Relatively brief interventions have consistently been found to be effective in reducing alcohol consumption or achieving treatment referral of problem drinkers. To date, the literature includes at least a dozen randomized trials of brief referral or retention procedures, and 32 controlled studies of brief interventions targeting drinking behavior, enrolling over 6000 problem drinkers in both health care and treatment settings across 14 nations. These studies indicate that brief interventions are more effective than no counseling, and often as effective as more extensive treatment. The outcome literature is reviewed, and common motivational elements of effective brief interventions are described. There is encouraging evidence that the course of harmful alcohol use can be effectively altered by well-designed intervention strategies which are feasible within relatively brief-contact contexts such as primary health care settings and employee assistance programs. Implications for future research and practice are considered.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1360-0443.1993.tb00820.x

Brief interventions for alcohol problems: a review

The Transtheoretical Model of Change: Toward a Comprehensive, Transtheoretical Model of Change: Stages of Change and Addictive Behaviors C.C. DiClemente, J.O. Prochaska. The Transtheoretical Model: A Critical Overview R. Davidson. Comments, Criteria, and Creating Better Models J.O. Prochaska, C.C. DiClemente. Understanding Change-Five Perspectives: Readiness, Importance, and Confidence: Critical Conditions of Change in Treatment S. Rollnick. Self-Regulation and the Addictive Behaviors J.M. Brown. Alcohol Motivations as Outcome Expectancies B.T. Jones, J. McMahon. Preparing for Change: Enhancing Motivation for Change W.R. Miller. Using Brief Opportunities for Change in Medical Settings N. Heather. Working Through the Concerned Significant Other R.J. Meyers, et al. Facilitating Change: Guiding Self-Change M.B. Sobell, L.C. Sobell. A Wealth of Alternatives: Effective Treatments for Alcohol Problems W.R. Miller, et al. Sustaining Change: What Predicts Success? V.S. Westerberg. Continuing Care: Promoting the Maintenance of Change D.M. Donovan. 11 Additional Chapters. Index.

Treating addictive behaviors

OBJECTIVE: To assess the effectiveness of brief interventions in heavy drinkers by analyzing the outcome data and methodologic quality. DESIGN: (1) Qualitative analysis of randomized control trials (RCTs) using criteria from Chalmers' scoring system; (2) calculating and combining odds ratios (ORs) of RCTs using the One-Step (Peto) and the Mantel-Haenszel methods. STUDY SELECTION AND DATA ANALYSIS: A MEDLINE and PsycLIT search identified RCTs testing brief interventions in heavy alcohol drinkers. Brief interventions were less than 1 hour and incorporated simple motivational counseling techniques much like outpatient smoking cessation programs. By a single-reviewer, nonblinded format, eligible studies were selected for adult subjects, sample sizes greater than 30, a randomized control design, and incorporation of brief alcohol interventions. Methodologic quality was assessed using an established scoring system developed by Chalmers and colleagues. Outcome data were combined by the One-Step (Peto) method; confidence limits and test for heterogeneity were calculated. RESULTS: Twelve RCTs met all inclusion criteria, with an average quality score of 0.49 +/- 0.17. This was comparable to published average scores in other areas of research (0.42 +/- 0.16). Outcome data from RCTs were pooled, and a combined OR was close to 2 (1.91; 95% confidence interval 1.61-2.27) in favor of brief alcohol interventions over no intervention. This was consistent across gender, intensity of intervention, type of clinical setting, and higher-quality clinical trials. CONCLUSIONS: Heavy drinkers who received a brief intervention were twice as likely to moderate their drinking 6 to 12 months after an intervention when compared with heavy drinkers who received no intervention. Brief intervention is a low-cost, effective preventive measure for heavy drinkers in outpatient settings.

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Meta-analysis of Randomized Control Trials Addressing Brief Interventions in Heavy Alcohol Drinkers

This study undertakes an analysis of cost effectiveness of alcoholism treatment modalities based upon (1) findings from clinical trials, (2) costs for treatment in settings and/or by providers and (3) recommendations from treatment experts about appropriate settings, providers and treatment events. This analysis, which assumes a prototypic patient, suggests that modalities with the most evidence of effectiveness (based on three or more clinical trials) are not the most expensive. Within this study, total cost of care was negatively related to effectiveness. Modalities categorized as having insufficient evidence of effectiveness (i.e., lacking three or more clinical trials) are in the higher cost categories. The results of this first effort to establish initial cost/effectiveness considerations are intended to stimulate researchers to conduct the types of clinical studies where both cost and effectiveness are carefully measured to increase the scientific basis for future cost/effect policy considerations. The authors expect future clinical studies will revise the results of this initial effort.

The Cost Effectiveness of Treatment for Alcoholism: A First Approximation*

Used meta-analysis to examine the efficacy of bibliotherapy. Bibliotherapy treatments were compared to control groups and therapist-administered treatments. The mean estimated effect size (d) of the 70 samples analyzed was +0.565. There was no significant differences between the effects of bibliotherapy and therapist-administered treatments, as well as no significant erosion of effect sizes at follow-up. Bibliotherapy did appear more effective for certain problem types (assertion training, anxiety, and sexual dysfunction) than for others (weight loss, impulse control, and studying problems). Overall, the amount of therapist contact during bibliotherapy did not seem to relate to effectiveness, but there was evidence that certain problem types (weight loss and anxiety reduction) responded better with increased therapist contact. Recommendations for future research were given, especially for more research on the commonly purchased books and moderator analyses by personality type and reading ability.

/pdf/a-meta-analysis-of-bibliotherapy-studies-4glkinnfxe.pdf

A meta-analysis of bibliotherapy studies

A total of 785 individuals responded to a newspaper advertisement offering free help to cut down drinking and were sent alternately either a self-help manual based on behavioural principles or a general information and advice booklet. Of these, 247 (31.3 per cent) returned assessment questionnaires or agreed to be interviewed by telephone and 132 of these respondents (53.4 per cent) were successfully contacted at six-month follow-up. Those lost to follow-up were more ‘ socially stable’ on initial measures than those successfully contacted. Results showed a greater reduction in previous week's consumption in the group receiving the manual than in the control group. In addition, respondents interviewed by telephone showed a greater reduction on a measure of alcohol-related problems and a higher proportion reducing drinking than those contacted only by post. There was no evidence that reductions in consumption were confined to relatively low consumers or to those showing only early signs of dependence on alcohol, irrespective of which type of material was received.

Barbara Whitton

Papers

Evaluation of a self-help manual for media-recruited problem drinkers: six-month follow-up results.