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Brief intervention for unhealthy alcohol and other drug use

Author
Richard Saitz, MD, MPH, FACP, DFASAM
Section Editor
Andrew J Saxon, MD
Deputy Editor
Richard Hermann, MD

INTRODUCTION

Unhealthy alcohol and other drug use are among the most common causes of preventable death [1]. “Unhealthy use” describes use of amounts that risk adverse consequences, have resulted in consequences, or meet DSM-5 criteria for a substance use disorder [2]. Despite their frequent presentation in primary care, unhealthy alcohol and other drug use often go unrecognized. The combination of screening all adult primary care patients to identify individuals with unhealthy use and a brief counseling intervention has been proposed as a population-wide, preventive intervention in primary care [3]. Clinical trials support the use of screening and brief intervention for unhealthy alcohol use for adults.

The DSM-IV-TR diagnoses, substance abuse and substance dependence, were replaced by one diagnosis, substance use disorder, in DSM-5 [2]. Although the crosswalk between DSM-IV and DSM-5 disorders is imprecise, substance dependence is approximately comparable to substance use disorder, moderate to severe subtype, while substance abuse is similar to the mild subtype.

This topic reviews treatment with brief intervention of adult primary care patients identified by screening to have unhealthy alcohol or other drug use. Screening for unhealthy alcohol and other drug use is described separately. The epidemiology, clinical manifestations, and diagnosis of substance use disorder are described separately as are pharmacotherapy and psychosocial interventions for the disorders. (See "Screening for unhealthy use of alcohol and other drugs in primary care" and "Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Pharmacotherapy for alcohol use disorder" and "Psychosocial treatment of alcohol use disorder" and "Cocaine use disorder in adults: Epidemiology, pharmacology, clinical manifestations, medical consequences, and diagnosis" and "Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis" and "Pharmacotherapy for opioid use disorder" and "Cannabis use and disorder: Clinical manifestations, course, assessment, and diagnosis".)

GOALS

The goals of a brief intervention for people without a moderate to severe disorder include either reduction of use or abstinence, as well as change in related behaviors (eg, avoiding bars). The goals will depend on patient readiness and negotiation. Ideal goals are described below:

Unhealthy alcohol use — “Unhealthy use” refers to use that can result in adverse health consequences, from use that risks adverse consequences, to use with consequences that do not reach a diagnostic threshold for substance use disorder (SUD), to use that meets DSM-5 criteria for an SUD. (See "Screening for unhealthy use of alcohol and other drugs in primary care", section on 'Unhealthy alcohol or drug use'.)

