logo

   

Need a supporting hand in manuscript formatting? Write to our team.
Assistance in presubmission | editorialoffice@clinmedjournals.org

     
International Journal of
Psychology and Psychoanalysis
ISSN: 2572-4037
REVIEW ARTICLE | VOLUME 3, ISSUE 2 | OPEN ACCESS DOI: 10.23937/2572-4037.1510020

Brief Intervention for Risky Alcohol Use: A Critical Analysis

Jaison Joseph1 and Debasish Basu2

1College of Nursing, Pt. B.D. Sharma University of Health Sciences, Rohtak, India

2Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India

*Corresponding author: Jaison Joseph, MSc (N), Junior Lecturer, College of Nursing, Pt. B.D. Sharma University of Health Sciences, Rohtak 124001, India, Tel: 09468277298, E-mail: jaisonjsph@yahoo.com

Received: August 01, 2017 | Accepted: October 03, 2017 | Published: October 05, 2017

Citation: Joseph J, Basu D (2017) Brief Intervention for Risky Alcohol Use: A Critical Analysis. Int J Psychol Psychoanal 3:020. doi.org/10.23937/2572-4037.1510020

Copyright: © 2017 Joseph J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract


Background

The negative impact of risky use of alcohol on health and well-being of individuals has been well documented. Recent reports reveal an alarming increase in the hazardous and harmful alcohol use worldwide. Brief intervention is increasingly becoming popular over the last decades in reducing harmful and hazardous alcohol use as compared to other psychosocial interventions.

Objectives

This review critically appraises the results of major systematic reviews related to brief intervention conducted at different settings by various health professionals.

Methods

Major systematic reviews and clinical trials related to alcohol brief interventions as per different settings in the last decade were identified through database and related article screening. Selected reviews were analyzed as per outcomes & methodological quality.

Findings

The present review identified systematic reviews on the efficacy of alcohol brief interventions conducted in primary care population, general and hospital settings and electronic Screening and Brief Intervention (eSBI) delivered in non-treatment-seeking hazardous/harmful drinking population. There is no systematic review identified on the efficacy of alcohol brief interventions in other settings such as emergency departments, workplace, and miscellaneous settings.

Conclusion

Numerous trials tested the efficacy of brief intervention as a psychosocial intervention in reducing harmful and hazardous alcohol use. Despite the methodological limitations, brief intervention seems to be a cost effective psychological treatment strategy in reducing harmful or hazardous alcohol use in a variety of settings through various health professionals.

Keywords


Brief intervention, Harmful and hazardous alcohol use

Introduction


Alcohol - the ancient wondrous potion has emerged as a social burden due to increasing trend of alcohol use disorders and related injuries [1]. The problem due to alcohol largely depends on the volume and quality of alcohol consumed, patterns of drinking and environmental triggers [2-3]. Globally the average alcohol consumption is rampant with a variety of patterns of use. Hazardous drinking is the use of alcohol that places patients at risk for adverse health consequences and harmful drinking is defined as the pattern of alcohol use causing physical or psychological harm [4]. The available empirical data suggest that apart from the notable ill effects of the dependent use of alcohol, harmful or hazardous alcohol consumption also leads to more than 200 diseases and results in 3.3 million deaths each year [1]. The available reports on alcohol use reveal an alarming decrease in the age of onset of alcohol use in developing countries [5,6].

There is a substantial voluminous data available on various treatment modalities on harmful or hazardous alcohol use and are majorly based on preventive and psychosocial interventions. Various approaches in preventive interventions include school based prevention programmes [7], family based prevention programmes [8], restricting or banning on alcohol advertisements [9]. Psychosocial interventions aim to cut down or reduce current pattern of hazardous or harmful alcohol use [10] and incorporates the strategies such as Motivational Interviewing (MI) [11], Cognitive-Behavioural Therapy (CBT), psychodynamic approaches, Screening and Brief Interventions (SBIs) and brief personalized digital interventions [12].

