Efficacy Of Brief Intervention Research Articles

Ethnic differences in drinking outcomes following a brief alcohol intervention in the trauma care setting.

Evidence suggests that brief interventions in the trauma care setting reduce drinking, subsequent injury and driving under the influence (DUI) arrest. However, evidence on the effectiveness of these interventions in ethnic minority groups is lacking. The current study evaluates the efficacy of brief intervention among whites, blacks and Hispanics in the United States. We conducted a two-group parallel randomized trial comparing brief motivational intervention (BMI) and treatment as usual with assessment (TAU+) to evaluate treatment differences in drinking patterns by ethnicity. Patients were recruited from a level 1 urban trauma center over a 2-year period. The study included 1493 trauma patients, including 668 whites, 288 blacks and 537 Hispanics. Hierarchical linear modeling was used to evaluate ethnic differences in drinking outcomes including volume per week, maximum amount consumed in 1 day, percentage days abstinent and percentage days heavy drinking at 6- and 12-month follow-up. Analyses controlled for age, gender, employment status, marital status, prior alcohol treatment, type of injury and injury severity. Special emphasis was given to potential ethnic differences by testing the interaction between ethnicity and BMI. At 6- and 12-month follow-up, BMI significantly reduced maximum amount consumed in 1 day (P < 0.001; P < 0.001, respectively) and percentage days heavy drinking (P < 0.05; P < 0.05, respectively) among Hispanics. Hispanics in the BMI group also reduced average volume per week at 12-month follow-up (chi(2) = 6.8, df = 1, P < 0.01). In addition, Hispanics in TAU+ reduced maximum amount consumed at 6- and 12-month follow-up (P < 0.001; P < 0.001) and volume per week at 12-month follow-up (P < 0.001). Whites and blacks in both BMI and TAU+ reduced volume per week and percentage days heavy drinking at 12-month follow-up (P < 0.001; P < 0.01, respectively) and decreased maximum amount at 6- (P < 0.001) and 12-month follow-up (P < 0.001). All three ethnic groups In both BMI and TAU+ reduced volume per week at 6-month follow-up (P < 0.001) and percentage days abstinent at 6- (P < 0.001) and 12-month follow-up (P < 0.001). All three ethnic groups evidenced reductions in drinking at 6- and 12-month follow-up independent of treatment assignment. Among Hispanics, BMI reduced alcohol intake significantly as measured by average volume per week, percentage days heavy drinking and maximum amount consumed in 1 day.

THE EFFECT OF BRIEF ALCOHOL INTERVENTION ON POSTPARTUM DEPRESSION

To report on secondary results from the Healthy Moms Study, a clinical trial to test the efficacy of brief intervention on reducing alcohol use and alcohol-related harms in postpartum women. Data from a randomized clinical trial conducted between 2002 and 2005 with a sample of Wisconsin women was analyzed. This report presents comparison data on depressive symptomatology between postpartum women drinking above recommended levels who received a brief alcohol intervention and those who received no intervention. At 6-month follow-up, there was a significant reduction in mean depression scores compared to baseline in the women who received the alcohol intervention (p < .001). There was no significant reduction in depressive symptomatology in the control group. Mean level of depression at 6 months was significantly predicted by baseline depression and the alcohol intervention (p = .018). Alcohol use at either baseline or follow-up was not a predictive factor in determining mean depressive symptomatology. The results of the Healthy Moms Study support the importance of both alcohol and depression screening during the postpartum period. Brief alcohol intervention during this time may also positively affect depressive symptomatology.

Brief motivational interventions for college student problem gamblers

College students experience high rates of problem and pathological gambling, yet little research has investigated methods for reducing gambling in this population. This study sought to examine the efficacy of brief intervention strategies. Randomized trial. College campuses. A total of 117 college student problem and pathological gamblers. Students were assigned randomly to: an assessment-only control, 10 minutes of brief advice, one session of motivational enhancement therapy (MET) or one session of MET, plus three sessions of cognitive-behavioral therapy (CBT). The three interventions were designed to reduce gambling. Gambling was assessed at baseline, week 6 and month 9 using the Addiction Severity Index-gambling (ASI-G) module, which also assesses days and dollars wagered. Compared to the assessment-only condition, those receiving any intervention had significant decreases in ASI-G scores and days and dollars wagered over time. The MET condition decreased significantly ASI-G scores and dollars wagered over time, and increased the odds of a clinically significant reduction in gambling at the 9-month follow-up relative to the assessment-only condition, even after controlling for baseline indices that could impact outcomes. The Brief Advice and MET+CBT conditions had benefits on some, but not all, indices of gambling. None of the interventions differed significantly from one another. Conclusions These results suggest the efficacy of brief interventions for reducing gambling problems in college students.