                           
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Literature review current through: Sep 2017. | This topic last updated: Aug 16, 2017.
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References
Top
  1. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA 2004; 291:1238.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
  3. U.S. Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med 2004; 140:554.
  4. Friedmann PD, Saitz R, Samet JH. Management of adults recovering from alcohol or other drug problems: relapse prevention in primary care. JAMA 1998; 279:1227.
  5. Kaner EF, Dickinson HO, Beyer F, et al. The effectiveness of brief alcohol interventions in primary care settings: a systematic review. Drug Alcohol Rev 2009; 28:301.
  6. Whitlock EP, Polen MR, Green CA, et al. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2004; 140:557.
  7. Bien TH, Miller WR, Tonigan JS. Brief interventions for alcohol problems: a review. Addiction 1993; 88:315.
  8. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol 1992; 47:1102.
  9. Samet JH, Rollnick S, Barnes H. Beyond CAGE. A brief clinical approach after detection of substance abuse. Arch Intern Med 1996; 156:2287.
  10. Rollnick S, Butler CC, Stott N. Helping smokers make decisions: the enhancement of brief intervention for general medical practice. Patient Educ Couns 1997; 31:191.
  11. Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change, Guilford Press, New York 2002.
  12. Rollnick S, Heather N, Bell A. Negotiating behavior change in medical settings: The development of brief motivational interviewing. Journal of Mental Health 1992; 1:25.
  13. Rollnick S, Mason P, Butler C. Health Behavior Change, Churchill Livingstone, Edinburgh 1999.
  14. Kristenson H, Ohlin H, Hultén-Nosslin MB, et al. Identification and intervention of heavy drinking in middle-aged men: results and follow-up of 24-60 months of long-term study with randomized controls. Alcohol Clin Exp Res 1983; 7:203.
  15. Ballesteros J, Duffy JC, Querejeta I, et al. Efficacy of brief interventions for hazardous drinkers in primary care: systematic review and meta-analyses. Alcohol Clin Exp Res 2004; 28:608.
  16. Bertholet N, Daeppen JB, Wietlisbach V, et al. Reduction of alcohol consumption by brief alcohol intervention in primary care: systematic review and meta-analysis. Arch Intern Med 2005; 165:986.
  17. Beich A, Thorsen T, Rollnick S. Screening in brief intervention trials targeting excessive drinkers in general practice: systematic review and meta-analysis. BMJ 2003; 327:536.
  18. Jonas DE, Garbutt JC, Amick HR, et al. Behavioral counseling after screening for alcohol misuse in primary care: a systematic review and meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2012; 157:645.
  19. O'Donnell A, Anderson P, Newbury-Birch D, et al. The impact of brief alcohol interventions in primary healthcare: a systematic review of reviews. Alcohol Alcohol 2014; 49:66.
  20. Fleming MF, Mundt MP, French MT, et al. Brief physician advice for problem drinkers: long-term efficacy and benefit-cost analysis. Alcohol Clin Exp Res 2002; 26:36.
  21. Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness. Am J Prev Med 2008; 34:143.
  22. McQueen J, Howe TE, Allan L, et al. Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database Syst Rev 2011; :CD005191.
  23. Mdege ND, Fayter D, Watson JM, et al. Interventions for reducing alcohol consumption among general hospital inpatient heavy alcohol users: a systematic review. Drug Alcohol Depend 2013; 131:1.
  24. Emmen MJ, Schippers GM, Bleijenberg G, Wollersheim H. Effectiveness of opportunistic brief interventions for problem drinking in a general hospital setting: systematic review. BMJ 2004; 328:318.
  25. Saitz R, Palfai TP, Cheng DM, et al. Brief intervention for medical inpatients with unhealthy alcohol use: a randomized, controlled trial. Ann Intern Med 2007; 146:167.
  26. Freyer-Adam J, Coder B, Baumeister SE, et al. Brief alcohol intervention for general hospital inpatients: a randomized controlled trial. Drug Alcohol Depend 2008; 93:233.