Brief intervention is a time limited psychological treatment strategy in which structured therapy of short duration offered with the aim of assisting an individual to stop or reduce harmful or hazardous drinking. Screening is often offered before brief intervention and the length of the intervention is determined by the risk levels of alcohol use as per the screening instrument [13]. Most of the previous studies used the World Health Organization (WHO) developed instrument - Alcohol Use Disorders Identification Test (AUDIT) [4,14] and Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) [15] to detect harmful or hazardous alcohol use. Brief intervention is based on the principles of motivational interviewing [16,17] and uses techniques such as FRAMES (Feedback, Responsibility, Advice, Menu, Empathy, Self-efficacy), DARES (Develop discrepancy, Avoid argumentation, Roll with resistance, Express empathy, Support Self-efficacy) [18]. The present review is a critical analysis of the efficacy of brief interventions in treating risky alcohol use.

Objective


This review critically appraises the results of major systematic reviews on alcohol brief intervention conducted in different settings by various health professionals.

Methods


Major systematic reviews and clinical trials on alcohol brief interventions as per different settings were identified using the key terms "brief intervention" "harmful or hazardous alcohol use", "systematic reviews" through resources:- MEDLINE and Cochrane Library. Results of major reviews on brief intervention available in English and as per settings in the last decade were analyzed and included in this review. Two reviewers independently analyzed the selected systematic reviews in terms of major findings, the comparison between treatment and control group and methodological quality of the included trials.

Findings


The present review identified six systematic reviews on alcohol brief interventions conducted in primary care population, general and emergency hospital settings published between 2005 and 2017 and included forty-eight trials of average methodological quality. There is no systematic review identified on the efficacy of alcohol brief interventions in other settings such as emergency departments, workplace and miscellaneous settings and the results of controlled and uncontrolled trials in these settings are described. The present paper also identified a systematic review on electronic Screening and Brief Intervention (eSBI) in non-treatment-seeking hazardous/harmful drinking population and is appraised as per outcomes.

There is sufficient empirical evidence exists on the efficacy of brief interventions that warrant its implementation as a part of routine care for problematic drinking since 1990 [19-22]. Numerous trials in the last decade envisaged the role of brief interventions in various dimensions such as efficacy in a variety of settings, efficacy as per the involvement of healthcare professionals and as per outcome measures. The following are the systematic summary of the role of brief interventions in reducing harmful or hazardous alcohol use in different perspectives.

Alcohol brief interventions in primary care population & general hospital settings

A meta-analysis of 10 RCTs conducted in primary care population that brief interventions lowered alcohol consumption at one year follow up. The review further suggested that short duration (1-2 sessions) of 10 to 60 minutes of brief interventions are effective in reducing excessive drinking pattern [23]. McQueen, et al. analysed fourteen trials in terms of the impact of brief interventions in reducing alcohol consumption levels, hospital re-admission rates, alcohol related injuries among heavy alcohol users and included adolescents. The review included adolescents and adults admitted to general inpatient hospital care such as general medical wards, medical/surgical units for any reason other than specifically for alcohol treatment and found that brief intervention resulted in the reduction of alcohol consumption and death rates of male participants in this setting at 6-9 month follow up [24]. However, in a comprehensive systematic review, researchers analyzed twenty-four systematic reviews of brief intervention relevant to primary care population and identified the lacuna of evidence on the effectiveness of brief intervention in terms of its longevity, frequency and content across different population especially from developing countries. Most of the trials targeted middle aged population leaving the need for further researches on pregnant women and younger and older adults in primary healthcare settings [25].

Alcohol brief interventions in emergency departments

There were few emergency departments based randomized controlled trials of brief intervention with the reasonable methodological quality for alcohol problems. Most of the available trials have variation in the study protocol, alcohol-related recruitment criteria, screening and assessment methods, and injury severity etc. [26-28]. Although brief intervention is found to be cost effective in the emergency departments [29], evidence suggests that brief intervention resulted in the reduction of alcohol related subsequent injuries rather than reduction in excessive alcohol consumption requiring a consistent evaluation of outcome measures in this setting [30-33].

