Kathleen Louden

May 06, 2013

CHICAGO — Screening alone for alcohol use appears to garner long-term reductions in drinking frequency as well as binge drinking, new research show.

Investigators found that a control group that received alcohol assessment only, with no therapeutic intervention, had reduced alcohol consumption 6 months later and that this effect persisted at 30-month follow-up.

"There was a feeling among some researchers that the short-term changes that have been reported in control groups are temporary and that these people would resume their drinking," said coinvestigator J. Paul Seale, MD, a professor of family medicine at Mercer University School of Medicine, Macon, Georgia.

"We found that whatever is happening in these patients appears to be a durable change," Dr. Seale told Medscape Medical News.

Dr. Seale and principal investigator J. Aaron Johnson, PhD, also from Mercer University, recently presented their findings here as a scientific poster at the American Society of Addiction Medicine (ASAM) 44th Annual Medical-Scientific Conference.

Surrogate Intervention?

Many studies have reported that screening, brief intervention, and referral to treatment (SBIRT) for risky drinking are effective in reducing patients' alcohol use. Dr. Seale said it is unclear why control patients, who do not receive an intervention such as patient counseling, may also experience a significant decrease in their drinking.

The researchers studied the long-term effects of screening-only on a SBIRT control group of 893 adults who visited an emergency department in Macon, Georgia, between February and April 2009.

The control group received a 15-minute assessment for at-risk alcohol or drug use and a list of alcohol and drug treatment resources, but they did not receive motivational interviewing (the intervention) after the screening. Study participants received telephone follow-up 6, 18, and 30 months after the visit to monitor changes in drinking patterns.

Most participants were male (63.7%) and nonwhite (62.3%), and 25.7% were in the 18- to 30-year age group, the poster data showed.

Thirty-month follow-up data were available from 415 participants for total number of self-reported drinking days and for 408 participants for binge-drinking days, according to the poster. Binge drinking was defined as having 5 or more drinks for women and 6 or more drinks for men in a single sitting, according to Dr. Johnson.

The decline in number of drinking days seen at 6 months remained approximately the same at 18 and 30 months; however, days of binge drinking continued to decline, the investigators reported (Table).

Table. Control Group's Change in Drinking Over 30 Months

Time Mean No. of Drinking Days in Past 30 Days
Drinking Binge Drinking
Intake 8.69 6.03
6 mo 5.75 3.91
18 mo 5.12 2.93a
30 mo 5.12 2.17

aSignificant using a linear mixed model (P = .001).

 

Dr. Seale called the finding that binge-drinking days decreased further over 30 days "very encouraging." In addition to other harmful effects, he said there is a link in the medical literature between binge drinking and driving under the influence.

Because of the large change in their control groups' drinking, Dr. Johnson told Medscape Medical News, "Our study emphasizes the importance of enrolling a control group in a SBIRT study to determine the true effect of the intervention."

The study did not address the reasons why control patients' drinking declined, he said.

However, Dr. Seale said that their questionnaire, a 15-minute interview by a health education specialist, was more detailed than the usual SBIRT assessment for risky drinking. It included asking how important it is to the patient to change his or her drinking.

"The assessment may well have served as a brief intervention," he said.

Don't Misinterpret

Asked to comment by Medscape Medical News on the research, John P. Femino, MD, a past ASAM board director, said it would be a mistake to interpret these results as meaning that screening could be a sole intervention for alcohol misuse.

Dr. Femino, an addiction medicine specialist in Kingstown, Rhode Island, who was not involved in the study, stressed that SBIRT involves both screening and a discussion with the patient to encourage behavioral change when risk is identified. The approach is a well-validated tool for categorizing risk for substance use and has been studied in almost every healthcare setting, he stated.

He said the study findings confirm that a patient's visit to a medical setting is an opportunity for the patient to make a healthier behavioral change.

"Let's take advantage of patients coming to a healthcare setting to intervene in substance abuse in a routine manner," Dr. Femino said.

This study was funded by the Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Dr. Johnson and Dr. Seale report no relevant financial relationships. Dr. Femino reports that he is a paid consultant for Dominion Diagnostics in North Kingstown, Rhode Island, and is a trainer for Reckitt Benckiser Pharmaceuticals, Richmond, Virginia, and Orexo AB, Uppsala, Sweden.

American Society of Addiction Medicine (ASAM) 44th Annual Medical-Scientific Conference. Poster 13. Presented April 26, 2013.

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