THE EFFECT OF BRIEF INTERVENTIONS ON REDUCING ALCOHOL CONSUMPTION IN ADULTS: A SYSTEMATIC REVIEW

Lima, Larissa Alves de Araújo; Silva Júnior, Fernando José Guedes da; Monteiro, Claudete Ferreira de Souza; Santos, Giovanna Vitória Aragão de Almeida; Costa, Ana Paula Cardoso; Sales, Jaqueline Carvalho e Silva

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REVIEW • Cogit. Enferm. 27 • 2022 • https://doi.org/10.5380/ce.v27i0.80768 copy

THE EFFECT OF BRIEF INTERVENTIONS ON REDUCING ALCOHOL CONSUMPTION IN ADULTS: A SYSTEMATIC REVIEW

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to synthesize evidence on the effects of brief interventions on reducing alcohol consumption among adults.

Method:

systematic review study, protocol registered in the International Prospective Register of Systematic Reviews, registration no. CRD42020153034. The search was conducted in 2020, in electronic databases and randomized clinical trials that evaluated the effects of Brief Interventions in adult alcohol drinkers were included.

Results:

11 articles were evaluated. All studies performed, in the control and experimental groups, a test to identify the pattern of alcohol consumption, with feedback offered to the user afterwards. The interventions use methodologies that encourage the user to make a decision, as well as maintain the decision made and avoid relapse.

Conclusion:

this research contributes to health care teaching and assistance, through reflections on the identification of alcohol abuse and compiled on the application and impact of Brief Interventions.

DESCRIPTORS:
Systematic Review; Alcohol Abuse; Brief Psychotherapy; Treatment Outcome; Harm Reduction