Alcohol brief interventions in workplace settings

Research on workplace alcohol brief intervention was limited in number and identified the issues such as poor response rates, feasibility issues as per type of job and problems with self-disclosure [34-36]. Most of the studies conducted at large companies and tested the efficacy of web based as well as face to face alcohol brief intervention [37-40]. Although less attention has been given to workplace as an arena for brief alcohol interventions due to heterogeneous barriers on its acceptance and potential effectiveness, evidence on its efficacy is growing [41,42] even from developing countries [43,44].

Alcohol brief interventions in miscellaneous settings

Although very limited in number and methodological quality, there is some evidence on brief intervention for heavy drinkings such as psychiatric outpatient setting, [45] community-based counselling centres, sexual health clinics, and antenatal care and postpartum care settings [46-49]. However, none of the studies reported a superior benefit for brief intervention as compared to routine care [50,51].

Brief intervention for harmful drinking: Involvement of healthcare professionals

Healthcare professionals such as general physicians, nurses, psychologists, social workers community pharmacist were involved as a principal therapist in a variety of settings and were found to be efficacious in reducing harmful or heavy drinking regardless of the healthcare professionals involved as the therapist [52-56].

Brief intervention for risky alcohol use: From efficacy to effectiveness

Empirical evidence suggests that screening linked brief intervention is effective in reducing harmful drinking pattern in the primary care population [57]. But there is also evidence available that fails to provide an additional benefit for the implementation of the brief intervention in reducing harmful or hazardous alcohol use [58,59]. Hence "The efficacy and effectiveness distinction in trials of alcohol brief intervention" is a hot debate at the present scenario [60-62]. However, the present paper critically appraises the results of major systematic reviews of brief intervention as per specific settings by various health professionals (Table 1). The major findings are described below. (a) Most of the trials reported a significant reduction in alcohol consumption in the brief intervention group. But, it is worth to note that the control group also reduced their alcohol drinking pattern at later follow ups. Also, there was no statistically significant difference in some of the primary outcome measures in both the groups. However, a very recent review identified the superior benefit of brief intervention in five trials in various settings of middle-income countries [63]. (b) Major trials have serious methodological limitations such as allocation bias, attrition bias, and problems with blinding. (c) The optimal content, length and frequency of brief intervention are still unclear as it has been portrayed as "motivational interviewing" or "brief advice on the change in alcohol use" in most of the earlier studies.

Table 1: Critical appraisal of the major systematic reviews on alcohol brief interventions. View Table 1

Conclusion


Numerous trials tested the efficacy of brief intervention as a psychosocial intervention in reducing harmful and hazardous alcohol use. Despite the methodological limitations and absence of a significant superior benefit, brief intervention seems to be a cost effective psychological treatment strategy in reducing harmful or hazardous alcohol use in a variety of settings through various health professionals.

Future Prospects - Brief Intervention - What is Missing?


As low to modest evidence exists on the efficacy of brief intervention in developed countries, future studies should focus more on the implementation issues and policy changes regarding the delivery of both face to face and electronic brief intervention. However, brief intervention still remains as "unconscious" in developing countries and prompt attention and support needed to unravel the knowledge on the "royal road" to alcohol brief intervention trials in this setting for a better transnational acceptance.

References


  1. World health organization (2017) Substance abuse: Alcohol.

  2. Rehm J, Room R, Graham K, Monteiro M, Gmel G, et al. (2003) The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: An overview. Addiction 98: 1209-1228.

  3. Rehm J, Kanteres F, Lachenmeier DW (2010) Unrecorded consumption, quality of alcohol and health consequences. Drug Alcohol Rev 29: 426-436.

  4. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M (1993) Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II. Addiction 88: 791-804.

