Brief physician and nurse practitioner-delivered counseling for high-risk drinking

BACKGROUND: The objective of this study was to determine the effects of a brief primary care provider-delivered counseling intervention on the reduction of alcohol consumption by high-risk drinkers. The intervention was implemented as part of routine primary care medical practice. METHODS: We performed a controlled clinical trial with 6- and 12-month follow-up. Three primary care practices affiliated with an academic medical center were randomly assigned to special intervention (SI) or usual care (UC). A total of 9,772 primary care patients were screened for high-risk drinking. A fourth site was added later. From the group that was screened, 530 high-risk drinkers entered into the study, with 447 providing follow-up at 12 months. The intervention consisted of brief (5-10 minute) patient-centered counseling plus an office system that cued providers to intervene and provided patient educational materials. RESULTS: At 12-month follow-up, after controlling for baseline differences in alcohol consumption, SI participants had significantly larger changes (P=.03) in weekly alcohol intake compared to UC (SI=-5.7 drinks per week; UC=-3.1 drinks per week), and of those who changed to safe drinking at 6 months more SI participants maintained that change at 12 months than UC. CONCLUSIONS: Project Health provides evidence that screening and very brief (5-10 minute) advice and counseling delivered by a patient's personal physician or nurse practitioner as a routine part of a primary care visit can reduce alcohol consumption by high-risk drinkers.