  27. Liu SI, Wu SI, Chen SC, et al. Randomized controlled trial of a brief intervention for unhealthy alcohol use in hospitalized Taiwanese men. Addiction 2011; 106:928.
  28. Field C, Walters S, Marti CN, et al. A multisite randomized controlled trial of brief intervention to reduce drinking in the trauma care setting: how brief is brief? Ann Surg 2014; 259:873.
  29. Zatzick D, Donovan DM, Jurkovich G, et al. Disseminating alcohol screening and brief intervention at trauma centers: a policy-relevant cluster randomized effectiveness trial. Addiction 2014; 109:754.
  30. Bischof G, Reinhardt S, Freyer-Adam J, et al. Severity of unhealthy alcohol consumption in medical inpatients and the general population: is the general hospital a suitable place for brief interventions? Int J Public Health 2010; 55:637.
  31. Saitz R. Most inpatients with unhealthy alcohol use have an alcohol use disorder. Int J Public Health 2010; 55:527.
  32. Belen-Martinez A, Roson B, Hernandez R, Lazaro M, Bolao F, Vallejo J, et al. Usefulness of AUDIT-C as screening tool in an opportunistic brief intervention program for alcohol problems in hospitalized patients. Presentation November 19, 2007 at the meeting of the International Network on Brief Interventions for Alcohol Problems. Brussels, Belgium.
  33. Schmidt CS, Schulte B, Seo HN, et al. Meta-analysis on the effectiveness of alcohol screening with brief interventions for patients in emergency care settings. Addiction 2016; 111:783.
  34. Nilsen P, Baird J, Mello MJ, et al. A systematic review of emergency care brief alcohol interventions for injury patients. J Subst Abuse Treat 2008; 35:184.
  35. D'Onofrio G, Fiellin DA, Pantalon MV, et al. A brief intervention reduces hazardous and harmful drinking in emergency department patients. Ann Emerg Med 2012; 60:181.
  36. D'Onofrio G, Pantalon MV, Degutis LC, et al. Brief intervention for hazardous and harmful drinkers in the emergency department. Ann Emerg Med 2008; 51:742.
  37. Drummond C, Deluca P, Coulton S, et al. The effectiveness of alcohol screening and brief intervention in emergency departments: a multicentre pragmatic cluster randomized controlled trial. PLoS One 2014; 9:e99463.
  38. Kristenson H, Osterling A, Nilsson JA, Lindgärde F. Prevention of alcohol-related deaths in middle-aged heavy drinkers. Alcohol Clin Exp Res 2002; 26:478.
  39. Dhital R, Norman I, Whittlesea C, et al. The effectiveness of brief alcohol interventions delivered by community pharmacists: randomized controlled trial. Addiction 2015; 110:1586.
  40. Watson MC, Inch J, Jaffray M, Stewart D. Screening and brief interventions for alcohol misuse delivered in the community pharmacy setting: a pilot study. Int J Pharm 2011; 19:5.
  41. Fernandez AC, Claborn KR, Borsari B. A systematic review of behavioural interventions to reduce preoperative alcohol use. Drug Alcohol Rev 2015.
  42. Kummel M, Vahlberg T, Ojanlatva A, et al. Effects of an intervention on health behaviors of older coronary artery bypass (CAB) patients. Arch Gerontol Geriatr 2008; 46:227.
  43. Oppedal K, Møller AM, Pedersen B, Tønnesen H. Preoperative alcohol cessation prior to elective surgery. Cochrane Database Syst Rev 2012; :CD008343.
  44. Saitz R. Alcohol screening and brief intervention in primary care: Absence of evidence for efficacy in people with dependence or very heavy drinking. Drug Alcohol Rev 2010; 29:631.
  45. Field CA, Caetano R. The effectiveness of brief intervention among injured patients with alcohol dependence: who benefits from brief interventions? Drug Alcohol Depend 2010; 111:13.
  46. Owens L, Kolamunnage-Dona R, Owens A, et al. A Randomized Controlled Trial of Extended Brief Intervention for Alcohol-Dependent Patients in an Acute Hospital Setting. Alcohol Alcohol 2016; 51:584.
  47. Glass JE, Hamilton AM, Powell BJ, et al. Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials. Addiction 2015; 110:1404.