  5. Prasad R (2009) Alcohol use on the rise in India. Lancet 373: 17-18.

  6. Pillai A, Nayak MB, Greenfield TK, Bond JC, Hasin DS, et al. (2014) Adolescent drinking onset and its adult consequences among men: a population based study from India. J Epidemiol Community Health 68: 922-927.

  7. Foxcroft DR, Tsertsvadze A (2011) Universal school-based prevention programs for alcohol misuse in young people. Cochrane Database Syst Rev CD009113.

  8. Foxcroft DR, Tsertsvadze A (2011) Universal family-based prevention programs for alcohol misuse in young people. Cochrane Database Syst Rev CD009308.

  9. Siegfried N, Pienaar DC, Ataguba JE, Volmink J, Kredo T, et al. (2014) Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents. Cochrane Database Syst Rev CD010704.

  10. Klimas J, Tobin H, Field CA, O'Gorman CS, Glynn LG, et al. (2014) Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev CD009269.

  11. Foxcroft DR, Coombes L, Wood S, Allen D, Almeida Santimano NM (2014) Motivational interviewing for alcohol misuse in young adults. Cochrane Database Syst Rev CD007025.

  12. Kaner EF, Beyer FR, Brown J, Crane D, Garnett C, et al. (2015) Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations (Protocol). Cochrane Database Syst Rev CD011479.

  13. Babor T, Higgins-Biddle J (2001) Brief intervention for hazardous and harmful drinking. A manual for use in primary care. WHO, Geneva.

  14. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG (1989) AUDIT - The alcohol use disorders identification test: Guidelines for use in primary care. World Health Organization, Geneva.

  15. World Health Organization (2010) The alcohol, smoking and substance involvement screening test (ASSIST): Manual for use in primary care.

  16. Miller WR, Rollnick S (2004) Talking oneself into change: Motivational interviewing, stages of change, and therapeutic process. J Cogn Psychother 18: 299-308.

  17. Prochaska JO, DiClemente CC, Norcross JC (1992) In search of how people change: Applications to addictive behaviors. Am Psychol 47: 1102-1114.

  18. Miller WR, Zweben A, Di Clemente C, Rychtarik RG (1992) Motivational enhancement therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. (Project MATCH Monograph Series Vol 2). National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland.

  19. Bien TH, Miller WR, Tonigan JS (1993) Brief interventions for alcohol problems: A review. Addiction 88: 315-335.

  20. Peltzer K (2009) Brief intervention of alcohol problems in Sub-Saharan Africa: A review. J Psychol Africa 19: 415-422.

  21. Moyer A, Finney JW, Swearingen CE, Vergun P (2009) Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction 97: 279-292.

  22. Elzerbi C, Donoghue K, Drummond C (2009) A comparison of the efficacy of brief interventions to reduce hazardous and harmful alcohol consumption between European and non-European countries: A systematic review and meta-analysis of randomized controlled trials. Addiction 110: 1082-1091.

  23. Kaner EF, Beyer F, Dickinson HO, Pienaar E, Campbell F, et al. (2007) Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev CD004148.

  24. McQueen J, Howe TE, Allan L, Mains D, Hardy V (2011) Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database Syst Rev CD005191.

  25. O'Donnell A, Anderson P, Newbury-Birch D, Schulte B, Schmidt C, et al. (2014) The impact of brief alcohol interventions in primary healthcare: A systematic review of reviews. Alcohol Alcohol 49: 66-78.

  26. Coulton S, Perryman K, Bland M, Cassidy P, Crawford M, et al. (2009) Screening and brief interventions for hazardous alcohol use in accident and emergency departments: A randomised controlled trial protocol. BMC Health Serv Res 9: 114.

  27. Pengpid S, Peltzer K, Skaal L, Van der Heever H (2013) Screening and brief interventions for hazardous and harmful alcohol use among hospital outpatients in South Africa: Results from a randomized controlled trial. BMC Public Health 13: 644.

  28. Daeppen JB, Gaume J, Bady P, Yersin B, Calmes JM, et al. (2007) Brief alcohol intervention and alcohol assessment do not influence alcohol use in injured patients treated in the emergency department: a randomized controlled clinical trial. Addiction 102: 1224-1233.

