Most alcohol-related harm in the community is caused by people who drink excessively whose consumption exceeds recommended drinking levels, not the people who drink with alcohol dependence. One way to reduce consumption levels in a community is to provide access to brief interventions. Brief interventions containing MI are superior to no treatment for reducing alcohol consumption in adolescents, younger and older adults across multiple settings, but effects are small. Brief MI is not more effective than standard care or alternative alcohol treatments for reducing alcohol consumption in adults with risky patterns of alcohol use. it is more effective than alternative alcohol treatments in young adults, but effects are very small. However, it should be noted that the generalisability of the recommendations contained in this Chapter are limited to non-European first world countries (e.g. mainly North America) where the majority of studies were conducted.
Evidence for the efficacy of brief alcohol intervention is strongest in in primary care settings, including general practice, general medical inpatients wards and emergency departments. Evidence is strongest in general practice settings and weakest in emergency departments, particularly in young people. Brief interventions of 3-4 sessions have been found to be no less effective than more extended alcohol treatments in specialist substance use treatment settings; however, more research on brief interventions in specialist services is needed. There is also evidence MIs are beneficial in higher education settings but effects are very small. There is no or insufficient evidence for brief alcohol interventions in hospital outpatient clinics, secondary school students, community welfare, pharmacies or workplace settings. Finally, there is preliminary evidence for the efficacy of BIs for female prisoners.
The implementation of brief interventions into clinical practice remains a challenge. Little is known about how to best train, supervise and monitor MI therapist fidelity; however, 1-2+ day workshops, with follow-up coaching sessions, and ongoing supervision is likely to be beneficial. While some progress has been made with identification of common barriers and facilitators to implementation this research is in its infancy. Common faciliators of implementation that warrant consideration include technological aids, specialist roles to deliver the brief interventions, leadership commitment and involvement in the implementation, embedding the screen and brief intervention into normal workplace practices, and using telehealth services to increase reach.
The outcomes of this review could be perceived as modest and discourage clinicians from using brief interventions routinely. One key limitation of brief intervention are their small effects. For example, a mean reduction 20 grams/week (2 standard drinks) in alcohol use was found for brief interventions delivered in primary care settings. Even smaller effects were found in young adults, primarily college students. This means many participants would continue to drink at a level that would be considered hazardous according to recommendations in most countries. However, any reduction is still likely to be beneficial at an individual level, given the adverse impact of alcohol on health. At a population level, any reduction is likely to have a significant impact on health, quality of life and healthcare resource use, given that between 5 and 12% of the burden of disease in Australia is attributable to alcohol.
It should be noted that more recent brief intervention trials tend to demonstrate less impact on alcohol consumption than older trials. As a result meta-analyses on brief alcohol interventions have found smaller effect sizes over time. There are several potential reasons for this. First, the definition of excessive drinking used in national guidelines have reduced over time, which has reduced the inclusion criteria threshold for at risk drinking in more recent trials. Consequently, less change is required to reach a lower risk drinking level, reducing effect sizes. Second and third, assessment reactivity to the screening tools, as well as the provision of alcohol-related information to the minimal or no treatment control conditions in more recent trials, might have increased the control group’s awareness of alcohol problems and resulted in decreases in alcohol use. Future research evaluating BIs using ultra-brief research assessments and masked research designs (e.g. lifestyle survey containing alcohol questions) is required to investigate these issues further.
These limitations highlight the need for further research on how to enhance the impact of brief interventions. Research examining the active ingredients of brief interventions and characteristics of the individuals most likely to benefit from them may help increase their effectiveness. There is an urgent need for consensus agreement on a core set of alcohol consumption and alcohol-related problem measures to increase the comparability of brief intervention trials and facilitate future meta-analyses. Longer follow-up times are also needed to increase understanding of the duration of effects.