ETHNIC DIFFERENCES IN RESPONSE TO BRIEF INTERVENTION IN THE TRAUMA CARE SETTING

Background: There is sufficient evidence to suggest that brief interventions in the trauma care setting reduce drinking, subsequent injury and DUI arrest (Gentilello, 1999, Schermer, 2006). The current study evaluates the relative efficacy of brief intervention among Whites, Blacks and Hispanics.Methods: A randomized controlled trial of brief intervention based on motivation interviewing in comparison to a semi‐structured assessment was conducted in an urban level I trauma center. The current study includes 1493 trauma patients including 668 Whites, 288 Blacks, and 537 Hispanics. hierarchical linear modeling was used to evaluate ethnic differences in drinking outcomes including volume per week, frequency of five or more per occasion, maximum amount consumed in one day, percent days abstinent and percent days heavy drinking at 6 and 12 month follow up. Analyses controlled for age, gender, employment status, marital status, prior alcohol treatment, type of injury and injury severity. Special emphasis was given to ethnicity and testing of a potential interaction effect between ethnicity and brief intervention efficacy.Results: Across ethnic groups,patients in both intervention and control groups reduced their drinking. Across drinking outcomes, there were significant interactions between treatment and ethnicity (p&lt;.05). Among Hispanics, brief intervention in comparison to control significantly reduced average volume per week at 12 month follow up (β=‐.56, SE=.23, p&lt;.05), maximum amount consumed in one day at 6 and 12 month follow up (β=‐.32, SE=.12, p=.01; β=.42, SE=.13, p&lt;.01, respectively), frequency of five or more per occasion at 12 month follow up (β=‐.49, SE=.25, p&lt;.05) and percent days heavy drinking at 12 months (β=‐.16, SE.06, p=.01).Conclusions: All three ethnic groups evidenced reductions in drinking at 6 and 12 month follow up independent of treatment. Among Hispanics, brief intervention significantly reduced drinking patterns typically associated with injury and other negative health consequences.

Brief Intervention for Hazardous and Harmful Drinkers in the Emergency Department

To determine the efficacy of emergency practitioner-performed brief intervention for hazardous/harmful drinkers in reducing alcohol consumption and negative consequences in an emergency department (ED) setting. A randomized clinical trial (Project ED Health) was conducted in an urban ED from May 2002 to November 2003 for hazardous/harmful drinkers. Patients 18 years or older who screened above National Institute for Alcohol Abuse and Alcoholism guidelines for "low-risk" drinking or presented with an injury in the setting of alcohol ingestion were eligible. The mean number of drinks per week and binge-drinking episodes during the past 30 days were collected at 6 and 12 months; negative consequences and use of treatment services, at 12 months. A Brief Negotiation Interview performed by emergency practitioners was compared to scripted Discharge Instructions. A total of 494 hazardous/harmful drinkers were studied. The 2 groups were similar with respect to baseline characteristics. In the Brief Negotiation Interview group, the mean number of drinks per week at 12 months was 3.8 less than the 13.6 reported at baseline. The Discharge Instructions group decreased 2.6 from 12.4 at baseline. Likewise, binge-drinking episodes per month decreased by 2.0 from a baseline of 6.0 in the Brief Negotiation Interview group and 1.5 from 5.4 in the Discharge Instructions group. For each outcome, the time effect was significant and the treatment effect was not. Among ED patients with hazardous/harmful drinking, we did not detect a difference in efficacy between emergency practitioner-performed Brief Negotiation Interview and Discharge Instructions. Further studies to test the efficacy of brief intervention in the ED are needed.