  29. Barbosa C, Cowell A, Bray J, Aldridge A (2015) The Cost-effectiveness of Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Emergency and Outpatient Medical Settings. J Subst Abuse Treat 53: 1-8.

  30. D'Onofrio G, Pantalon MV, Degutis LC, Fiellin DA, Busch SH, et al. (2008) Brief intervention for hazardous and harmful drinkers in the emergency department. Ann Emerg Med 51: 742-750.e2.

  31. Havard A, Shakeshaft A, Sanson-Fisher R (2008) Systematic review and meta-analyses of strategies targeting alcohol problems in emergency departments: interventions reduce alcohol-related injuries. Addiction 103: 368-376.

  32. Nilsen P, Baird J, Mello MJ, Nirenberg T, Woolard R, et al. (2008) A systematic review of emergency care brief alcohol interventions for injury patients. J Subst Abuse Treat 35: 184-201.

  33. Merz V, Baptista J, Haller DM (2015) Brief interventions to prevent recurrence and alcohol-related problems in young adults admitted to the emergency ward following an alcohol-related event: a systematic review. J Epidemiol Community Health 69: 912-917.

  34. Schulte B, O'Donnell AJ, Kastner S, Schmidt CS, Schäfer I, et al. (2014) Alcohol screening and brief intervention in workplace settings and social services: a comparison of literature. Front Psychiatry 5: 131.

  35. Hagger MS, Lonsdale A, Chatzisarantis NL (2011) Effectiveness of a brief intervention using mental simulations in reducing alcohol consumption in corporate employees. Psychol Health Med 16: 375-392.

  36. Osilla KC, Zellmer SP, Larimer ME, Neighbors C, Marlatt GA (2008) A brief intervention for at-risk drinking in an employee assistance program. J Stud Alcohol Drugs 69: 14-20.

  37. Araki I, Hashimoto H, Kono K, Matsuki H, Yano E (2006) Controlled trial of worksite health education through face-to-face counseling vs. e-mail on drinking behavior modification. J Occup Health 48: 239-245.

  38. Doumas DM, Hannah E (2008) Preventing high-risk drinking in youth in the workplace: A web-based non-native feedback program. J Subst Abuse Treat 34: 263-271.

  39. Matano RA, Koopman C, Wanat SF, Winzelberg AJ, Whitsell SD, et al. (2007) A pilot study of an interactive web site in the workplace for reducing alcohol consumption. J Subst Abuse Treat 32: 71-80

  40. Donoghue K, Patton R, Phillips T, Deluca P, Drummond C (2014) The effectiveness of electronic screening and brief intervention for reducing levels of alcohol consumption: A systematic review and meta-analysis. J Med Internet Res 16: e142.

  41. Hermansson U, Helander A, Brandt L, Huss A, Rönnberg S (2010) Screening and brief intervention for risky alcohol consumption in the workplace: Results of a 1-year randomized controlled study. Alcohol Alcohol 45: 252-257.

  42. Watson H, Godfrey C, McFadyen A, McArthur K, Stevenson M, et al. (2015) Screening and brief intervention delivery in the workplace to reduce alcohol-related harm: a pilot randomized controlled trial. Int J Nurs Stud 52: 39-48.

  43. Joseph J, Das K, Sharma S, Basu D (2013) ASSIST linked Alcohol Screening and Brief intervention in workplace: A feasibility study from a tertiary hospital of North India. Indian J Soc Psychiatry 29: 75-78.

  44. Joseph J, Das K, Sharma S, Basu D (2014) ASSIST linked Alcohol Screening and Brief intervention in workplace: Results of 4 month follow up. Indian J Soc Psychiatry 30: 80-86.

  45. Eberhard S, Nordström G, Höglund P, Ojehagen A (2009) Secondary prevention of hazardous alcohol consumption in psychiatric out-patients: A randomised controlled study. Soc Psychiatry Psychiatr Epidemiol 44: 1013-1021.

