Does brief discussion in the office during regular appointments have any effect on alcohol consumption?

William L Iverson
5/30/97

CLINICAL SCENARIO:

A 44 yo male comes to you as a new patient work and in your social history you learn that he drinks 2-3 beers each night and sometimes a lot more on weekends.

CLINICAL BOTTOM LINES:

1) Project TrEAT found that brief 10-15 minute counseling visits delivered by physicians
using a scripted workbook that included advice, education and contracting information did
reduce the number of drinks per week, the number of binge drinking episodes and the
frequency of excessive drinking.

2) Project TrEAT also found a reduction in the number of days hospitalized in the group of
patients that had intervention by their physicians suggesting an economic benefit as well.

EVIDENCE:

Randomized controlled clinical trial with subjects only blinded carried out at 17 community-
based primary care practices located in 10 Wisconsin counties. 17,695 patients were screened
for problem drinking of which 482 men and 292 women met inclusion criteria and were
randomized into a control and an intervention group, Of these, 723 (93%) participated in a 12
month follow up.

 

All Patients

Men

Women
Status Treatment
(n=392)		 Control (n=382)

t score

 P value Treatment (n=244) Control (n=238)

t score

 P value Treatment (n=148) Control (n=144)

t score

 P value
Number of drinks in previous 7 days
  Mean
(SD)		 Mean (SD)   Mean
(SD)		 Mean (SD)   Mean
(SD)		 Mean (SD)  
Baseline 19.14 (12.26) 18.94 (11.84) 0.22 ... 21.67 (12.85) 21.95 (12.39) 0.60 ... 15.05 (10.02) 15.69 (10.13) 0.52 ...
6 mo 11.57 (10.94) 14.98 (11.12) 4.10 <.001 13.84 (11.99) 17.12 (12.51) 2.78 <0.05 7.91 ( 7.73) 11.54 (7.23) 3.99 <.001
12 mo 11.48 (11.31) 15.46 (12.93) 4.33 <.001 13.62 (12.39) 16.86 (13.49) 2.6 <.005 8.03 (8.26) 13.20 (11.67) 4.16 <.001
% Reduction                        
Base to 6 mo 39.54 20.88 ... ... 36.12 22.02 ... ... 47.48 26.45 ... ...
Base to 12 mo 40.02 18.35 ... ... 37.16 23.17 ... ... 46.65 15.89 ... ...

Number of Binge Drinking Episodes in Previous 30 days
  Mean (SD) Mean (SD) Mean (SD) Mean (SD)     Mean (SD) Mean (SD)
Baseline 5.65 (5.95) 5.34 (5.03) 0.76 ... 6.13 (6.58) 5.40 (4.98) 1.30 ... 4.88 (4.70) 5.23 (5.13) 0.57 ...
6 mo 2.88 (4.86) 3.93 (4.80) 2.90 <.005 3.33 (5.35) 4.37 (5.29) 2.04 <.025 2.14 (3.94) 3.22 (3.80) 2.29 <.02
12 mo 3.07 (5.23) 4.21 (5.52) 2.81 <.005 3.43 (5.52) 4.48 (5.66) 1.95 <.05 2.50 (4.70) 3.79 (5.27) 2.11 <.02
% Reduction                        
Base to 6 mo 49.13 26.32 ...   45.65 19.08 ... ... 56.19 38.39 ... ...
Base to 12 mo 45.67 21.05 ...   44.08 17.12 ... ... 48.89 27.60 ... ...

 

COMMENTS:

l) This is the first large-scale ETOH trial with a diverse sample of community-based, primary
care practices in rural and urban settings in the United States and the results support those
found in the two other major trials that have been conducted by the Medical Research
Council in Great Britain, and World Health ORganization conducted in 10 countries.

2) This population seems similar to our own and the results are probably relevant and
generalizable to our outpatient clinics.

3) The Intervention protocol does not clearly state what the physicians were actually taught
to counsel or tell patients during the intervention sessions; however, the results suggest that
some form of screening and intervention with our patients will be beneficial.
4) One major limitation of the study is reliance of self reporting and the desire of the subjects
to please the physician. Other studies conducted by a number of researchers has indicated
that self reporting is still more reliable then other methods of testing and corroborative
family member interviews also suggest that the subjects self report was a valid estimate of
ETOH use.

5) There were no confidence intervals mentioned and SDs are large but intervention is so
easy and benign that it should still be done.

Reference:
Fleming, MF, et al. Brief Physician Advice for Problem Alcohol Drinkers. JAMA.1997,
277:1039-1045.