  48. Madras BK, Compton WM, Avula D, et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend 2009; 99:280.
  49. Bernstein J, Bernstein E, Tassiopoulos K, et al. Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug Alcohol Depend 2005; 77:49.
  50. Otto C, Crackau B, Löhrmann I, et al. Brief intervention in general hospital for problematic prescription drug use: 12-month outcome. Drug Alcohol Depend 2009; 105:221.
  51. Zahradnik A, Otto C, Crackau B, et al. Randomized controlled trial of a brief intervention for problematic prescription drug use in non-treatment-seeking patients. Addiction 2009; 104:109.
  52. Roy-Byrne P, Bumgardner K, Krupski A, et al. Brief intervention for problem drug use in safety-net primary care settings: a randomized clinical trial. JAMA 2014; 312:492.
  53. Saitz R, Palfai TP, Cheng DM, et al. Screening and brief intervention for drug use in primary care: the ASPIRE randomized clinical trial. JAMA 2014; 312:502.
  54. Gelberg L, Andersen RM, Afifi AA, et al. Project QUIT (Quit Using Drugs Intervention Trial): a randomized controlled trial of a primary care-based multi-component brief intervention to reduce risky drug use. Addiction 2015; 110:1777.
  55. Humeniuk R, Ali R, Babor T, et al. A randomized controlled trial of a brief intervention for illicit drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in clients recruited from primary health-care settings in four countries. Addiction 2012; 107:957.
  56. Bogenschutz MP, Donovan DM, Mandler RN, et al. Brief intervention for patients with problematic drug use presenting in emergency departments: a randomized clinical trial. JAMA Intern Med 2014; 174:1736.
  57. Young MM, Stevens A, Galipeau J, et al. Effectiveness of brief interventions as part of the Screening, Brief Intervention and Referral to Treatment (SBIRT) model for reducing the nonmedical use of psychoactive substances: a systematic review. Syst Rev 2014; 3:50.
  58. Chang G, Wilkins-Haug L, Berman S, Goetz MA. Brief intervention for alcohol use in pregnancy: a randomized trial. Addiction 1999; 94:1499.
  59. O'Connor MJ, Whaley SE. Brief intervention for alcohol use by pregnant women. Am J Public Health 2007; 97:252.
  60. Hankin JR. Fetal alcohol syndrome prevention research. Alcohol Res Health 2002; 26:58.
  61. Floyd RL, Sobell M, Velasquez MM, et al. Preventing alcohol-exposed pregnancies: a randomized controlled trial. Am J Prev Med 2007; 32:1.
  62. Chang G, McNamara TK, Orav EJ, et al. Brief intervention for prenatal alcohol use: a randomized trial. Obstet Gynecol 2005; 105:991.
  63. Rubio DM, Day NL, Conigliaro J, et al. Brief motivational enhancement intervention to prevent or reduce postpartum alcohol use: a single-blinded, randomized controlled effectiveness trial. J Subst Abuse Treat 2014; 46:382.
  64. Samson JE, Tanner-Smith EE. Single-Session Alcohol Interventions for Heavy Drinking College Students: A Systematic Review and Meta-Analysis. J Stud Alcohol Drugs 2015; 76:530.
  65. Schaus JF, Sole ML, McCoy TP, et al. Alcohol screening and brief intervention in a college student health center: a randomized controlled trial. J Stud Alcohol Drugs Suppl 2009; :131.
  66. Scott-Sheldon LA, Carey KB, Elliott JC, et al. Efficacy of alcohol interventions for first-year college students: a meta-analytic review of randomized controlled trials. J Consult Clin Psychol 2014; 82:177.
  67. Miller WR, Taylor CA. Relative effectiveness of bibliotherapy, individual and group self-control training in the treatment of problem drinkers. Addict Behav 1980; 5:13.
  68. Miller WR, Muñoz RF. Controlling your drinking : tools to make moderation work for you, Guilford Press, New York 2005.
  69. Hester RK, Delaney HD, Campbell W. ModerateDrinking.Com and moderation management: outcomes of a randomized clinical trial with non-dependent problem drinkers. J Consult Clin Psychol 2011; 79:215.
  70. Hester RK, Lenberg KL, Campbell W, Delaney HD. Overcoming Addictions, a Web-based application, and SMART Recovery, an online and in-person mutual help group for problem drinkers, part 1: three-month outcomes of a randomized controlled trial. J Med Internet Res 2013; 15:e134.