  46. Chander G, Hutton HE, Lau B, Xu X, McCaul ME (2015) Brief Intervention Decreases Drinking Frequency in HIV-Infected, Heavy Drinking Women: Results of a Randomized Controlled Trial. J Acquir Immune Defic Syndr 70: 137-145.

  47. Rubio MD (2014) Brief motivational enhancement intervention to prevent or reduce postpartum alcohol use: A single-blinded, randomized controlled effectiveness trial. J Subst Abuse Treat 46: 382-389.

  48. Ondersma SJ, Beatty JR, Svikis DS, Strickler RC, Tzilos GK, et al. (2015) Computer-delivered screening and brief intervention for alcohol use in pregnancy: a pilot randomized trial. Alcohol Clin Exp Res 39: 1219-1226.

  49. Watt K, Shepherd J, Newcombe R (2008) Drunk and dangerous: A randomised controlled trial of alcohol brief intervention for violent offenders. J Exp Criminol 4: 1-19.

  50. Vasilaki EI, Hosier GS, Cox WM (2006) The efficacy of motivational interviewing as a brief intervention for excessive drinking: a meta-analytic review. Alcohol Alcohol 41: 328-335.

  51. Sullivan LE, Tetrault JM, Braithwaite RS, Turner BJ, Fiellin DA (2011) A meta-analysis of the efficacy of nonphysician brief interventions for unhealthy alcohol use: Implications for the patient-centered medical home. Am J Addict 20: 343-356.

  52. Joseph J, Basu D, Dandapani M, Krishnan N (2014) Are nurse-conducted brief interventions (NCBIs) efficacious for hazardous or harmful alcohol use? A systematic review. Int Nurs Rev 61: 203-210.

  53. Khan NS, Norman IJ, Dhital R, McCrone P, Milligan P, et al. (2013) Alcohol brief intervention in community pharmacies: a feasibility study of outcomes and customer experiences. Int J Clin Pharm 35: 1178-1187.

  54. Dhital R, Norman I, Whittlesea C, McCambridge J (2013) Effectiveness of alcohol brief intervention delivered by community pharmacists: Study protocol of a two-arm randomised controlled trial. BMC Public Health 13: 152.

  55. Fitzgerald N, Stewart D, Jaffray M, Inch J, Duncan E, et al. (2012) A pilot study of alcohol screening and brief interventions in community pharmacies. Addict Sci Clin Pract 7: 22.

  56. Khan NS, Norman IJ, Dhital R, McCrone P, Milligan P, et al. (2012) Community pharmacy-based alcohol brief intervention in the UK: Significant alcohol consumption reduction in risky drinkers. Addict Sci Clin Pract 7: 55.

  57. World Health Organization.

  58. van Beurden I, Anderson P, Akkermans RP, Grol RP, Wensing M, et al. (2012) Involvement of general practitioners in managing alcohol problems: A randomized controlled trial of a tailored improvement programme. Addiction 107: 1601-1611.

  59. Butler CC, Simpson SA, Hood K, Cohen D, Pickles T, et al. (2013) Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: A cluster randomised trial. BMJ 346: 1191.

  60. Heather N (2014) The efficacy-effectiveness distinction in trials of alcohol brief intervention. Addict Sci Clin Pract 9: 13.

  61. O'Donnell A, Wallace P, Kaner E (2014) From efficacy to effectiveness and beyond: What next for brief interventions in primary care? Front Psychiatry 5: 113.

  62. Johnson AJ, Seale PJ (2015) Implementing alcohol screening and brief intervention in primary care: Identifying barriers, proposing solutions. Addict Sci Clin Pract 10: 24.

  63. Joseph J, Basu D (2017) Efficacy of brief interventions in reducing hazardous or harmful alcohol use in Middle-income countries - Systematic review of randomized controlled trials. Alcohol Alcohol 52: 56-64.