Gender differences in the efficacy of brief interventions with a stepped care approach in general practice patients with alcohol-related disorders

To analyse gender differences in the efficacy of stepped care brief interventions for general practice patients with alcohol problems. Data are part of "Stepped Interventions for Problem Drinkers," in which 10,803 patients from 85 general practitioners were screened using alcohol related questionnaires; 408 patients were randomized (32% were female) to a control (booklet only) or two different intervention groups: stepped care (feedback, manual, and up to three counselling sessions depending on the success of the previous intervention) and fixed care (four sessions). Response rate for the 12 months follow-up was 91.7%. Regression analysis revealed a significant effect size only in women (P = 0.039). After excluding alcohol dependents and binge drinkers, an effect size (R(2)) of 0.031 (P = 0.050) in women and an effect size (R(2)) of 0.069 (P = 0.057) in men was obtained. Among the patients in stepped care who, by the first assessment point, had reduced drinking to within safe-drinking limits, there was a tendency for females to have achieved this more often than males (40% vs. 24%; P = 0.089). In a heterogeneous sample, the intervention was only effective for women. Women tended to profit more from the first, less intensive intervention than men. When analysis was limited to those reporting "at risk" average daily consumption and "alcohol abuse," the gender differences in efficacy appeared to be less, but the study was not sufficiently powered to affirm that.

Do brief personalized feedback interventions work for mandated students or is it just getting caught that works?

Studies evaluating the efficacy of brief interventions with mandated college students have reported declines in drinking from baseline to short-term follow-up regardless of intervention condition. A key question is whether these observed changes are due to the intervention or to the incident and/or reprimand. This study evaluates a brief personalized feedback intervention (PFI) for students (N = 230) who were referred to a student assistance program because of infractions of university rules regarding substance use to determine whether observed changes in substance use are attributable to the intervention. Half the students received immediate feedback (at baseline and after the 2-month follow-up), and half received delayed feedback (only after the 2-month follow-up). Students in both conditions generally reduced their drinking and alcohol-related problems from baseline to the 2-month follow-up and from the 2-month to the 7-month follow-up; however, there were no significant between-group differences at either follow-up. Therefore, it appears that the incident and/or reprimand are important instigators of mandated student change and that written PFIs do not enhance these effects on a short-term basis but may on a longer term basis.

Brief intervention for alcohol use by pregnant women.

We examined the efficacy of brief intervention as a technique to help pregnant women achieve abstinence from alcohol. A second aim was to assess newborn outcomes as a function of brief intervention. Two hundred fifty-five pregnant women who were participants in the Public Health Foundation Enterprises Management Solutions Special Supplemental Nutrition Program for Women, Infants, and Children and who reported drinking alcohol were assigned to an assessment-only or a brief intervention condition and followed to their third trimester of pregnancy. Brief intervention consisted of 10- to 15-minute sessions of counseling by a nutritionist, who used a scripted manual to guide the intervention. Newborn outcomes of gestation, birth-weight, birth length, and viability were assessed. Women in the brief intervention condition were 5 times more likely to report abstinence after intervention compared with women in the assessment-only condition. Newborns whose mothers received brief intervention had higher birthweights and birth lengths, and fetal mortality rates were 3 times lower (0.9%) compared with newborns in the assessment-only (2.9%) condition. The success of brief intervention conducted in a community setting by nonmedical professionals has significant implications for national public health policies.

What I Think I May Have Learned—Reflections on 50 Years of Teaching: An Interview with Michael Wertheimer

Kurt Michael is an associate professor in the Department of Psychology at Appalachian State University (ASU) where he teaches history and systems of psychology, abnormal psychology, child psychopathology, and interventions for children and adolescents. He received his BA (cum laude) from the University of Colorado at Boulder and his MS and PhD in clinical psychology from Utah State University. He completed his internship in clinical psychology at Duke University Medical Center. His empirical research has focused on the assessment and treatment of child and adolescent psychopathology, meta-analytic designs, and the efficacy of brief interventions for excessive alcohol consumption among college students. In addition to his teaching and research endeavors, he serves as associate director for Clinical Services at ASU's Institute for Health and Human Services. Michael Wertheimer, professor emeritus at the University of Colorado at Boulder, has won awards for the teaching of psychology, for service, and for contributions to the history of psychology. After earning his BA (with high honors) from Swarthmore College and an MA in psychology from The Johns Hopkins University, he received his PhD in experimental psychology from Harvard University under the supervision of S. S. Stevens and Edwin G. Boring. He also worked for 1 semester as a full-time research assistant to social psychologist Solomon E. Asch. His career at the University of Colorado at Boulder (after teaching for 3 years at Wesleyan University) included decades of service as director or codirector of the departmental honors program in psychology (1956 to 1993) as well as the presidency of Divisions 1 (General), 2 (Society for the Teaching of Psychology), 24 (Theoretical and Philosophical Psychology—twice), and 26 (History) of the American Psychological Association (APA) and of Psi Chi and the Rocky Mountain Psychological Association. Among his scholarly endeavors in the history of psychology is the preservation of his father's (Max Wertheimer) contributions to the development of Gestalt theory (King &amp; Wertheimer, 2005). He is the recipient of the Distinguished Teaching Award of the American Psychological Foundation and a Lifetime Achievement Award for Sustained, Outstanding, and Unusual Contributions to the History of Psychology from the APA's Division 26.

