Why BI? Because Brief Interventions Work!

Brief interventions (BI) have been shown to be efficient and effective. They do not take a lot of time, they are easy to do for the provider, and they help patients. The patient-centered techniques integrated in brief interventions foster behavioral change.

The medical and health literature has increasingly provided quantitative and qualitative evidence that brief interventions are a best practice approach to intervening with patients who report problematic substance use.

For example…

  • Baer et al found that a single session of feedback and advice compared favorably to a more intensive intervention in reducing alcohol-related risks among heavy drinking college students
  • Marlatt et a reported that a motivational interviewing approach resulted in reduction in both drinking rates and harmful consequences, when applied in a sample of high-risk college students.
  • Borsari and Carey found that college-aged drinkers who received a brief intervention exhibited a notable reduction 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, and that students were willing and interested to participate in the study.
  • Wagner et al studied the effectiveness of a school-based intervention among 14 to 18-year olds, and found that 10% of students’ substance use stopped completely, 33% “decreased a lot,” and 42% “decreased a little.”

There is evidence for the efficacy of brief interventions in a variety of settings including the outpatient clinic. Because of the scope of the problem and the effectiveness of these interventions, the American Academy of Pediatrics recommends the use of brief intervention techniques in the clinical setting. They further advocate that pediatricians be familiar with motivational interviewing techniques to work with patients who use alcohol but do not meet criteria for immediate referral.

Some of these studies include (probably more than you want to know!):

Efficacy of Brief Interventions in Primary Care to Reduce Risky and Harmful Alcohol Use

Objectives/Methods

  • To inform clinical guidelines of the U.S. Preventive Services Task Force (USPSTF) about brief behavioral counseling interventions.
  • Systematic review of 12 controlled trials on the efficacy of brief interventions

Result

  • Those receiving brief multi-contact interventions (initial session up to 15 minutes and at least 1 follow-up) reduced their average weekly alcohol intake by 13%–34% more than controls in 4 of 7 trials
  • 10%–19% more intervention participants than controls drank safe amounts.

Screening in Brief Intervention Trials Targeting Excessive Drinkers in General Practice: Systematic Review and Meta-Analysis

Objectives/Methods

  • To examine the efficiency of screening and efficacy of subsequent brief intervention (BI) for risky drinkers.
  • Systematic review and meta-analysis of 8 randomized clinical trials that used screening as a precursor to BI for risky drinkers.

Results

  • 9% screened drank risky amounts; 3% received BI.
  • Pooled absolute risk reduction= 10.5% (from 69% of patients drinking risky amounts to 57%).
  • 10 risky drinkers need BI to yield 1 patient no longer drinking risky amounts.
  • Screening 1000 patients and giving BI to 1/3 of patients with positive screens (the average in the studies reviewed) would yield 2 –3 patients no longer drinking risky amounts.
Intervention group* Control group* Absolute risk reduction # needed to treat
600/1410 (43%) 432/1374 (31%) 10.5 (7.1 to 13.9) 10 (7 to 14)

Are Brief Alcohol Interventions Likely to Be Effective in Routine Primary Care Practice?

Objectives/Methods

  • To determine whether brief interventions (BI) decrease consumption in nondependent drinkers with unhealthy alcohol use in a range of research designs, investigators reviewed 22 randomized trials of BI including over 5800 patients.
  • Trials were classified on a spectrum from tightly controlled (efficacy design) to real world (effectiveness design).

Results

  • Participants who received BI drank 38 g of alcohol (approximately 3 standard drinks) per week less than those who did not.
  • Longer duration of intervention was not significantly associated with a larger effect.
  • The effect of BI on drinking was similar in studies, regardless of whether they were considered efficacy or effectiveness designs.
  • The U.S. Preventive Services Task Force (USPSTF) recommends screening and behavioral counseling interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings
  • The USPSTF found good evidence that screening in primary care settings can accurately identify patients whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence, but place them at risk for increased morbidity and mortality, and good evidence that brief behavioral counseling interventions with follow-up produce small to moderate reductions in alcohol consumption that are sustained over 6- to 12-month periods or longer.