Authors - Year (Country)	Intervention		Results	Jadad score
Authors - Year (Country)	Experimental Group	Control Group
Burnhams et al. 2015¹¹11 Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JPT, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. [Internet]. 2019 [acesso em 05 jul 2020]; 10: ED000142. Disponível em: https://doi.org/10.1002/14651858.ED000142. https://doi.org/10.1002/14651858.ED00014... (South Africa)	n=168 Team Awareness (TA). Session duration: 8 h. Follow up: two weeks and three months	n=157 Lecture on well-being. Duration of session: 1 h	The results show that TA had the greatest impact on risky drinking practices and hangover effects.	4
Clarke, Field, Rose 2015¹²12 Burnhams NH, London L, Laubscher R, Nel E, Parry C. Results of a cluster randomised controlled trial to reduce risky use of alcohol, alcohol-related HIV risks and improve help-seeking behaviour among safety and security employees in the Western Cape, South Africa. Subst Abuse Treat Prev Policy. [Internet]. 2015 [acesso em 10 jul 2020];10:18. Disponível em: http://doi.org/10.1186/s13011-015-0014-5. http://doi.org/10.1186/s13011-015-0014-5... (England)	n=52 Feedback personalizado sobre consumo de álcool e questionário relacionado ao álcool. Duração: 10 a 15 minutos; Follow up: duas semanas	n=51 Only completed the alcohol-related questionnaire on the UK Department of Health’s Change4Life website. Duration: 15min.	Both groups significantly reduced alcohol consumption and the frequency of binge drinking, but there were no significant differences between the groups on any of these measures.	4
Kaner et al. 2003¹³13 Clarke NC, Field M, Rose AK. Evaluation of a Brief Personalised Intervention for Alcohol Consumption in College Students. PLoS One. [Internet]. 2015 [acesso em 10 jul 2020];10(6):e0131229. Disponível em: http://doi.org/10.1371/journal.pone.0131229. http://doi.org/10.1371/journal.pone.0131... (England)	n=136 G1: extension training (n=68). Duration: Average of 8.6 minutes. G2: training plus phone support (n=68). Duration: 5 minutes connection. Follow up: three months	n=76 Written guidelines, directions.	The cost-effectiveness ratios were similar between intervention groups, showing that the effectiveness of the interventions will depend on whether such lifestyle advice is routine practice or an additional activity for primary care.	4
Wood et al. 2007¹⁴14 Kaner E, Lock C, Heather N, McNamee P, Bond S. Promoting brief alcohol intervention by nurses in primary care: a cluster randomised controlled trial. Patient Educ Couns. [Internet]. 2003 [acesso em 05 fev 2020];51(3):277-84. Disponível em: http://doi.org/10.1016/s0738-3991(02)00242-2. http://doi.org/10.1016/s0738-3991(02)002... (USA)	n=168 Brief motivational intervention (BMI) followed by Alcohol Expectancy Challenge (AEC). Duration: 45 to 60 min. Follow-up: one, three and six months.	n=167 AEC followed by BMI. Duration: 45 to 60 min.	BMI produced significant decreases in heavy drinking and problems, while AEC produced significant decreases in heavy drinking. There was no evidence of an additive effect of combining the interventions.	2
Korcha et al. 2012¹⁵15 Wood MD, Capone C, Laforge R, Erickson DJ, Brand NH. Brief motivational intervention and alcohol expectancy challenge with heavy drinking college students: a randomized factorial study. Addict Behav. [Internet]. 2007 [acesso em 15 fev 2020];32(11):2509-28. Disponível em: https://doi.org/10.1016/j.addbeh.2007.06.018. https://doi.org/10.1016/j.addbeh.2007.06... (Poland)	n=152 SBIRT* method with 15-to-20 minute session. Follow-up: three and 12 months	n=147 Conversations with professionals.	Patients who showed greater motivation to change their drinking behavior were significantly more likely to reduce the amount of drinking at three months; however, at 12 months this change was already significant.	2
Pal et al. 2007¹⁶16 Korcha RA, Cherpitel CJ, Moskalewicz J, Swiatkiewicz G, Bond J, Ye Y. Readiness to change, drinking, and negative consequences among Polish SBIRT patients. Addictive Behaviors. [Internet]. 2012 [acesso em 15 fev 2020];37:287-292. Disponível em: http://doi.org/10.1016/j.addbeh.2011.11.006. http://doi.org/10.1016/j.addbeh.2011.11.... (India)	n=45 Motivational interview (MI) based on the FRAMES protocol. Duration: two sessions of 30- to- 45 min; Follow-up: one and three months	n=45 They received simple advice (SA) from trained professionals.	There was significant improvement in many consumptions and quality of life parameters in the BI and SA groups. Significant differences were observed in interventions, with a decrease in the severity of dependence, as measured by past 30-day alcohol use, and improvement	5
