A brief, low-cost intervention conducted by a primary care physician can reduce problem drinking, with associated decreases in health problems and alcohol-related motor vehicle accidents, according to an article published in the journal Alcoholism: Clinical and Experimental Research.

Researcher Michael Fleming, M.D., and colleagues from the University of Wisconsin Medical School studied the effects of brief interventions by physicians on a sample of primary care patients with drinking problems, and found that the positive effects continued for up to four years following the intervention.

The Fleming et al. study was part of Project TrEAT (Trial for Early Alcohol Treatment), which was conducted in the offices of 64 community-based primary care physicians in southern Wisconsin. As part of the project, all patients, ages 18 - 65, were asked to complete a self-administered health screening questionnaire when care" control group (N = 382) or an experimental group (N = 392).

Subjects in the control group were given a general health booklet and told to contact their physicians if they had health concerns after reading the booklet. Subjects in the experimental group received the same booklet and were scheduled to see their physician for the brief intervention. The intervention consisted of two 15-minute sessions scheduled one month apart, and two five-minute follow-up phone calls from an office nurse. During the intervention, physicians followed a scripted workbook with tasks for subjects to complete at home.

Outcome variables included alcohol use, motor vehicle and legal events, injuries, health care utilization, health status and mortality. Subjects were interviewed at six, 12, 24, 36 and 48 months following the intervention. They were asked to recall alcohol consumption in the past seven days and binge drinking episodes in the past 30 days. Other outcome information was gathered through state of Wisconsin records, the Social Security Death Index and from family member contacts. Medical and social costs and benefits were also calculated.

Significant differences between the experimental and control groups emerged during the four-year follow-up period. Men in the experimental group reduced their alcohol use from 21.3 drinks/week at baseline to 14.4 drinks; women reduced their consumption from 14.8 drinks/week to 8.4 drinks. Both of these reductions were evident at six-month follow-up and were maintained throughout the study period. Controls also reduced their drinking, but not as much as the experimental subjects.

Binge drinking was also reduced at six months for both groups, but increased through 48 months.

A reduction in the number of very heavy drinkers in the experimental group was also identified. This was defined as consuming more than 20 drinks per week for men and more than 13 drinks per week for women. The number of subjects in the treatment group meeting this criteria decreased from 46.7 percent to 22.4 percent -- a 57 percent reduction over the 48-month follow-up period, compared to a decrease from 49.2 percent to 26.4 percent for the control group. Although both groups experienced a decrease, the greater improvement in the experimental group compared to the improvement in the control group was statistically significant.

Patients in the experimental group had 20 percent fewer emergency department visits and 37 percent fewer days of hospitalization. Subjects in the usual care group experienced more traffic fatalities and 55 percent more crashes with nonfatal injuries, as well as 46 percent more arrests.

Cost-benefit analysis indicated a medical care savings of $712 per patient; $102 for legal events and $7,171 savings per patient in motor vehicle crashes. In addition, 10 subjects died during the follow-up period, including seven in the usual care group and three in the experimental group.

Study Limits

The use of self-report data for changes in alcohol use and health care utilization is a potential limitation of this study.

Authors' Conclusions

This study provides the first direct evidence that brief physician advice is associated with reductions in alcohol use, health care utilization, legal events and associated costs. The authors estimate that each $1 spent on this brief intervention saves $4.30 for the health care system, with even greater savings if societal costs are included. Patients drinking above recommended limits of alcohol use can respond to brief physician advice, with significant benefits to patients, the health care system and society.

Fleming MF, Mundt MP, French MT, Baier Manwell L, Stauffacher EA, Lawton Berry KF: Brief physician advice for problem drinkers: Long-term efficacy and benefit-cost analysis. Alcoholism: Clinical and Experimental Research 2002; 26:36-43. Correspondence to: Dr. Fleming, Dept. of Family Medicine, University of Wisconsin-Madison, 777 S. Mills St., Madison, WI 53715.