , a multisite clinical trial design ed to test a priori client treatment matching hypotheses . The main purpose of this study was to characterize the status of the matching hypotheses at the 3-year follow-up . This entailed investigating which matching findings were sustained or even strengthened across the 3-year study period , and whether any hypotheses that were not supported earlier eventually emerged at 3 years , or conversely , whether matching findings discerned earlier dissipated at this later time . This research also examines the prognostic effects of the client matching attributes , characterizes the overall outcomes at 37 to 39 months , and explores differential effects of the three treatments at extended follow-up . With regard to the matching effects , client anger demonstrated the most consistent interaction in the trial , with significant matching effects evident at both the 1-year and 3-year follow-ups . As predicted , clients high in anger fared better in Motivational Enhancement Therapy ( MET ) than in the other two MATCH treatments : Cognitive-Behavioral Therapy ( CBT ) and Twelve-Step Facilitation ( TSF ) . Among subjects in the highest third of the anger variable , clients treated in MET had on average 76.4 % abstinent days , whereas their counterparts in the other two treatments ( CBT and TSF ) had on average 66 % abstinent days . Conversely , clients low in anger performed better after treatment in CBT and TSF than in MET . Significant matching effects for the support for drinking variable emerged in the 3-year outcome analysis , such that clients whose social networks were more supportive of drinking derived greater benefit from TSF treatment than from MET . Among subjects in the highest third of the support for drinking variable , TSF participants were abstinent 16.1 % more days than MET participants . At the lower end of this variable , difference in percent days abstinent between MET and TSF was 3 % , with MET clients having more abstinent days . A significant matching effect for psychiatric severity that appeared in the first year posttreatment was not observed after 3 years . Of the 21 client attributes used in testing the matching hypotheses , 11 had prognostic value at 3 years . Among these , readiness-to-change and self-efficacy emerged as the strongest predictors of long-term drinking outcome . With regard to the overall outcomes , the reductions in drinking that were observed in the first year after treatment were sustained over the 3-year follow-up period : almost 30 % of the subjects were totally abstinent in months 37 to 39 , whereas those who did report drinking nevertheless remained abstinent an average of two-thirds of the time . As in the 1-year follow-up , there were few differences among the three treatments , although TSF continued to show a possible slight advantage BACKGROUND In a health survey of more than 21,000 men and women ages 12 - 62 years , measurement of gamma-glutamyltransferase ( GGT ) and answers on five questions on alcohol consumption were used as a basis for selecting an intervention population of early-stage risk drinkers . Altogether 290 men and 48 women met the criteria for inclusion . METHODS The 338 subjects were r and omized to a control group and two intervention groups . The minor intervention consisted of a single consultation during which possible reasons for the elevated GGT were discussed and a pamphlet with advice on changes in drinking habits was h and ed out . In the major intervention group the intervention was directed more specifically toward alcohol , with an extensive interview on drinking habits . In addition , the subjects in this group were offered follow-up consultations for new measurements of GGT .  RESULTS All three groups were examined after 1 year with GGT determination and an interview on change in drinking habits during the past year . At follow-up , significant decreases in mean GGT ( 26.5 U/liter ) and self-reported alcohol intake ( 24.7 g/day ) were observed in the intervention groups compared with the control group . No significant differences were , however , observed between the intervention groups . CONCLUSION The study indicates that modest and simple interventions may yield important changes in drinking habits in early-stage risk drinkers OBJECTIVE This study evaluated the relative efficacy of personalized drinking feedback ( PDF ) delivered with and without a motivational interview ( MI ) for college student drinkers . METHOD Heavy-drinking college students ( N = 54 ; 691 % female ) were identified from a large screening sample and r and omly assigned either to receive PDF during a single MI session or to receive PDF without an MI . Of these participants , 51 ( 94 % ) completed a 6-month follow-up assessment that included measures of alcohol consumption and alcohol-related problems . RESULTS At 6-months postintervention , participants in both groups showed significant , small to moderate reductions in alcohol consumption , but the groups did not differ . Women showed larger reductions than men . Rates of alcohol-related problems remained relatively unchanged . CONCLUSIONS The hypothesis that an MI would enhance the efficacy of PDF was not supported The subjects were recruited from participants in a health examination of r and om sample s of the adult population in Stockholm county . Those aged 18 - 64 years who admitted a high alcohol consumption ( greater than 40 g 100 % ethanol/day ) among men and greater than 30 g among women ) or had an elevated value of serum-gammaglutamyltransferase ( GGT ) ( cut-off point 1.0 microkatal/l for men and 0.6 microkatal/l for women ) or had certain other indications of a high alcohol consumption were included . More severe cases , and those with an elevated GGT due to reasons other than alcohol , were excluded . The remaining subjects , 70 men and 13 women , were allocated at r and om to either an intervention or a comparison group . An elevated GGT was the main inclusion criteria . The subjects in the comparison group were advised by the general practitioner to cut their alcohol consumption , while those in the intervention group made further visits to their general practitioner , who gave general support and used an elevated GGT as an indication of the recent level of alcohol consumption at consecutive visits . There were three visits on average , so we are comparing a group receiving advice with a group receiving further minimal intervention . At the one-year follow-up there were greater , however not significant , reduction in GGT-level , in self-reported alcohol consumption and in a ' problem index ' in the minimal intervention group than in the comparison group AIMS To examine the effectiveness of a brief intervention ( BI ) and cognitive behaviour therapy ( CBT ) for alcohol abuse . DESIGN A r and omized trial with clients r and omized within counsellors . SETTING Community-based drug and alcohol counselling in Australia . PARTICIPANTS Of all new clients attending counselling . 