Screening and intervention for excessive drinking produce small results

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Screening and intervention for excessive drinking produce small results

J Fam Pract. 2004 January;53(1):8-24

By

Marc R. Via, MD

BACKGROUND: The World Health Organization has recommended screening for excessive alcohol consumption. However, the effectiveness of screening, as a precursor to brief intervention, has not been systematically evaluated. This meta-analysis aims to measure the effectiveness of screening followed by a brief intervention in a primary care setting as a significant factor in the reduction of alcohol consumption.
POPULATION STUDIED: The 8 US, UK, and Australian studies conducted in a primary care setting were combined to include a screened group of 134,693 adults aged 17 to 84 years. Of these, 12,345 screened positive for excessive alcohol consumption (variously defined as consuming from >11 to >29 drinks per week); 3317 were randomized to receive a brief intervention.
STUDY DESIGN AND VALIDITY: This meta-analysis of 8 randomized controlled trials was designed to evaluate the effect a 2-step process—screening for excessive alcohol consumption followed by a brief intervention—had on decreasing alcohol consumption in a clinically meaningful manner. The authors used robust methodology outlined by the Cochrane collaboration to locate and select relevant studies; they performed a solid and clearly outlined internal and external validity assessment on each trial before inclusion.
OUTCOMES MEASURED: The primary outcome was number needed to screen (NNS); that is, the number of people identified as excessive drinkers who would need to receive the intervention for 1 person to benefit. Secondary outcomes were the proportion of patients positive for excessive drinking on screening, the proportion given brief interventions, and the effect of screening.
RESULTS: Nine percent of patients (range, 3.3%–18%) screened positive. Further assessment of drinking history identified 2.5% (range, 0.9%–5.4%) who qualified for a brief intervention. Of these patients, about 10% decreased their drinking as a result of the intervention (absolute risk reduction [ARR]=10%; 95% confidence interval [CI], 7.1%–13.9%). The pooled screening effect was 2.6 (95% CI, 1.7–3.4) patients who achieved sensible drinking out of the 1000 screened.

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Screening and intervention for excessive drinking produce small results

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