Early Intervention Proves Effective

Early Intervention Proves Effective In Alcohol Consumption

04/03 1500 US HHS:

APR 3, 1997, M2 Communications – Michael Fleming, M.D., M.P.H., and
colleagues at the University of Wisconsin Medical School in Madison
report in the April 2 Journal of the American Medical Association results
from Project TrEAT (Trial for Early Alcohol Treatment), the first large
U.S. clinical trial to test the effectiveness of brief physician advice
for intervening with nondependent problem drinkers. Supported by a grant
from the National Institute on Alcohol Abuse and Alcoholism, the
researchers found that brief interventions by general internists and
family physicians reduced average drinks each week, excessive drinking,
and binge drinking in at-risk drinkers by 20 percent or more at 1 year,
twice the reduction rate of patients who did not receive the
intervention. Relative to men in the control group, men in the
intervention group also experienced a twofold reduction in length of
hospitalizations during the followup year.

According to NIAAA Director Enoch Gordis, M.D., several studies in
other countries had indicated that brief interventions held promise for
the almost 20 percent of American adults who are nondependent problem
drinkers: “The Project TrEAT results add to the research base for
broadening clinical practice to screen for patients whose drinking
practices place them at risk for developing alcohol problems so that
these at-risk patients can avoid alcohol damage.”

Project TrEAT used a questionnaire on drinking habits and other health
behaviors to screen 2,450 problem drinkers from among 17,695 regularly
scheduled patients in 17 Wisconsin clinics. Of the 2,450 patients who
screened positive (men who drank more than 14 drinks or 168 grams of
alcohol and women who drank more than 11 drinks or 121 grams of alcohol
each week, those who drank more than 5 drinks on at least four occasions
in the prior month, and those who gave two or more positive responses to
a simple screening instrument), 1,705 subsequently completed face-to-face
interviews in a physician’s office. The 774 patients who met all
inclusion criteria, including the absence of alcohol dependence symptoms,
were randomized to experimental and control conditions and assessed at 6
and 12 months.

Patients in the experimental group were scheduled for two 15-minute
sessions one month apart with their physicians. The intervention protocol
used during those sessions included a workbook with feedback regarding
current health behaviors, information on alcohol effects and problem
drinking, a worksheet on drinking cues, a drinking agreement in the form
of a prescription, and self-monitoring materials. Physicians were trained
to administer the protocol in education sessions at each of the 17
clinics.

According to Richard Fuller, M.D., Director of Clinical and Prevention
Research at NIAAA: “Screening for alcohol problems in doctors’ offices is
rarely done. This study provides further evidence that physicians or
personnel in their offices should screen patients to identify those who
may be at risk for developing alcohol problems. However, that is only the
first step. It also is important to discuss screening results with the
patient and advise that the patient cut down or stop drinking. In my
view, those who report symptoms of alcohol dependence should be referred
to specialized treatment.”

Project TrEAT found large reductions in drinking practice measures at
both 6 and 12 months in both men and women who received the intervention.
At 12 months, men in the intervention group showed a 14 percent and women
in the intervention group showed a 31 percent reduction of alcohol use.
Both men and women also showed sizable reductions in excessive and binge
drinking episodes. Although the control group also experienced reductions
on drinking practice measures, patients in the experimental group were
twice as likely to reduce their drinking by 20 percent or more.

On health care utilization measures, neither men nor women experienced
significantly different numbers of emergency room visits during the
course of the study or relative to intervention status. Nor was a change
observed for either group in other measures of health status. However,
men in the control group experienced substantially longer
hospitalizations than men in the intervention group, an effect that the
authors call “the first direct evidence of decreases in the utilization
of U.S. health services as a result of physician intervention with
problem drinkers.”

Conducted in four managed care organizations and community- based
private practices in urban and rural settings, Project TrEAT produced
results that may be generalizable across the U.S. health care system,
state the authors. For most patients, such settings are the first point
of contact with the health care system and more than 90 percent of health
care in the United States occurs in community-based practices.

“Since 70 percent of people in the U.S. visit their physician at least
once every 2 years, brief physician advice could have enormous
implications for the U.S. health care system. This trial supports the
implementation of screening, assessment, and brief intervention for all
patients who seek health care services in primary care community-based
settings.”

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NIAAA’s Office of Scientific Affairs
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Copyright 1997

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