869 ( 82 % ) completed a computerized assessment at their first consultation . Four hundred and twenty-one ( 48 % ) were defined as eligible , of whom 295 ( 70 % ) consented and were allocated r and omly to an intervention . Of these , 13 3 ( 45 % ) were followed-up at 6 months post-test . INTERVENTIONS BI comprised the elements identified by the acronym FRAMES : feedback , responsibility , advice , menu , empathy , self-efficacy . Face-to-face counselling time was not to exceed 90 minutes . CBT comprised six consecutive weekly sessions : introduction : cravings and urges ; managing crises ; saying ' no ' and solving problems : emergencies and lapses : and maintenance . Total face-to-face counselling time was 270 minutes ( six 45-minute sessions ) . MEASUREMENTS Treatment outcomes are measured in terms of counsellor compliance , client satisfaction , weekly and binge consumption , alcohol-related problems , the AUDIT question naire and cost-effectiveness . FINDINGS When analysed on an intention-to-treat basis and for those followed-up . treatment outcomes between BI and CBT were not statistically significantly different at pre- or post-test , whether considered as continuous or categorical variables . BI was statistically significantly more cost-effective than CBT and there was no difference between them in clients ' reported levels of satisfaction . CONCLUSION For low-dependence alcohol abuse in community setting s , BI may be the treatment of choice General practitioners have the potential to treat patients with alcohol problems effectively . Despite the medical implication s of excessive alcohol intake , it appears that general practitioners are not sufficiently aware of the drinking habits of their patients . The aim of the study was to investigate the accuracy of 56 r and omly chosen general practitioners  in detecting which of their patients had a high alcohol intake . Altogether , 2081 patients were recruited in general practitioners ' waiting rooms , where they answered questions about their drinking habits . After the consultations general practitioners were asked to indicate the patients ' levels of alcohol intake . The results showed that general practitioners correctly identified only 27.5 % of patients who were classified as " high risk " drinkers , using Australian Medical Association criteria . They correctly identified only 45.2 % of patients who were classified as " moderate to heavy " drinkers , defined by them as drinkers who consume four or more st and ard drinks a day . These findings have important implication s for clinical practice since they indicate that general practitioners are failing to perform adequately in an important area of preventive medicine . This issue needs to be addressed in undergraduate and postgraduate medical education INTRODUCTION The study was design ed to test a brief intervention for reducing alcohol consumption among moderate to heavy ( hazardous ) drinkers in a busy HMO primary care setting . METHODS In a r and omized controlled trial , hazardous drinkers ( n = 516 ) were identified by the AUDIT screening question naire . Intervention included brief clinician advice ( 30 seconds ) , a 15-minute motivational session by counselors , and printed material s. RESULTS At six-month follow-up , intervention subjects reported fewer total st and ard drinks in the past three months ( 176 versus 216 , P = .04 , one-tailed ) and fewer drinking days per week ( 2.8 versus 3.3 , P = .02 ) than controls , but similar drinks per drinking day ( 3.3 versus 3.5 ; P = .13 ) . At 12 months , intervention subjects again reported fewer drinking days per week ( 2.7 versus 3.1 ; P = .04 ) than controls , but similar numbers of st and ard drinks ( 157 versus 179 ; P = .13 ) and drinks per drinking day ( 3.6 versus 3.3 ; P = .20 ) . Intervention subjects were somewhat more likely than controls to report drinking within daily recommended limits ( < or = 3 for men , < or = 2 for women ) at both six months ( 79 % versus 71 % ; P = .06 ) and 12 months ( 80 % versus 73 % ; P = .07 ) , but did not differ significantly from controls on other drinking outcomes ( percent abstinent , frequency of drinking > or = 6 drinks per drinking occasion , estimated peak blood alcohol concentration ) , or use of medical care in the year following intervention . CONCLUSIONS A one-time , brief motivational intervention using minimal clinician time supplemented by trained counselors result ed in a modest reduction in frequency of alcohol consumption in a busy primary care population . Future research should focus on strengthening and maintaining intervention effects This trial evaluated the clinical impact and cost-effectiveness of strategies promoting screening and brief alcohol intervention ( SBI ) by nurses in primary care . R and omisation was at the level of the practice and the interventions were : written guidelines ( controls , n=76 ) ; outreach training ( n=68 ) ; and training plus telephone-based support ( n=68 ) . After 3 months , just 39 % of controls implemented the SBI programme compared to 74 % of nurses in trained practice s and 71 % in trained and supported practice s. Controls also screened fewer patients and delivered fewer brief interventions to risk drinkers than other colleagues . However , there was a trade-off between the extent and the appropriateness of brief intervention delivery with controls displaying the least errors in overall patient management . Thus