			in physical and psychological quality of life in those who received BI compared with those who received SA
Gaume et al. 2017¹⁷17 Pal HR, Yadav D, Mehta S, Mohan I. A comparison of brief intervention versus simple advice for alcohol use disorders in a North India community-based sample followed for 3 months. Alcohol Alcohol. [Internet]. 2007 [acesso em 05 dez 2019];42(4):328-32. Disponível em: http://doi.org/10.1093/alcalc/agm009. http://doi.org/10.1093/alcalc/agm009... (Switzerland)	n=296 Immediate Brief Motivational Intervention (BMI). Follow-up: six months	n=276 AUDIT application and feedback.	Among non-heavy episodic users, there was a protective effect of BMI on weekly alcohol use (p<0.05). Among heavy episodic users, there were no significant effects of BMI.	5
Jo et al. 2019¹⁸18 Gaume J, Bertholet N, Daeppen J-B. Readiness to change predicts drinking: findings from 12-month follow-up of alcohol use disorder outpatients. Alcohol Alcohol. [Internet]. 2017 [acesso em 05 nov 2019]; 52(1):65-71. Disponível em: http://doi.org/10.1093/alcalc/agw047. http://doi.org/10.1093/alcalc/agw047... (South Korea)	n=748 on-BEAM** assessment of drinking behavior in three steps Duration: 23 to 30min Follow-up: four weeks	n=748 Assessment with AUDIT without normative feedback.	On-BEAM was effective in reducing participants’ alcohol consumption. The intervention group reported consuming less alcohol in the past week than the control group.	5
Allen et al. 2011¹⁹19 Jo S-J, Lee HK, Kang K, Joe KH, Lee S-B. Efficacy of a web-based screening and brief intervention to prevent problematic alcohol use in Korea: results of a randomized controlled trial. Alcohol Clin Exp Res. [Internet]. 2019 [acesso em 05 jul 2020];43(10):2196-2202. Disponível em: https://doi.org/10.1111/acer.14169. https://doi.org/10.1111/acer.14169... (London)	n=221 The intervention lasted up to four sessions. Follow up: three and 12 months	n=220 Conducting a health check and general health promotion, feedback in the form of a letter.	It was possible to involve men who drink dangerously in a brief intervention aimed at reducing alcohol-related harm. However, the results regarding effectiveness are ambiguous.	5
Dench, Bennet (2000)²⁰20 Allen E, Polikina O, Saburova L, McCambridge J, Elbourne D, Pakriev S, et al. The efficacy of a brief intervention in reducing hazardous drinking in working age men in Russia: the HIM (Health for Izhevsk men) individually randomised parallel group exploratory trial. Trials. [Internet]. 2011 [acesso em 28 set 2019];12:238. Disponível em: http://doi.org/10.1186/1745-6215-12-238. http://doi.org/10.1186/1745-6215-12-238... 30-50 years old (United Kingdom)	n=24 SOCRATES 8A and discussion about effects of alcohol and reflection of feelings. Duration: two sessions of 10 to 15min Follow up: six weeks	n=27 A round of conversation with the user, with the objective of the user identifying the harmful side of his consumption.	At one week after the intervention, the motivational participants reported significantly higher levels of problem recognition. The motivational group’s post-intervention scores group were significantly higher on the Execution Scale and significantly lower on the Ambivalence Scale.	3
Finn, Andréasson, Hammarberg (2020)²¹21 Dench S, Bennett G. The impact of brief motivational intervention at the start of an outpatient day programme for alcohol dependence. Cogn. Behav. Ther [Internet]. 2000 [acesso em 05 out 2019]; 28(2):121-130. Disponível em: http://doi.org/10.1017/S135246580000103X. http://doi.org/10.1017/S135246580000103X...	n=133 Patients in primary care. Maximum of five 15min sessions; 30min only in the first because of feedback; Method 15 Follow up: 6 and 12 months after.	n=138 Patients in specialist care. Feedback from the initial assessment, delivered by a physician. - Decision making. -pharmacological and/or psychological treatment.	The change in consumption occurred from the beginning to the six months follow-up and was maintained until the 12 months follow-up. This study indicates brief treatment of alcohol dependence in primary care with Method 15 as a viable method.	3

