Brief counseling sessions with primary care doctors can help curb risky drinking in people who aren’t full-blown alcoholics but who binge drink or otherwise consume more alcohol than is considered healthy, a new study has found.
The most effective interventions included two 15-minute visits with a doctor, followed two weeks later by five-minute phone calls with a nurse, according to the study, a comprehensive review of clinical trials stretching back 25 years.
Counseling sessions typically covered the hazards of excessive drinking and strategies for cutting back. Unlike programs geared toward alcoholics, which tend to stress total sobriety, the so-called behavioral counseling interventions examined in the study are designed to reduce drinking without necessarily eliminating it.
Adults participating in this type of program reduced their alcohol intake by an average of 3.6 drinks per week, with the changes lasting at least six to 12 months. And compared to people in control groups, those who received counseling were more likely to stop binge drinking and meet the consumption limits recommended by their doctors.
The review, which was published today in the Annals of Internal Medicine, was conducted on behalf of the U.S. Preventive Services Task Force (USPSTF), an independent group of experts that provides guidance on preventive care to the federal government. The task force is in the process of updating its recommendations on the screening and treatment of alcohol misuse.
The body of evidence summarized in the new study has grown appreciably since 2004, when the USPSTF last weighed in on this topic, but the draft recommendations issued today are largely unchanged, says Michael LeFevre, M.D., co-vice chair of the USPSTF panel that drew up the recommendations.
“The evidence that we have certainly supports that by screening and doing counseling, we can alter some risky behavior,” says LeFevre, a professor of family and community medicine at the University of Missouri–Columbia. “We still recommend screening for adults.”
The task force recommendations apply only to people over age 18 who engage in “risky” or “hazardous” drinking. They do not apply to adolescents, nor to people suffering from alcoholism (also known as alcohol dependence), who generally require more extensive treatment.
There is no firm definition for risky drinking. According to the National Institute on Alcohol Abuse and Alcoholism, men who consume more than four drinks in a single day (or 14 per week) and women who consume more than three in a day (or seven per week) run the risk of experiencing alcohol-related health problems.
In one of the successful 15-minute interventions highlighted by the authors, doctors asked patients to keep a diary of how much they drank, complete a worksheet on drinking triggers, and create a “drinking agreement,” a contract of sorts in which they spelled out their goals for reducing their consumption.
Short interventions (as brief as five minutes) and longer interventions (up to two hours) weren’t as effective as 15-minute sessions, the study found.
Why? Fifteen minutes may be just long enough to deliver a message, yet not so long that the patient is turned off or overloaded with information, says lead author Daniel E. Jonas, M.D., an assistant professor of medicine at the University of North Carolina at Chapel Hill.
This type of brief intervention “is effective but has to be done repeatedly,” says Ihsan M. Salloum, M.D., the chief of substance and alcohol abuse at the University of Miami Miller School of Medicine. “People respond to personalized feedback from their doctors,” adds Salloum, who was not involved in the new review.
That personalized attention can be hard to come by, however. At a time when doctor’s appointments are often rushed as it is, incorporating alcohol screening and counseling into a regular checkup may be “challenging,” Jonas says.
The review left several questions unanswered. For instance, although the authors did conclude that counseling can lower health-care costs and reduce hospital stays, it’s still unclear if this approach can also decrease alcohol-related health problems, accidents, injuries, and deaths.