cost-effectiveness ratios ( cost per patient appropriately treated ) were similar between the three strategies . Given the potential for anxiety due to misdirected advice about alcohol-related risk , the balance of evidence favoured the use of written guidelines to promote SBI by nurses in primary care Summary Forty-eight early-stage problem drinkers were recruited through a newspaper announcement and r and omly assigned to one of four outpatient treatment groups : ( 1 ) Bibliotherapy- Behavioral Self-Control Training ( BSCT ) , ( 2 ) BSCT-therapist directed , ( 3 ) Training in Coping Skills and ( 4 ) a combination of BSCT and Coping Skill Training . The weekly alcohol consumption in all groups decreased significantly from intake to 3 , 6 and 12 month follow-up . There were no significant differences among the groups . At the same time the number of life problems decreased significantly . The majority of the clients reduced their alcohol consumption during the assessment period , before treatment started . The absence of a non-treatment control group means that we can not be sure about the reasons for this early change . Theoretical implication s of these results are discussed Abstract The effectiveness of 4 alternative forms of behavioral self-control training ( BSCT ) design ed to reduce alcohol consumption was evaluated . Forty-one problem drinkers were assigned to 1 of 4 treatment conditions : ( a ) bibliotherapy , in which clients were evaluated and then provided with a self-help manual ( Miller & Munoz , 1976 ) and self-monitoring cards but were not given therapy sessions , ( b ) BSCT alone , consisting of 10 individual sessions following material presented in the manual , ( c ) BSCT plus relaxation training , being identical to ( b ) except that training in progressive deep muscle relaxation was added within the 10 sessions , and ( d ) group therapy identical in content to ( c ) but offered in a group rather than in individual format . Outcome data included information from client interviews , psychometric measures , self-monitoring cards , and interviews with significant others . All data sources indicated significant and substantial reduction in alcohol consumption , particularly in “ alcoholismic ” drinking patterns . No significant differences were found among the 4 treatment groups . The cost-effectiveness of a bibliotherapy approach was supported , consistent with prior research . Overall improvement rates were 84 % and 69 % at 3- and 12-month follow-up , respectively Present methods to screen for alcohol abuse are generally obtrusive and result in referral to services that deal mainly with alcoholics . These factors deter physicians from identifying alcohol abuse patients at an early stage . In the present study , 81 % of all primary care physicians of a single city evaluated ( i ) the efficiency and the acceptability of a nonobtrusive screening method for the identification of problem drinkers and ( ii ) the effectiveness of brief cognitive behavioral counseling given by a nurse in a lifestyle context . Patients ( n = 15,686 ) attending the private practice s of 42 primary -care physicians were asked four alcohol-neutral trauma questions in the reception area . Physicians asked about alcohol use and alcohol-related problems only to patients with previous trauma . Problem drinkers by defined criteria were offered an appointment with a nurse who , by r and om assignment , gave either 3-hr of cognitive behavioral counseling over 1 year or simply advised patients to reduce their alcohol intake . The screening method identified 62 - 85 % of expected number of problem drinkers in this population . Following the application of exclusion criteria , 105 problem drinkers were entered in the intervention part of the study . After 1 year , patients who received counseling showed significant reductions in reported alcohol consumption ( -70 % ; p < 0.001 ) , psychosocial problems ( -85 % ; p < 0.001 ) and serum gamma glutamyl transferase ( -32 % to -58 % ; p < 0.02 ) . Physician visits were reduced ( -34 % ; p < 0.02 ) following counseling . Patients receiving only advice showed neither reductions in psychosocial problems nor in serum gamma glutamyl transferase or physician visits , but reported a 46 % reduction ( p < 0.01 ) in alcohol consumption . Data indicate that asking patients about recent trauma is efficient and is well accepted as the first screening instrument in the identification of the problem drinker . Cost of screening per patient is under one dollar . Counseling of 3 hr given by a nurse is markedly superior ( p < 0.05 ) to simple advice in reducing alcohol consumption , objective indicators of alcohol-related morbidity , and the frequency of physician visits Summary The Marital Systems Study ( MSS ) compared the effectiveness of a short-term systems-based outpatient treatment consisting of eight sessions of Conjoint Therapy with a single session of Advice Counselling which also involved the spouse . Eligible couples were r and omly assigned to either Conjoint Therapy or Advice Counselling . In all , 218 couples were recruited for the Study . From this initial sample , 102 couples dropped out of treatment or follow-up leaving the remaining 116 couples as the Study sample . Couples in both Advice Counselling and Conjoint Therapy showed significant improvement on all marital adjustment and drinking-related outcome measures . Although significant treatment-by-time interactions were found on three of the nine variables , there were no significant differences in the change pattern between the groups on the principal drinking outcome measure , the percentage of heavy drinking days . There were also no significant between-group differences on any of the outcome measures . In essence , a single session of Advice Counselling was as effective as eight sessions of Conjoint Therapy . Couples completing the Study represented a socially stable group , with a moderate degree of alcohol-related difficulties and relatively non-distressed marital relationships . Thus , the findings pertaining to the relative effectiveness of the two treatments may be limited to this specific client population OBJECTIVE Project TrEAT ( Trial for Early Alcohol Treatment ) was