Source	Random sequence generation (selection bias)	Allocation concealment (Selection bias)	Blinding of participants and staff involved (performance bias)	Blinding of outcome assessors (detection bias)	Blinding of outcome assessors (detection bias)	Selective Outcome Report (Publication bias)	Other sources of bias	Classification	Level of Evidence⁹9 Oxford Center for Evidence Based Medicine. Níveis de evidência vicentífica segundo a Classificação de Oxford Centre for Evidence-Based Medicine. [Internet]. 2001 [acesso em 10 dez 2020]. Disponível em: https://portalarquivos2.saude.gov.br/images/pdf/2014/janeiro/28/tabela-nivel-evidencia.pdf. https://portalarquivos2.saude.gov.br/ima...
	Risk of bias domains
Burnhams et al. 2015¹¹11 Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JPT, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. [Internet]. 2019 [acesso em 05 jul 2020]; 10: ED000142. Disponível em: https://doi.org/10.1002/14651858.ED000142. https://doi.org/10.1002/14651858.ED00014...	(+)*	(+)†	(?)†	(?)†	(+)‡	(+)*	(+)‡	Low	1B
Clarke et al. 2015¹²12 Burnhams NH, London L, Laubscher R, Nel E, Parry C. Results of a cluster randomised controlled trial to reduce risky use of alcohol, alcohol-related HIV risks and improve help-seeking behaviour among safety and security employees in the Western Cape, South Africa. Subst Abuse Treat Prev Policy. [Internet]. 2015 [acesso em 10 jul 2020];10:18. Disponível em: http://doi.org/10.1186/s13011-015-0014-5. http://doi.org/10.1186/s13011-015-0014-5...	(+)†	(-)†	(+)†	(?)†	(+)*	(?)‡	(-)†	Low	1B
Kaner et al. 2003¹³13 Clarke NC, Field M, Rose AK. Evaluation of a Brief Personalised Intervention for Alcohol Consumption in College Students. PLoS One. [Internet]. 2015 [acesso em 10 jul 2020];10(6):e0131229. Disponível em: http://doi.org/10.1371/journal.pone.0131229. http://doi.org/10.1371/journal.pone.0131...	(+)*	(-)*	(-)†	(-)*	(-)*	(-)‡	(-)‡	High	2B
Wood et al. 2007¹⁴14 Kaner E, Lock C, Heather N, McNamee P, Bond S. Promoting brief alcohol intervention by nurses in primary care: a cluster randomised controlled trial. Patient Educ Couns. [Internet]. 2003 [acesso em 05 fev 2020];51(3):277-84. Disponível em: http://doi.org/10.1016/s0738-3991(02)00242-2. http://doi.org/10.1016/s0738-3991(02)002...	(+)*	(+)*	(+)†	(+)*	(+)*	(-)*	(?)*	Low	1B
Korcha et al. 2012¹⁵15 Wood MD, Capone C, Laforge R, Erickson DJ, Brand NH. Brief motivational intervention and alcohol expectancy challenge with heavy drinking college students: a randomized factorial study. Addict Behav. [Internet]. 2007 [acesso em 15 fev 2020];32(11):2509-28. Disponível em: https://doi.org/10.1016/j.addbeh.2007.06.018. https://doi.org/10.1016/j.addbeh.2007.06...	(+)*	(+)*	(?)†	(?)‡	(+)†	(+)‡	(-)†	Low	1B
Pal et al., 2007¹⁶16 Korcha RA, Cherpitel CJ, Moskalewicz J, Swiatkiewicz G, Bond J, Ye Y. Readiness to change, drinking, and negative consequences among Polish SBIRT patients. Addictive Behaviors. [Internet]. 2012 [acesso em 15 fev 2020];37:287-292. Disponível em: http://doi.org/10.1016/j.addbeh.2011.11.006. http://doi.org/10.1016/j.addbeh.2011.11....	(+)*	(-)*	(-)†	(-)*	(-)*	(-)*	(?)*	High	2B
Gaume et al. 2017¹⁷17 Pal HR, Yadav D, Mehta S, Mohan I. A comparison of brief intervention versus simple advice for alcohol use disorders in a North India community-based sample followed for 3 months. Alcohol Alcohol. [Internet]. 2007 [acesso em 05 dez 2019];42(4):328-32. Disponível em: http://doi.org/10.1093/alcalc/agm009. http://doi.org/10.1093/alcalc/agm009...	(+)†	(+)‡	(+)†	(+)†	(+)*	(+)*	(?)†	Low	1B
Jo et al. 2019¹⁸18 Gaume J, Bertholet N, Daeppen J-B. Readiness to change predicts drinking: findings from 12-month follow-up of alcohol use disorder outpatients. Alcohol Alcohol. [Internet]. 2017 [acesso em 05 nov 2019]; 52(1):65-71. Disponível em: http://doi.org/10.1093/alcalc/agw047. http://doi.org/10.1093/alcalc/agw047...	(+)†	(+)‡	(+)†	(+)†	(+)*	(?)*	(?)†	Low	1B
Allen et al. 2011¹⁹19 Jo S-J, Lee HK, Kang K, Joe KH, Lee S-B. Efficacy of a web-based screening and brief intervention to prevent problematic alcohol use in Korea: results of a randomized controlled trial. Alcohol Clin Exp Res. [Internet]. 2019 [acesso em 05 jul 2020];43(10):2196-2202. Disponível em: https://doi.org/10.1111/acer.14169. https://doi.org/10.1111/acer.14169...	(+)†	(+)‡	(+)†	(+)†	(+)*	(?)*	(?)†	Low	1B
Dench, Bennet 2000²⁰20 Allen E, Polikina O, Saburova L, McCambridge J, Elbourne D, Pakriev S, et al. The efficacy of a brief intervention in reducing hazardous drinking in working age men in Russia: the HIM (Health for Izhevsk men) individually randomised parallel group exploratory trial. Trials. [Internet]. 2011 [acesso em 28 set 2019];12:238. Disponível em: http://doi.org/10.1186/1745-6215-12-238. http://doi.org/10.1186/1745-6215-12-238...	(+)†	(-)‡	(+)†	(-)†	(?)*	(+)*	(?)†	High	2B
Finn, Andréasson, Hammarberg 2020²¹21 Dench S, Bennett G. The impact of brief motivational intervention at the start of an outpatient day programme for alcohol dependence. Cogn. Behav. Ther [Internet]. 2000 [acesso em 05 out 2019]; 28(2):121-130. Disponível em: http://doi.org/10.1017/S135246580000103X. http://doi.org/10.1017/S135246580000103X...	( + )	( - )	( - )	( - )	( + )	( + )	( + )	High	2B

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[1] Corresponding author:
Larissa Alves de Araújo Lima Universidade Federal do Piauí - Teresina, PI, Brasil E-mail: larissaaal@gmail.com