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