design ed to test the efficacy of brief physician advice in reducing alcohol use and health care utilization  in problem drinkers . DESIGN R and omized controlled clinical trial with 12-month follow-up . SETTING A total of 17 community-based primary care practice s ( 64 physicians ) located in 10 Wisconsin counties . PARTICIPANTS Of the 17695 patients screened for problem drinking , 482 men and 292 women met inclusion criteria and were r and omized into a control ( n=382 ) or an experimental ( n=392 ) group . A total of 723 subjects ( 93 % ) participated in the 12-month follow-up procedures . INTERVENTION The intervention consisted of two 10- to 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 visits , and hospital days . RESULTS There were no significant differences 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 ) , episodes 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 for the experimental group vs 5.3 at baseline to 4.2 at 12 months for controls ; t=2.81 ; P<.001 ) , and frequency of excessive drinking ( percentage drinking excessively in previous 7 days decreased from 47.5 % at baseline to 17.8 % at 12 months for the experimental group vs 48.1 % at baseline to 32.5 % at 12 months for controls ; t=4.53 ; P<.001 ) . The chi2 test of independence revealed a significant relationship between group status and length of hospitalization over the study period for men ( P<.01 ) . CONCLUSIONS This study provides the first direct evidence that physician intervention with problem drinkers decreases alcohol use and health re source utilization in the US health care system OBJECTIVE The current study tested the efficacy of a brief intervention design ed to reduce drinking and drinking-related consequences among first-year fraternity members . METHOD Twelve fraternities were r and omly assigned to receive either a motivational enhancement intervention with individual and housewide feedback components ( n = 6 houses ) or a treatment-as-usual control condition ( n = 6 houses ) . Individual feedback was delivered either by peer interviewers or professional research staff . Participants were assessed during their pledge ( first ) year of house membership and during a follow-up period 1 year later . RESULTS Of the participants who completed follow-up ( N = 120 ) , fraternity members who received the brief intervention reported significant reductions in alcohol use ( total average consumption ) and typical peak blood alcohol concentrations when compared with fraternity members in the control condition . No differences in drinking-related consequences were observed . Fraternity members who received their individualized feedback from peer interviewers and professional members of the research staff reported similar outcomes . CONCLUSIONS Results provide support for the efficacy of a brief motivational enhancement intervention in reducing drinking within this high-risk population . The cost-effective use of peer interviewers appears to be a promising strategy for delivering individualized prevention programming in college population In an on-going population study in Malmö , serum-gamma-glutamyltransferase ( GGT ) is utilized both in biochemical screening of high alcohol consumption and as a tool in further investigation , treatment and control of middle-aged men with screening GGT in the top decile of the distribution . For this purpose , a special outpatient clinic has been instituted and is described in the present report . The composition of the intervention group and the feasibility of the program are reported for the first 6760 middle-aged male screening participants . A r and om one-half of the individuals with screening GGT in the top decile were allocated to the intervention group , which after primary dropouts and exclusion of concurrent diseases consisted of 252 individuals who have now been followed between three to six years . On the basis of structured interviews , hazardous levels of alcohol consumption were concluded to be present in 76 % of the group . Although one-quarter of the group dropped out of the intervention program , the results indicate that it is feasible to institute an outpatient clinic for individuals with  increased GGT levels  found in a general health screening examination , to retain most individuals in this outpatient clinic and to consider alcohol habits and consumption levels in relation to the laboratory test value and general physical health status The study examined the effectiveness of routine intervention in alcohol abuse by a general practitioner , with help of a laboratory test . Patients diagnosed as abusers because of high erythrocyte mean cell volume value ( MCV ) and having no other cause for it were r and omly allocated to two groups : 1 ) an  intervention group  , comprising 92 patients ( 69 men and 23 women ) , who were invited for follow-up at three-monthly intervals for a year ; 2 ) a  control ( mini-intervention ) group , 86 patients ( 71 men and 15 women ) , who were followed-up only after 12 months . Follow-up attendance was poor , particularly in the intervention group . In general , MCV-values were unchanged in the groups at the end of the study , though there was a clear trend for the female controls to have lower values ( 101.9 fl at the start , 98.5 fl at the end , p = 0.06 ) . Altogether 11 % ( 4/38 ) of the women and 7 % ( 10/140 ) of the men had clearly reduced their alcohol consumption after one year , and this was also seen in their MCV-values .  