The severity of unhealthy alcohol use in hospitalized medical patients

Professional organizations recommend screening and brief intervention for unhealthy alcohol use; however, brief intervention has established efficacy only for people without alcohol dependence. Whether many medical inpatients with unhealthy alcohol use have nondependent use, and thus might benefit from brief intervention, is unknown. To determine the prevalence and spectrum of unhealthy alcohol use in medical inpatients. Interviews of medical inpatients (March 2001 to June 2003). Adult medical inpatients (5,813) in an urban teaching hospital. Proportion drinking risky amounts in the past month (defined by national standards); proportion drinking risky amounts with a current alcohol diagnosis (determined by diagnostic interview). Seventeen percent (986) were drinking risky amounts; 97% exceeded per occasion limits. Most scored > or =8 on the Alcohol Use Disorders Identification Test, strongly correlating with alcohol diagnoses. Most of a subsample of subjects who drank risky amounts and received further evaluation had dependence (77%). Drinking risky amounts was common in medical inpatients. Most drinkers of risky amounts had dependence, not the broad spectrum of unhealthy alcohol use anticipated. Screening on a medicine service largely identifies patients with dependence--a group for whom the efficacy of brief intervention (a recommended practice) is not well established.

Efficacy of brief interventions for hazardous drinkers in primary care: systematic review and meta-analyses.

Because recent research in primary care has challenged the findings of previous reviews on the efficacy of brief interventions (BIs) on hazardous drinkers, we conducted a systematic review and meta-analysis to update the evidence of BIs as applied in the primary care setting. We obtained source material by searching electronic databases and reference lists and hand-searching journals. We selected randomized trials providing frequency data that allowed assessment of the efficacy of BIs on an intention-to-treat basis. Results were summarized by the odds ratio (OR) of response. When appropriate, risk difference (RD) and its inverse (number needed to treat [NNT] to achieve a positive result) were also computed. Fixed and/or random effect models were fitted according to heterogeneity estimates. Thirteen studies provided data for a dose-effect analysis, 12 for comparison of BIs with reference categories. No clear evidence of a dose-effect relationship was found. BIs outperformed minimal interventions and usual care (random effects model OR = 1.55, 95% confidence interval [CI] = 1.27-1.90; RD = 0.11, 95% CI = 0.06-0.16; NNT = 10, 95% CI = 7-17). Similar results were obtained when two influential studies were removed (fixed effect model OR = 1.57, 95% CI = 1.32-1.87; RD = 0.11, 95% CI = 0.07-0.15; NNT = 9, 95% CI = 7-15). The heterogeneity between individual estimates was accounted for by the type of hazardous drinkers (heavy versus moderate) and by the characteristics of the included individuals (treatment seekers versus nontreatment seekers). The funnel plot did not show evidence of publication bias. Our results, although indicating smaller effect sizes than previous meta-analyses, do support the moderate efficacy of BIs. Further research is outlined.

