Randomized-Controlled Trial of a Telephone and Mail Intervention for Alcohol Use Disorders: Three-Month Drinking Outcomes

Do health educator telephone calls reduce at-risk drinking among older adults in primary care?

BACKGROUND

Alcohol screening and brief intervention for unhealthy alcohol use has not been consistently delivered in primary care as part of preventive healthcare.

OBJECTIVE

To explore whether telephone-based intervention delivered by a health educator is efficacious in reducing at-risk drinking among older adults in primary care settings.

DESIGN

Secondary analyses of data from a randomized controlled trial.

PARTICIPANTS

Subjects randomized to the intervention arm of the trial (n = 310).

INTERVENTIONS

Personalized risk reports, advice from physicians, booklet about alcohol and aging, and up to three telephone calls from a health educator. All interventions were completed before the three-month follow-up.

MEASUREMENTS

Risk outcomes (at-risk or not at-risk) at 3 and 12 months after enrollment.

MAIN RESULTS

In univariate analyses, compared to those who remained at risk, those who achieved not at-risk outcome at 3 months were more likely to be women, Hispanic or non-white, have lower levels of education, consume less alcohol, drink less frequently, and have lower baseline number of risks. In mixed-effects logistic regression models, completing all three health educator calls increased the odds of achieving not at-risk outcome compared to not completing any calls at 3 months (OR 5.31; 95% CI 1.92-14.7; p = 0.001), but not at 12 months (OR 2.01; 95% CI 0.71-5.67; p = 0.18).

CONCLUSIONS

Telephone-based intervention delivered by a health educator was moderately efficacious in reducing at-risk drinking at 3 months after enrollment among older adults receiving a multi-faceted intervention in primary care settings; however, the effect was not sustained at 12 months.

Secondary prevention of hazardous alcohol consumption in psychiatric out-patients: a randomised controlled study

BACKGROUND

Hazardous alcohol use is associated with an increased risk for development of a substance use disorder, leading to negative outcomes in psychiatric patients.

AIMS

In order to investigate whether psychiatric outpatients' hazardous alcohol consumption could be reduced by way of a brief intervention by telephone.

METHOD

Non-psychotic psychiatric outpatients, n = 1,670, completed a self-rating form concerning alcohol habits (AUDIT). Participants with scores indicating risk consumption (n = 344) were randomised to intervention (immediate advice) or control (advice after 6 months).

RESULTS

Hazardous alcohol habits occurred among 19% of the women and 24% of the men. In the intervention group, half of the patients reduced their alcohol consumption to non-hazardous levels at 6-month follow-up (ITT analysis). In women, 41.5% in the intervention group had no hazardous consumption at follow-up compared to 24.7% in the control group (P = 0.003), corresponding figure for men was 49.1 and 34.0%.

CONCLUSION

Brief intervention seems to be effective to reduce hazardous alcohol consumption in psychiatric outpatients.

Mailed treatment to augment primary care for alcohol disorders: a randomised controlled trial

INTRODUCTION AND AIMS

Remote delivery of interventions is needed to address large numbers of people with alcohol use disorders who are spread over large areas. Previous correspondence trials typically examined its effects as stand-alone treatment. This study aimed to test whether adding postal treatment to general practitioner (GP) support would lower alcohol use more than GP intervention alone.

DESIGN AND METHODS

A single-blind, randomised controlled trial with a crossover design was conducted over 12 months on 204 people with alcohol use disorders. Participants in an immediate correspondence condition received treatment over the first 3 months; those receiving delayed treatment received it in months 3-6.

RESULTS

Few participants were referred from GPs, and little intervention was offered by them. At 3 months, 78% of participants remained in the study. Those in immediate treatment showed greater reductions in alcohol per week, drinking days, anxiety, depression and distress than those in the delayed condition. However, post-treatment and follow-up outcomes still showed elevated alcohol use, depression, anxiety and distress. Greater baseline anxiety predicted better alcohol outcomes, although more mental distress at baseline predicted dropout.

DISCUSSION AND CONCLUSIONS

The study gave consistent results with those from previous research on correspondence treatments, and showed that high levels of participant engagement over 3 months can be obtained. Substantial reductions in alcohol use are seen, with indications that they are well maintained. However, many participants continue to show high-risk alcohol use and psychological distress.

Systematic review and meta-analyses of strategies targeting alcohol problems in emergency departments: interventions reduce alcohol-related injuries

AIMS

To critique the methodological adequacy of evaluations of emergency department (ED)-based interventions for alcohol problems and to conduct a meta-analysis to examine the extent to which interventions in this setting are effective in reducing alcohol consumption and related harm.

METHODS

An electronic search of 11 databases and a manual search of reference lists were conducted to identify studies published in peer-review journals between January 1996 and July 2007 (inclusive). Studies evaluating the outcome of an intervention designed to reduce alcohol problems in patients presenting to the ED were eligible for inclusion. Methodological data were extracted using review criteria adapted from the both the Center for Disease Control (CDC) Guide to Community Preventive Services Data Collection Instrument and the Cochrane Effective Practice and Organization of Care Review Group Data Collection Checklist. Continuous outcomes were pooled using a fixed effect inverse variance approach while binary outcomes were pooled in a generic inverse variance meta-analysis.

RESULTS

Thirteen studies were identified for inclusion in the review. Methodological quality was found to be reasonable, with the exception of poor reporting of effect-size information and inconsistent selection of outcome measures. Meta-analyses revealed that interventions did not significantly reduce subsequent alcohol consumption, but were associated with approximately half the odds of experiencing an alcohol-related injury (odds ratio = 0.59, 95% confidence interval 0.42-0.84).

CONCLUSIONS

There are few evaluations of emergency department-based interventions for alcohol problems. Future evaluations should use consistent outcome measures and report effect sizes. The existing evidence suggests that interventions are effective in reducing subsequent alcohol-related injuries.