Mini-intervention , especially in women with an abnormal laboratory value , seems to be , with the help of MCV , at least as effective a way of counselling nonalcoholic abusers as a more systematic intervention BACKGROUND Alcohol as a cause of death in middle-aged patients is well-known from clinical studies . A similarly important correlation in the general population of urban middle-aged men is highly underestimated . Health screening investigations have shown that mortality related to alcohol is five times more common in non participants than in participants . From the mid-70s , the Malmoe Screening and Intervention Study ( MSIS ) commenced screening investigations including a large number of residents of Malmoe . One goal was to find intervention programs for individuals in an early development of problem drinking , thereby preventing development of serious complications of endstage alcoholism . Herein , we report on the mortality of heavy drinkers ( drinking more than 40 g alcohol/day ) who were r and omized to an intervention or control procedure and whose median survival was 13 years postentry into the MSIS . METHODS Health-screened men , aged 45 - 49 years at the initial screening examination and displaying serum gamma-glutamyltransferase ( GT ) in the top decentile of the GT distribution , were included . A total of 978 out of 11,257 participants met this criteria . A r and omized intervention and control study was performed for four years and consisted of men ( n = 667 ) who were born between 1927 - 1937 and who had two consecutive high GT values within 3 weeks along with heavy alcohol consumption . Half the individuals were informed of the test results and invited for further assessment by a senior physician ( n = 365 ) . The principles for brief intervention ( DiClemente et al.,1991 ; Miller and Sanchez , 1993 ; National Institute of Alcohol Abuse and Alcoholism , 1999 ) were applied . The other half of the men ( n = 302 ) were left with the information that they had a high GT value and were followed up with laboratory checkups every 2nd year . Mortality was followed up until 1991 and information on deaths was obtained from hospital and police records , necropsy reports , and death certificates . RESULTS Long-term follow-up of mortality for 10 - 16 years ( median , 13 years ) showed that 124 of the 978 men had died ( 12.7 % ) . Autopsy was performed in 96.5 % of the cases . In 59 men ( 48 % ) , death was alcohol-related . In the intervention group ( n = 365 ) , 38 ( 10.4 % ) men were dead and in the control group ( n = 302 ) , 42 ( 13.9 % ) men had died . There was a statistically significant difference ( p = 0.026 ) , with advantage for treatment . Less alcohol-related deaths and deaths occurring later during follow-up were found in the intervention group compared with the control group . The difference between the groups in total mortality , coronary heart disease , and cancer death was not statistically significant . CONCLUSIONS These findings support previous results from the MSIS study indicating that long-term intervention in urban males with alcohol-induced GT increases may be beneficial in terms of survival OBJECTIVE To evaluate the effect of a nurse-conducted intervention on  excessive drinkers .  DESIGN R and omized , controlled trial . SETTING Vårby Health Centre , Stockholm . INTERVENTION The intervention group visited a nurse three times during a 12-month period . The controls met once with a general practitioner ( GP ) . PATIENTS Patients were recruited at a health screening on the basis of a raised gamma-glutamyl transferase ( GGT ) . Of 2338 subjects , aged 25 - 54 years , 222 had a screening GGT of > or = 0.9 mukat/l . 100 were r and omized to the treatment and 122 to the control group . MAIN OUTCOME MEASURES GGT , self-reported alcohol consumption ( g/week ) , sickness allowance and use of health care . RESULTS After 2 years a reduction of GGT from 1.52 to 1.21 mukat/l ( p = 0.02 ) had occurred in the treatment group . The controls increased their mean level of GGT from 1.75 to 2.16 mukat/l . Mean weekly alcohol consumption in the intervention group was reduced from 337 to 228 g/week ( p = 0.02 ) . The controls did not quantify their alcohol consumption initially , but reported a reduced weekly consumption at follow-up . CONCLUSION The intervention had an impact on GGT and self-reported consumption . The controls also reported decreased consumption possibly because their appointment with the GP functioned as a very brief intervention OBJECTIVE Brief interventions for hazardous and low-dependent drinkers in the primary care setting have considerable empirical support . The purpose of this study was to ( 1 ) evaluate the effects of brief advice ( BA ) and motivational enhancement ( ME ) interventions on alcohol consumption . In addition , a hindsight matching design was used to ( 2 ) study the moderator effects of patient readiness to change ( alcohol use ) on alcohol consumption . METHOD The subjects ( N = 301 , 70 % men ) were patients 21 years of age or older who presented for treatment at one of 12 primary care clinics . After screening for eligibility and providing consent to participate in the study , the patients completed a baseline assessment and were r and omly assigned to the BA , ME or st and ard care ( SC ) interventions condition . Follow-up assessment s were completed at 1- , 3- , 6- , 9- and 12-months postbaseline assessment . RESULTS Evaluation of the first hypothesis ( n = 232 for these analyses ) showed that all participants tended to reduce their alcohol use considerably between the baseline and 12-month assessment s. In addition , evaluation of the second hypothesis showed a moderator effect of readiness to change in predicting the number of drinks at 12 months , such that the BA intervention seemed more effective for patients relatively low in readiness to change compared to those higher in readiness . Readiness to change did not seem to be related to changes in drinking of participants in the SC or ME conditions . CONCLUSIONS The results confirm that , among primary care patients , substantial changes in alcohol consumption are possible . They further suggest that matching studies of patient readiness to change their alcohol use , as well as other variables , are warranted Summary Baseline data were collected on 263 general hospital patients screened as problem drinkers , who were r and omly allocated to one of two groups . In one group an attempt was made to refer patients for treatment while no action was taken for the other . Both groups were followed up at 12 and 18 months . At 12 months the referred group had improved significantly more than the control group in terms of self-reported alcohol problems , personal happiness , period since last drinking and work performance . However , these effects had diminished at 18 months , largely because of improvements in the control group after the 12-months follow-up , which appeared to function