Brief interventions: good in theory but weak in practice

A substantial body of research evidence has accumulated in support of the efficacy of brief interventions for a number of alcohol and drug-related problem areas, most notably alcohol and tobacco. This evidence has been used to exhort a range of professional groups such as general practitioners (GPs), and more recently emergency department hospital staff to engage in brief interventions. Internationally, however, these secondary prevention efforts have largely failed. Why have these proven interventions not been embraced by frontline workers? This is a little-asked question as efforts to press-gang unwilling professionals to take up the cudgel continue. This paper examines the characteristics of brief interventions and their principal delivery agents and explores reasons for the failure to move from efficacy to effectiveness. Given the prevention potential that rests with brief intervention, these are crucial questions to address. A key feature of brief intervention delivery also examined is the role of GPs versus the less well-explored option of the practice nurse. It will be proposed that perhaps we have the right vehicle but the wrong driver and that until closer scrutiny is made of this issue efforts in this key prevention area will continue to fail to achieve optimum results.

Brief interventions for hazardous drinkers delivered in primary care are equally effective in men and women.

Despite the accumulated evidence on the efficacy of brief interventions in hazardous drinkers some ambiguity remains regarding their differential effectiveness by gender. Meta-analysis of independent studies conducted in primary health care settings with a follow-up of 6-12 months which report results separately by gender. Two outcome measures were selected: the quantity of typical weekly alcohol consumption and the frequency of drinkers who reported consumption below hazardous levels after the intervention. Seven studies were included in the meta-analysis. The standardized effect sizes for the reduction of alcohol consumption were similar in men (d=- 0.25; 95% CI=- 0.34 to -0.17) and women (d=- 0.26; 95% CI=- 0.38 to - 0.13). The odds ratios (OR) for the frequency of individuals who drank below harmful levels were also similar (four studies; OR for men=2.32; 95% CI=1.78-2.93; OR for women=2.31; 95% CI=1.60-3.17). The difference between genders was negligible. Our results support the equality of outcomes among men and women achieved by brief interventions for hazardous alcohol consumption in primary care settings.

Conversation with Richard Fuller.

Conversation with Richard Fuller.

Effectiveness of medical advice for reducing excessive alcohol conssumption: meta-analysis of Spanish studies in primary care

INTRODUCTION Former systematic reviews have backed the efficacy of medical counselling, a form of brief intervention, on the treatment of excessive drinkers detected in primary care settings. Nevertheless, these results cannot be applied without criticism to Mediterranean populations which, so far, have not been represented in the aforementioned studies. The aim of the present study was to update the results on the efficacy of brief interventions in primary care by pooling Spanish studies. METHODS Studies were searched for by using appropriate databases and also by consulting to experts in the field to retrieve grey literature. Pooled estimations of effect sizes were calculated for two outcomes, the reduction in the amount of alcohol consumption and the decrease in the number of excessive drinkers. RESULTS Two over the 5 retrieved studies were not included in a former review. The effect size regarding the decrease of alcohol consumption was medium (d = 0.46; 95% CI, 0.29 to 0.63; p < 0.0005; the intervention group outperformed the control by a 22%) and small for the decrease in the frequency of excessive drinkers (OR = 1.55; 95% CI, 1.06 to 2.26; p = 0.02; the intervention group outperformed the control by a 11%). The analysis by complimented protocols at the end of the study showed an effect size 1.5 times larger than the analysis performed on intention-to-treat basis. CONCLUSIONS The results of this meta-analysis support the efficacy of brief intervention for excessive drinkers in primary care settings in Spain.

Eficacia del consejo médico para la reducción del consumo excesivo de alcohol. Metaanálisis de estudios españoles en atención primaria

IntroductionFormer systematic reviews have backed the efficacy of medical counselling, a form of brief intervention, on the treatment of excessive drinkers detected in primary care settings. Nevertheless, these results cannot be applied without criticism to Mediterranean populations which, so far, have not been represented in the aforementioned studies. The aim of the present study was to update the results on the efficacy of brief interventions in primary care by pooling Spanish studies. MethodsStudies were searched for by using appropriate databases and also by consulting to experts in the field to retrieve grey literature. Pooled estimations of effect sizes were calculated for two outcomes, the reduction in the amount of alcohol consumption and the decrease in the number of excessive drinkers. ResultsTwo over the 5 retrieved studies were not included in a former review. The effect size regarding the decrease of alcohol consumption was medium (d = –0.46; 95% CI, –0.29 to –0.63; p < 0.0005; the intervention group outperformed the control by a 22%) and small for the decrease in the frequency of excessive drinkers (OR = 1.55; 95% CI, 1.06 to 2.26; p = 0.02; the intervention group outperformed the control by a 11%). The analysis by complimented protocols at the end of the study showed an effect size 1.5 times larger than the analysis performed on intention-to-treat basis. ConclusionsThe results of this meta-analysis support the efficacy of brief intervention for excessive drinkers in primary care settings in Spain.

