Brief Interventions for Problem Drinking: Another Piece of the Puzzle

Problem drinking has been associated with a wide variety of serious health and social problems (1), along with more than 100 000 deaths per year and an annual economic cost of more than $180 billion in the United States alone (2). The impact of these problems has motivated leaders in government and science to support research on screening and treatment strategies for patients with problem drinking (3). On the basis of this research, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has published recommendations for identifying patients with problem drinking and treating them individually according to their pattern of alcohol use (4). “At-risk” or “hazardous” drinkers are men who drink 5 or more drinks per day or 15 or more drinks per week and women who drink 4 or more drinks per day or 8 or more drinks per week. According to the NIAAA, about 3 in 10 U.S. adults drink at these risky levels and approximately 1 in 4 of these heavy drinkers meet DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria for alcohol abuse or alcohol dependence (4).

The strategy recommended by the NIAAA (4), which is supported by experts (1, 5) and the U.S. Preventive Services Task Force (6), suggests “brief intervention” approaches for selected nondependent, at-risk drinkers and more intensive specialized approaches—including referral to treatment programs or pharmacologic therapy—for persons who are alcohol-dependent. Brief interventions that last a few minutes or more, but generally well under an hour, and are administered once or a few times have been studied in primary care practices (7), emergency departments, (8), student health clinics (9), psychiatric inpatient wards (10), and the workplace (11). Systematic reviews of this …