as an intervention . These results suggest that intervention following screening is of benefit , and that such a strategy could usefully be incorporated into normal hospital routine This study examined whether a brief intervention to reduce hazardous alcohol consumption among primary care patients reduced use of medical care . In a parent , r and omized controlled trial , at-risk drinkers identified in HMO outpatient waiting rooms were r and omly assigned to receive usual care or brief clinician advice plus a 15-minute motivational counseling session . The current study ( n=514 ) examined the groups ' use of outpatient and inpatient medical services during two years after intervention . Although the intervention reduced alcohol consumption at six-month follow-up , intervention and control groups made similar numbers of outpatient visits ( M=17.7 vs. 18.3 , respectively;p=.47 ) , were equally likely to be hospitalized ( 21.2 % vs. 22.0%;p=.81 ) , and , among those hospitalized , had similar lengths of stay ( 4.7 vs. 6.6 days;p=.37 ) . Although brief interventions to reduce hazardous drinking may potentially reduce medical care utilization , more evidence is needed to substantiate their practicality and cost-effectiveness One hundred and seven problem drinkers responding to a newspaper advertisement were r and omly assigned to groups receiving : ( 1 ) a general advice and information booklet ; ( 2 ) a behaviourally-based self-help manual ; ( 3 ) in addition to the manual , an opportunity to make progress reports to a telephone answering service ; and ( 4 ) in addition to the manual , an opportunity to make telephoned progress reports to an interviewer . Eighty-seven ( 81.3 % ) respondents were successfully followed-up and collateral information was available for 54 ( 61.1 % ) of these . Results showed a higher proportion drinking above recommended limits at six months follow-up in the control group ( 78 % ) than in the groups receiving the manual ( 53 % ) . There were no significant differences due to presence or type of telephone contact and poor use was made of the opportunity for telephone contact . Findings justify the widespread promotion of self-help material s as a means of assisting the natural recovery process among problem drinkers Context Brief interventions can reduce problem drinking , but physicians infrequently use them . Contribution This r and omized trial , from an academic primary care setting , tested whether prompting  physicians with positive alcohol screening results that are linked to specific management recommendations works . Prompted faculty , but not residents , tended to discuss alcohol problems and counsel patients more often than did their counterparts who were not prompted . At 6 months , however , only patients of prompted residents had reduced their drinking . Implication s Prompting physicians with positive alcohol screening results and recommendations for action may or may not be effective , depending on patient , physician , and setting characteristics . The Editors Alcohol use disorders are a leading cause of disability and are as common and costly as coronary artery disease and depression ( 1 - 6 ) . Primary care setting s are ideal for alcohol screening and intervention ( 7 ) . Valid , brief , practical screening tools exist , and brief interventions can reduce drinking and improve health when delivered to primary care patients with alcohol problems ( 8 - 11 ) . However , alcohol problems are often unrecognized and untreated in primary care setting s ( 12 - 16 ) . Barriers to screening and intervention include issues related specifically to addictions ( such as patient readiness and physician discomfort , frustration , lack of confidence or skills , or pessimism about efficacy of intervention ) and issues related to the delivery of preventive services in general ( such as cost , acceptability , priorities , and time ) ( 17 , 18 ) . Physician prompting can improve the likelihood of cancer screening , administration of immunizations , and smoking cessation interventions ( 19 - 21 ) . Screening and intervention for alcohol problems , however , involve more complex assessment and intervention . The effectiveness of providing physicians with screening results and a prompt without training is unknown . Such a systems intervention would be easier and less costly to implement than training all physicians about addressing alcohol problems . We tested the hypotheses that providing physicians with patients ' alcohol screening results and simple individualized recommendations would increase physician alcohol counseling and decrease patient drinking . Methods Study Description The study was a cluster r and omized trial at the physician level because r and omization at the patient level would have risked contamination . The institutional review board of the Boston University Medical Center in Boston , Massachusetts , approved the study . Patients gave informed consent and were told that the physician may be given the results of alcohol screening questions . We obtained a Certificate of Confidentiality from the federal government . Participants Physicians were recruited , enrolled , and r and omly assigned before patients were enrolled . All faculty and resident primary care physicians in an urban academic practice ( excluding the authors ) were eligible . Physicians who had seen fewer than 80 patients in the previous 3 years or who anticipated leaving the practice within 6 months were excluded . We informed physicians that we would conduct a health screening study . We used a self-administered question naire to screen and enroll patients who spoke English or Spanish ( staff were available to assist ) ( 22 ) . This was done before a visit with one of the enrolled physicians . Eligible patients were current hazardous drinkers [ 23 ] , which was defined as having consumed alcohol in the past month and either 1 ) answered yes to one or more of the CAGE ( 24 - 26 ) alcohol screening questions  ( modified to refer to the past year rather than lifetime ) [ 27 ] or 2 ) drank hazardous amounts in the past month ( 28 , 29 ) . Hazardous amounts for men and women , respectively , were defined as more than 4 st and ard drinks per occasion or 