Alcohol use is a leading cause of mortality and morbidity internationally, and is ranked by the World Health Organization (WHO) as one of the top 5 risk factors for disease burden. Without treatment, approximately 16% of hazardous or harmful alcohol users will progress to more dependent patterns of alcohol consumption. This review covers interventions in hazardous or harmful, but not dependent, alcohol users.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions in hazardous or harmful drinkers in the primary-care setting? What are the effects of interventions in hazardous or harmful drinkers in the emergency-department setting? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 21 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions in primary care and in emergency departments: brief intervention (single or multiple session), universal screening plus brief interventions, and targeted screening plus brief interventions.
Alcohol use is a leading cause of mortality and morbidity internationally, and is ranked by the WHO as one of the top 5 risk factors for disease burden.
Without treatment, approximately 16% of hazardous or harmful alcohol users will progress to more dependent patterns of alcohol consumption.
This review covers interventions in hazardous or harmful (but not dependent) alcohol users.
Hazardous alcohol consumption is defined as a pattern of alcohol consumption that increases the individual's risk of alcohol-related harm, but is not currently causing alcohol-related harm.Harmful alcohol consumption is a pattern of consumption likely to have already led to alcohol-related harm.
Single- or multiple-session brief intervention reduces alcohol consumption over 1 year in hazardous drinkers treated in the primary-care setting, but we don't know how it affects mortality.
Brief intervention (single or multiple session) is also effective at reducing alcohol consumption in people treated in the emergency department, although the evidence is not as strong.
Adding universal screening to brief intervention enhances its benefits when given in primary care.
We found insufficient RCT evidence to assess whether universal screening and brief intervention is any more effective than usual care in emergency departments.We don't know whether targeted screening is effective, as we found no RCT evidence assessing its use in primary or emergency care.