Intervención en poblaciones de riesgo (2): los bebedores de riesgo

Most of the alcohol related harm occurs in non dependent drinkers. 9.5% of spanish adult population are risky drinkers. WHO conducts through the WHO Collaborative Study on Alcohol Early Interventions in Primary Health Care Settings, a cross-national study which aims to develop effective instruments for early detection and brief intervention in risky drinkers. Phase I of the Study was devoted to the design and validation of a screening tool (the AUDIT questionnaire). In Phase II, efficacy of brief interventions (using the Drinkless program) was shown. Phase III focused on marketing and support strategies most efficient to widespread brief interventions in Primary Health Care. Phase IV aims at real dissemination of brief interventions in Primary Health Care. The ‘Beveu Menys’ (Drink less) program is pioneering the experience. Through training the trainers strategies, based on the Skills for change package, and establishing solid coordination between PHC Centres and specialized alcohol units, the program allows general practitioners and nurses to handle with both, risky drinkers and alcoholics.

Smoking treatment interventions and policies to promote their use: a critical review.

Despite evidence regarding the effectiveness and cost-effectiveness of smoking cessation treatments, the involvement of health care workers in providing advice and the use of treatment is limited. Barriers to treatment access have been suggested as part of the reason physicians do not routinely provide brief interventions and smokers do not use proven cessation methods. The purpose of this paper is to review tobacco treatments and policy research, and highlight where more research is warranted to develop more effective policies at the private and public levels. Special attention is devoted to the recently released Guidelines (Fiore et al., Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: USDHHS, 2000). We also consider the policy issues faced by private and public insurers, such as cost-effectiveness, the different forms that policies could take, and potential problems in implementing those policies. The efficacy of brief interventions and cessation treatments has been well studied. Less understood, however, is their impact in population-based investigations. In particular, more information is needed on the prevalence of their use and on how treatment use depends on prior smoking, treatment history, and demographic subgroup. Public and private health policies designed to increase access to cessation treatments and information dissemination through brief interventions by health care providers also have the potential to increase cessation. Further research on the impact of these interventions on use and quit rates, particularly over longer periods of time, and how these effects depend on the form of the intervention, is warranted.

A Telephone Based Brief Intervention Using Motivational Enhancement to Facilitate HIV Risk Reduction Among MSM: A Pilot Study

We conducted a randomized controlled pilot intervention to evaluate the efficacy of a telephone-based brief counseling intervention to reduce sexual risk taking among men who have sex with men (MSM) in Seattle, Washington. The study targeted individuals who were currently engaging in unsafe sex but were not committed to making changes toward safer behaviors. Counselors used motivational interviewing strategies in a single 90-min session to enhance readiness for change, promote greater intentions to use condoms, and to support safer sex practices. Results are based on 89 MSM randomly assigned to Immediate counseling or a Delayed counseling control condition. Among minority participants, Immediates were significantly less likely to have engaged in unprotected anal intercourse at follow-up, compared to Delays. Immediate participants reported significantly less ambivalence about practicing safer sex at follow-up, and tended to report greater increases in intentions to use condoms. These findings support the potential efficacy of a brief intervention based upon motivational enhancement principles for promoting safer sex practices among at-risk MSM.

Effects of a brief motivational intervention with college student drinkers.

This study consisted of a randomized controlled trial of a 1-session motivational intervention for college student binge drinkers. Sixty students who reported binge drinking 2 or more times in the past 30 days were randomly assigned to either a no-treatment control or a brief intervention group. The intervention provided students with feedback regarding personal consumption, perceived drinking norms, alcohol-related problems, situations associated with heavy drinking, and alcohol expectancies. At 6-week follow-up, the brief intervention group exhibited significant reductions on number of drinks consumed per week, number of times drinking alcohol in the past month, and frequency of binge drinking in the past month. Estimates of typical student drinking mediated these reductions. This study replicates earlier research on the efficacy of brief interventions with college students and extends previous work regarding potential mechanisms of change.