14 drinks per week and as more than 3 st and ard drinks per occasion or 7 drinks per week in the past 30 days ( 26 , 30 ) . Assessment s Before patients were enrolled , physicians completed a confidential written survey ( July 1997 ) . They were asked about their attitudes toward patients with addictions ; their professional satisfaction when caring for patients with alcohol problems ; whether they or someone they knew had an alcohol or drug problem ; and other issues related to alcohol and physicians , including the physician 's usual practice s ( 18 ) . A trained staff research er interviewed enrolled patients before and after their visits with a physician ( between February 1998 and August 1999 ) . All questions not available in Spanish ( 31 ) were translated , back-translated , and checked for accuracy . The assessment visit that occurred before the physician visit addressed demographic characteristics , previous counseling for alcohol problems , and readiness to change ( 32 , 33 ) . Patients were also asked about medication use , medical comorbidity ( 34 , 35 ) , psychiatric comorbidity ( 36 , 37 ) , and tobacco and other drug use . Immediately after the physician visit , patients were interviewed to determine whether counseling had occurred , drinking amounts ( 38 , 39 ) , the quality of communication with the physician ( 40 ) , alcohol dependence symptoms ( 41 ) , and alcohol problems ( Short Inventory of Problems [ SIP-2R ] ) ( 42 ) . Six months later , patients were interviewed by telephone to determine alcohol consumption in the past 30 days ; the vali date d Timeline Followback method was used ( 43 ) . Patients and staff research ers were not blinded to group assignment ( in addition , patients were not necessarily given this information ) ; at follow-up , interviews were done without knowledge of group assignment . R and omization and Intervention Physicians were stratified by level of training ( resident or faculty ) and were r and omly assigned to the intervention or control group at the start of the study . The computer-generated r and omization was done by off-site data management personnel who had no patient or physician contact . The staff research er attached the intervention , a sheet of paper , to the encounter record the physician routinely received immediately before each patient visit . One side of the paper provided the patient 's alcohol screening results , a preliminary assessment , and specific recommendations . The screening results included answers to each of the CAGE questions , reports of usual weekly and per occasion maximum drinking amounts , and the patient 's report of readiness to change on a 10-point scale ( 44 ) ( see Appendix Figure ) . For patients reporting hazardous drinking amounts but no affirmative CAGE question naire responses , the assessment was drinking hazardous amounts and the recommendation was consider advising safe drinking limits and consider providing patients with a pamphlet provided by the study titled How to Cut Down on Your Drinking ( 27 ) . For patients reporting any affirmative CAGE responses but no hazardous drinking amounts , the assessment was possible alcohol problems and recommendations were consider advising abstinence , provide the pamphlet , and referral to addiction treatment . For patients reporting affirmative CAGE question naire responses and hazardous drinking amounts , the assessment was both possible alcohol problems and drinking hazardous amounts and recommendations were consider advising abstinence and referral to addiction treatment . The other side of the paper provided the predictive value of CAGE based on the prevalence of alcohol abuse or dependence in the practice ( 26 , 31 ) , definitions of hazardous drinking , an approach for patients who are not ready to change , a list of abuse or dependence symptoms , and referral information . To increase counseling rates ( not for data collection ) , we attached a Post-it note to the encounter form asking physicians to indicate whether alcohol was discussed and , if not , why ( 45 ) . Physicians in the  control  group did not receive any information from the study . Statistical Analysis All analyses were performed by using SAS software , version 8.1 [ SAS Institute , Inc. , Cary , North Carolina ] . The primary prespecified outcomes of the study were the occurrence of physician discussion s regarding alcohol problems during the physicianpatient encounter and a decrease in patient drinking . Patients were asked whether they had 1 ) received alcohol counseling , defined as advice on safe drinking limits , advice to cut down or abstain , or referral to an alcohol specialist or treatment program ; 2 ) received any advice [ including counseling ] ; or 3 ) participated in any discussion about alcohol ( including advice ) . An example question was : Did the doctor give you any advice about your drinking habits ? Drinks per drinking day was the primary drinking outcome . We examined additional measures in secondary analyses : days drinking ( any day on which a drink was taken ) , days binge drinking ( any day on which per occasion amounts noted previously were exceeded ) , proportion drinking hazardous amounts , proportion binge drinking , and proportion abstinent . We compared sociodemographic characteristics , level of training , and mean number of patients enrolled for physicians in the intervention and control groups by using the two independent sample s t-test and the Fisher exact test , as applicable . We then compared patients who were seen by physicians in the intervention and control groups with respect to measured characteristics . We compared patients who were available and unavailable at the 6-month follow-up by r and omized group , physician level of training , and sociodemographic characteristics . Outcomes were compared between physicians in the intervention and control groups by using an intention-to-treat analysis ( physicians were analyzed in the groups to which they were r and omly assigned ) . Generalized estimating equations ( GEE ) were used to adjust for clustering of patients by physician ( PROC GENMOD , SAS software , version 8.1 ) ( 46 ) . For continuous outcomes , we specified the identity link function ; for dichotomous outcomes , we specified the logit link OBJECTIVE This study examines the risk , predictors of relapse and the effects of successfully sustained remission on the drinking behavior , functioning , life context , coping and help seeking of older adults who were problem drinkers earlier in life . METHOD Older former problem drinkers ( n = 447 ) were prospect ively followed for 10 years and compared to lifetime nonproblem drinkers .  