  71. Dedert EA, McDuffie JR, Stein R, et al. Electronic Interventions for Alcohol Misuse and Alcohol Use Disorders: A Systematic Review. Ann Intern Med 2015; 163:205.
  72. Riper H, Blankers M, Hadiwijaya H, et al. Effectiveness of guided and unguided low-intensity internet interventions for adult alcohol misuse: a meta-analysis. PLoS One 2014; 9:e99912.
  73. Donoghue K, Patton R, Phillips T, et al. The effectiveness of electronic screening and brief intervention for reducing levels of alcohol consumption: a systematic review and meta-analysis. J Med Internet Res 2014; 16:e142.
  74. Kypri K, Langley JD, Saunders JB, et al. Randomized controlled trial of web-based alcohol screening and brief intervention in primary care. Arch Intern Med 2008; 168:530.
  75. https://www.thecommunityguide.org/findings/alcohol-excessive-consumption-electronic-screening-and-brief-interventions-e-sbi (Accessed on November 17, 2016).
  76. Schwartz RP, Gryczynski J, Mitchell SG, et al. Computerized versus in-person brief intervention for drug misuse: a randomized clinical trial. Addiction 2014; 109:1091.
  77. Stevens MM, Olson AL, Gaffney CA, et al. A pediatric, practice-based, randomized trial of drinking and smoking prevention and bicycle helmet, gun, and seatbelt safety promotion. Pediatrics 2002; 109:490.
  78. Miller WR, Moyers TB, Arciniega L, et al. Training, supervision and quality monitoring of the COMBINE Study behavioral interventions. J Stud Alcohol Suppl 2005; :188.
  79. Miller WR, Yahne CE, Moyers TB, et al. A randomized trial of methods to help clinicians learn motivational interviewing. J Consult Clin Psychol 2004; 72:1050.
  80. Gentilello LM, Samuels PN, Henningfield JE, Santora PB. Alcohol screening and intervention in trauma centers: confidentiality concerns and legal considerations. J Trauma 2005; 59:1250.
  81. Rivara FP, Tollefson S, Tesh E, Gentilello LM. Screening trauma patients for alcohol problems: are insurance companies barriers? J Trauma 2000; 48:115.
  82. Burns DL. Positive toxicology screening in newborns: ethical issues in the decision to legally intervene. Pediatr Nurs 1997; 23:73.
  83. Pelham TL, DeJong AR. Nationwide practices for screening and reporting prenatal cocaine abuse: a survey of teaching programs. Child Abuse Negl 1992; 16:763.
  84. Adirim TA, Sen Gupta N. A national survey of state maternal and newborn drug testing and reporting policies. Public Health Rep 1991; 106:292.
  85. Connolly WB Jr, Marshall AB. Drug addiction, pregnancy, and childbirth: legal issues for the medical and social services communities. Clin Perinatol 1991; 18:147.
  86. Saitz R, Horton NJ, Cheng DM, Samet JH. Alcohol counseling reflects higher quality of primary care. J Gen Intern Med 2008; 23:1482.
  87. Lock CA, Kaner EF. Implementation of brief alcohol interventions by nurses in primary care: do non-clinical factors influence practice? Fam Pract 2004; 21:270.
  88. Kaner EF, Heather N, Brodie J, et al. Patient and practitioner characteristics predict brief alcohol intervention in primary care. Br J Gen Pract 2001; 51:822.
  89. Beich A, Gannik D, Malterud K. Screening and brief intervention for excessive alcohol use: qualitative interview study of the experiences of general practitioners. BMJ 2002; 325:870.
  90. Platt L, Melendez-Torres GJ, O'Donnell A, et al. How effective are brief interventions in reducing alcohol consumption: do the setting, practitioner group and content matter? Findings from a systematic review and metaregression analysis. BMJ Open 2016; 6:e011473.
  91. Sullivan LE, Tetrault JM, Braithwaite RS, et al. A meta-analysis of the efficacy of nonphysician brief interventions for unhealthy alcohol use: implications for the patient-centered medical home. Am J Addict 2011; 20:343.
  92. Lock CA, Kaner E, Heather N, et al. Effectiveness of nurse-led brief alcohol intervention: a cluster randomized controlled trial. J Adv Nurs 2006; 54:426.