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 andPsycLIT 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 2 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. significant number of North Americans drink excessive amounts of alcohol. Although excessive alcohol use is often socially accepted behavior, there is a notable increased risk of workforce dysfunction, motor vehicle accidents, injuries, marital discord, family dysfunction, alcoholrelated disease, and death. 1 Average daily alcohol consumption above two or three drinks has been shown to result in subjective complaints, physical findings, alcoholrelated problems, and alcohol dependence. 2,3 These consequences of excessive alcohol use are seen in the primary care and hospital settings with prevalence rates approaching 20% to 40%. [4][5][6][7][8] Excessive drinking behavior, often described as problem drinking, heavy drinking, or at-risk drinking, is generally not associated with alcohol dependence such as major withdrawal symptoms, tolerance, complete loss of control, or preoccupation with drinking. 9 The definition of excessive or problem drinking is imprecise and often depends on not only quantity and frequency of alcohol consumed but also individual characteristics such as gender, age, weight, and comorbid conditions. 10 The Institute of Medicine reports that up to 20% of ...

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 andPsycLIT 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 2 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.KEY WORDS: meta-analysis; qualitative analysis; randomized control trial; heavy drinking; brief clinical interventions.

OBJECTIVE: To investigate a brief teaching intervention using standardized patients (SPs) trained to improve residents' detection and advising of problem drinkers. DESIGN: Pretest‐posttest design assessing resident behavior and skills. SUBJECTS: Nineteen internal medicine residents in a University Hospital General Internal Medicine Clinic. INTERVENTION: Announced SPs were interviewed by residents and presented to faculty who provided brief instruction on the National Institute on Alcohol Abuse and Alcoholism guidelines for screening and brief counseling of problem drinkers. MEASURE: Unannounced SPs assessed resident behavior and skills. RESULTS: Following the teaching intervention, 2 times more residents screened for alcohol use and nearly 3 times more residents did brief counseling. Residents reported that the intervention was informative and valuable. CONCLUSION: A single, 1‐hour teaching intervention lead to a 2‐ to 3‐fold increase in resident detection and advising of problem drinkers. SPs provide effective teaching encounters and a useful measure of resident behavior.

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A single, 1-hour teaching intervention lead to a 2- to 3-fold increase in resident detection and advising of problem drinkers. SPs provide effective teaching encounters and a useful measure of resident behavior.