7.6.1
Evidence
7.6.1.1 Psychiatric wards
Hulse and Tait (2002) in Australia evaluated a brief intervention to reduce alcohol consumption among psychiatric inpatients following the resolution of
psychiatric morbidity. Participants were randomised either to a brief motivational intervention or an information package. At six-month follow-up, the intervention group had reduced alcohol consumption significantly more than controls and included a greater proportion drinking at low-risk levels. The authors conclude that brief interventions are effective among the mid-range of psychiatric severity. In a subsequent five-year follow-up of this cohort (Hulse and Tait, 2003)), the specific effects of brief motivational intervention had disappeared, but patients who had received the intervention combined with those who had received the information pack showed fewer mental health inpatient episodes and shorter lengths of hospital stays than a group of matched controls. This last finding should be interpreted with caution owing to the non-randomised nature of the matched control group. The effectiveness of brief interventions as part of psychiatric services is clearly an important area for future research in the UK
7.6.1.2 Needle exchange programmes
Stein et al. (2002) in the USA investigated the effects of a brief motivational intervention for reducing alcohol use among service users of a needle exchange programme. Participants randomised to the intervention received a one-hour session of motivational interviewing with a booster session one month later, while controls received usual care. At six-month follow-up, participants in the intervention group showed significantly greater reductions in consumption, but the authors state that the optimal length of intervention in this setting deserves further study.
7.6.1.3 Prenatal care
In the USA, Chang et al. (1999b) assessed the impact of brief interventions on ante partum alcohol consumption among pregnant women receiving prenatal care. Both intervention and assessment–only control participants had reduced consumption at follow-up, but there were no significant differences between groups. Considering the importance of reducing excessive alcohol consumption among pregnant women, more studies of intervention in this context are warranted.
7.6.1.4 Somatic outpatient clinics
In a small study in Norway, Persson and Magnusson (1989) examined the effectiveness of a brief and early intervention among patients at a “somatic outpatient clinic” who had not yet experienced medical or social negative consequences from their alcohol misuse. At follow-up interviews over 12 months, participants in the intervention group showed decreased consumption, liver enzyme readings and sickness days compared with controls. The authors conclude that their early intervention programme was effective, carried out at low cost and received a positive response from patients.
7.6.1.5 General population health screening programmes
Pioneering studies of brief interventions in Scandinavian countries (Kristenson et al., 1983; Nilssen, 1991) were carried out as part of general population health screening programmes. In general terms, these studies provide good evidence for the effectiveness of these interventions, although, as we have noted, it is doubtful whether they can be considered brief.
7.6.2
Conclusions
• There is some evidence that brief interventions are
effective in producing short-term reductions in alcohol consumption among psychiatric patients with mid- range psychiatric disorders (IB)
• There is some evidence that brief interventions are
effective in reducing the alcohol consumption of heavy drinking service users in needle exchange
programmes (IB)
• There is no evidence as yet that brief interventions
reduce alcohol consumption among pregnant women (IB)
• There is some evidence that brief interventions are
effective among patients attending outpatient clinics for somatic disorders (IB)
• Scandinavian trials of intervention delivered as part of
general population health screening programmes showed positive effects, though these interventions were more intensive than those normally considered “brief” (IB).
7.7
Brief interventions in educational
establishments
7.7.1
Evidence
A series of studies by G Alan Marlatt and colleagues from the University of Washington tested the effectiveness of brief interventions on campus among heavy drinking college students (Baer et al., 1992; Marlatt et al., 1998; Baer et al., 2001). Earlier studies used a condensed form of cognitive-behavioural therapy but more recent work has focused on brief motivational interviewing. In the most recent study (Baer et al., 2001), heavy drinking students in their freshman year were randomly allocated to an intervention group that received individual motivational feedback based on a prior assessment, followed by mailed feedback derived from six-month and one-year follow-up contacts. At a two-year research follow-up, the intervention group showed greater reductions in drinking and harmful consequences compared to a non-intervention control group. The intervention group continued to report more alcohol problems that a matched, natural history comparison group not showing heavy drinking. However, the decline in problems over time suggested that the effects of brief
motivational intervention were added to maturational processes. At a later four-year follow-up, these trends were confirmed and the authors concluded that brief interventions for high-risk college drinkers “can achieve long-term benefits even in the context of maturational trends” (p1310).
Borsari and Carey (2000) randomised college student binge drinkers to a one-session motivational intervention or a no-treatment control group. The intervention
provided students with feedback regarding their personal consumption, perceived drinking norms, alcohol-related problems, situations associated with heavy drinking and alcohol expectancies. At six-week follow-up, the brief intervention group showed significant reductions in number of drinks per week and frequency of binge drinking in the past month.
In a recent study carried out in ten further education colleges in inner London, McCambridge and Strang (2004) evaluated the effects of a single one-hour,
individual session of motivational interviewing on students’ (16-20 years) drug use, including alcohol, cigarettes and cannabis. Control group participants received education as usual. At a three-month follow-up, students who had received interventions showed significantly greater reductions in alcohol and cannabis use, an effect that was greater among heavier users of both drugs. This effect had almost entirely disappeared at a later 12-month follow-up (McCambridge and Strang, 2005), although the authors suggest that this was mainly due to an
improvement in the control group, not a return to baseline levels in the intervention group (see also Miller, 2005).
7.7.2
Conclusion
• Brief motivational interventions are effective in reducing
levels of alcohol consumption and frequency of binge drinking among heavy-drinking college students (IB).