Screening and brief alcohol interventions effective in primary care populations

Screening and brief alcohol interventions effective in primary care populations

Brian McAvoy
Clinical question

How effective are screening and brief alcohol interventions (BAIs) in reducing excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings?

Bottom line

There was moderate-quality evidence that BAIs delivered in primary care reduced alcohol consumption in hazardous and harmful drinkers by an average of 20g/week (approximately 2–3 UK standard drinks) compared with controls receiving usual care, screening or assessment only, or minimal alcohol advice. While the effect sizes due to BAIs were relatively small, because of the high proportion of the population which attends primary care, these are likely to result in a positive public health or population-level benefit. The effect was robust and was found up to 1 year following the BAI. BAIs appeared to be effective for both men and women but there was insufficient evidence to make any judgements about differential effectiveness in different ethnic groups. There was a suggestion of a reduced effect in younger people compared with the general population aged 18 years or more, and in emergency care compared with general practice, but this disappeared when adjusted for the overall reduction in effect size due to newer trials. Longer or more intensive intervention appeared to have little effect in significantly improving outcomes.


Only 4 trials were based in countries not defined as high income by the WHO, so this evidence cannot be assumed to apply to countries where the structure or functioning of primary care differs, or where less liberal attitudes to alcohol consumption may exist. Most of the participants in trials were also Caucasian.


Excessive drinking is a significant cause of mortality, morbidity and social problems in many countries. BAIs aim to reduce alcohol consumption and related harm in hazardous and harmful drinkers who are not actively seeking help for alcohol problems. Interventions usually take the form of a conversation with a primary care provider and may include feedback on the person's alcohol use, information about potential harms and benefits of reducing intake, and advice on how to reduce consumption. Discussion informs the development of a personal plan to help reduce consumption. BAIs can also include behaviour change or motivationally focused counselling.

Cochrane Systematic Review

Kaner EFS et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Reviews, 2018, Issue 2. Art. No.: CD004148.DOI: 10.1002/14651858. CD004148.pub4. This review contains 69 studies involving 33,642 participants.