RESULTS Of former problem drinkers , 31 % ( n = 141 ) died over the 10-year interval , a rate 1.6 times higher than that of lifetime nonproblem drinkers . Among surviving former problem drinkers , although relapse was relatively uncommon ( 11 % ) , a less severe drinking history , heavier baseline alcohol consumption , and lower baseline income were associated with relapse . The majority ( 63 % ) of former problem drinkers who successfully achieved sustained remission continued to drink alcohol , though at levels below those consumed by older lifetime nonproblem drinkers ( n = 339 ) . Stably remitted problem drinkers who were abstinent ( SRAs ) generally reported more severe drinking histories , greater functioning and life context deficits and more help seeking than did stably remitted problem drinkers who were nonabstinent ( SRNs ) . Although SRAs and SRNs both experienced improvements in functioning over the 10-year interval , they continued to experience financial , health-related and life context deficits relative to older lifetime nonproblem drinkers . CONCLUSIONS Results suggest there are long-term costs associated with earlier drinking problems , even when remission is maintained . Both current drinking behavior and drinking history are worth considering when making recommendations regarding older adults ' alcohol consumption From a population of 2,114 patients attending somatic outpatient clinics , 78 patients were selected who had either an excessive consumption of alcohol according to question naires or a raised gamma glutamyltransferase ( GGT ) value ( above 0.6 mu kat/l ) due to alcohol . They had not undergone treatment for problem drinking previously , and had no serious alcohol dependence . They were thereby classified as excessive consumers of alcohol , and r and omly allocated to an intervention ( n = 36 ) or to a control group ( n = 42 ) . Those in the intervention group were followed up by a nurse once a month and by a doctor every third month for a total of 12 months . Laboratory tests were taken monthly . Consumption of alcohol , GGT and triglyceride levels , and sickness allowance days were decreased in the intervention group compared to the time before intervention . In contrast , the number of sickness allowance days in the control group increased . There was also a tendency towards a positive effect of intervention on the number of consultations made with a statistically not significant decrease of consultations after intervention . The study thus indicates that an early and relatively simple intervention programme for problem drinkers may be effective and can be carried out at a low cost and with a positive response from the patients A self-help book was offered to persons wanting to quit or cut down on their alcohol use . Study participants ( 99 men , 56 women ) were recruited through advertisements , screened by telephone , and r and omly assigned to 1 of 2 conditions . Book by mail or Assessment + Book ( 30-min telephone motivational interview plus book by mail ) . At 3-month follow-up , significantly more participants qualified as moderate drinkers in the Assessment + Book condition ( 65 % vs. 43 % ) , by this criterion : < or = 12 drinks/week and < or = 10 % heavy drinking days ( 5 + drinks if male and 4 + drinks if female ; 13.6 g of ethanol per drink ) . At 12 months there was no effect of condition , but significantly more women than men were rated as moderate drinkers ( 71 % vs. 52 % ) . Collateral informants corroborated the participants ' reports of drinking BACKGROUND There is a need for primary care providers to have brief effective methods to intervene with high-risk drinkers during a regular outpatient visit . OBJECTIVE To determine whether brief physician- and nurse practitioner-delivered counseling intervention is efficacious as part of routine primary care in reducing alcohol consumption by high-risk drinkers . METHODS Academic medical center-affiliated primary care practice sites were r and omized to special intervention or to usual care .  From a screened population of 9772 patients seeking routine medical care with their primary care providers , 530 high-risk drinkers were entered into the study . Special intervention included training providers in a brief ( 5- to 10-minute ) patient-centered counseling intervention , and an office support system that screened patients , cued providers to intervene , and made patient education material s available . The primary outcome measures were change in alcohol use from baseline to 6 months as measured by weekly alcohol consumption and frequency of binge drinking episodes . RESULTS Participants in the special intervention and usual care groups were similar on important background variables and potential confounders except 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 significantly reduced when adjusted for age , sex , and baseline alcohol usage ( special 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 practitioner as part of routine primary care significantly reduces alcohol consumption by high-risk drinkers
target: Sensitivity analysis indicates that from both perspectives the service is very cost effective and may be cost saving .
  CONCLUSIONS These results make alcohol screening and counseling one of the highest-ranking preventive services among the 25 effective services evaluated using st and ardized methods .
background: BACKGROUND The U.S. Preventive Services Task Force ( USPSTF ) has recommended screening and behavioral counseling interventions in primary care to reduce alcohol misuse .
  This study was design ed to develop a st and ardized rating for the clinical ly preventable burden and cost effectiveness of complying with that recommendation that would allow comparisons across many recommended services .