NDARC Technical Report No. 21 (1994)
Executive Summary
- In a controlled evaluation of general practitioner-based brief intervention for excessive drinking, 378 excessive drinkers identified opportunistically by screening in 40 group practices in metropolitan Sydney were assigned to one of four groups: (i) a group offered a five-session intervention by the GP (the Alcoholscreen Program); (ii) a group given a single-session of five minutes advice by the GP and a self-help manual to take away (minimal intervention); (iii) a group given a thorough assessment of alcohol consumption and related problems but no intervention; (iv) a group identified by screening but given neither intervention nor assessment.
- Blind follow-up was carried out at six and twelve months following initial contact. In addition to self-reports of alcohol consumption, blood samples were taken for the measurement of γ-glutamyltransferase at entry, and six and twelve months follow-up.
- Among all those patients allocated to receive it, the Alcoholscreen Program did not result in a statistically significantly greater reduction in alcohol consumption at follow-up than seen in control groups.
- However, patients offered Alcoholscreen showed a significantly greater reduction in alcohol-related problems in the period up to six months follow-up than those in control groups, with a similar but non-significant tendency at the twelve month follow-up point.
- A possible explanation for the failure to find a significant effect of brief intervention on alcohol consumption in the present study, compared with earlier British studies that have found such an effect, is as follows. When research is carried out under naturalistic conditions of routine general practice, as in the present study, fewer patients return for a counselling session than in the less naturalistic designs of the trials previously reported.
- This possibility is strengthened by the finding of the present study that those patients who returned for the crucial Alcoholscreen second visit, and who can thus be said to have received the Alcoholscreen Program, showed greater reductions in consumption at follow-up than those patients from all groups who did not receive Alcoholscreen.
- There was no evidence that the minimal intervention was effective in reducing alcohol consumption at follow-up.
- There was no evidence that a 15-minute alcohol-related assessment was effective in reducing alcohol consumption at follow-up.
- Across all groups, males showed a significantly greater reduction in consumption at follow-up than females. While men showed a drop in consumption over time, there was no evidence of any decrease in consumption among women.
- Implications of these findings for the application of GP-based brief interventions in practice and for further research into brief interventions are discussed.