Alcohol brief interventions

There is strong evidence that alcohol brief interventions reduce alcohol consumption and excessive drinking among adults when administered in primary care (O'Connor 2018, Cochrane-Kaner 2018, Alvarez-Bueno 2015, NICE-Jackson 2010, WHO-SBI) and general hospital settings (Schweer-Collins 2023, Scharer 2022, Cochrane-McQueen 2011), and reduce alcohol consumption among adolescents and young adults when administered in school and college settings (Hennessy 2019, Cochrane-Carney 2016, Tanner-Smith 2016, Seigers 2010). Such interventions have also been shown to modestly reduce alcohol-related injuries (NICE-Jackson 2010, Cochrane-Dinh-Zarr 2004).

Brief interventions in emergency departments appear to modestly decrease alcohol consumption and heavy drinking among patients who are injured or intoxicated (Barata 2017, Schmidt 2016). Brief interventions in primary care settings may be similarly effective between men and women (Cochrane-Kaner 2018), though women may be less likely to drink and more likely to pursue treatment when brief interventions are delivered in general hospital settings (Schweer-Collins 2023). Brief interventions for pregnant women appear to modestly increase rates of abstinence from alcohol during pregnancy and prevent preterm births (Popova 2023). People living with HIV, a third of whom have an alcohol use disorder, appear likely to reduce the number of drinks per day and excessive drinking episodes when they receive brief interventions, which lowers their mortality risk (Ghosh 2023). Brief interventions may reduce excessive drinking in older adults, however more research is needed to understand effects (Purser 2022, Kelly 2018). The effect of brief interventions on people with mental health conditions is unclear (Boniface 2018).

School-based alcohol brief interventions can reduce alcohol consumption among adolescents (Cochrane-Carney 2016), especially when individually delivered (Hennessy 2015). Effects on adolescents in hospital settings are mixed and vary by type of intervention (O'Connor 2018, Samson 2019); brief interventions with motivational interviewing techniques can reduce heavy alcohol use and substance-related problems for adolescents with substance use disorders (Steele 2020). Brief interventions can reduce driving after drinking among college students, especially when delivered using motivational interviewing techniques with personalized feedback (Mun 2022). Several brief interventions programs can be effective for college students: for example, BASICS may be the most effective and better suited for students at higher risk while THRIVE and e-CHUG may work best for universal prevention efforts (Hennessy 2019).

Electronic screening and brief interventions (e-SBI) reduce alcohol consumption (Sohi 2023), especially among youth and college students; effects are strongest in the short-term (Sohi 2023, Campbell-Smedslund 2017, Donoghue 2014). E-SBI conducted in college, health care, and community settings can also reduce excessive drinking and alcohol-related harms (CG-Alcohol).

Training physicians and nonphysician practitioners to deliver brief interventions appears to support effective implementation (Loughran 2021). Alcohol brief interventions appear to be cost effective approaches to reduce harmful alcohol consumption and health care utilization (Barbosa 2020, IAS-Anderson 2006, WHO-SBI, NICE-Jackson 2010). The cost-effectiveness ratio of brief interventions is calculated to be a $0.40 to $303 per drinks reduced per week, with a benefit-cost ratio of $39 per dollar invested (Le 2023a). Delivering brief interventions to pregnant women is likely a cost-effective approach for reducing cases of fetal alcohol spectrum disorder (FASD). Preventing one case of FASD costs just 3% of the total costs required to provide services to an individual with FASD over their lifetime (Popova 2023).

It is unclear what impact alcohol brief interventions can have on disparities in alcohol consumption and alcohol-related harms.

Brief interventions that utilize motivational interviewing techniques may be effective regardless of gender, race, or ethnicity (Contreras-Perez 2024). Brief alcohol interventions delivered by community health workers may have the potential to reduce alcohol use and alcohol-related problems in Hispanic communities, who experience higher rates of unhealthy alcohol use and morbidity, and lower access to addiction treatment (Carson 2023). People living with HIV are particularly at risk of having an alcohol use disorder, which negatively affects their HIV treatment and increases their morbidity and mortality. It appears that individual-level brief interventions delivered in clinical and community settings are effective at improving alcohol outcomes and reducing mortality risk in people living with HIV (Ghosh 2023).

A California-based study suggests women, particularly women of color, are less likely to receive brief interventions in primary care settings than men (Parthasarathy 2023). A study of patients in the Veterans Administration (VA) health systems suggests that Black women and men, and Asian/Pacific Islander women are less likely to receive brief interventions (Chen 2020b). Evidence indicates that race and ethnicity do not moderate treatment effects of brief interventions, suggesting that if disparities in receipt of brief interventions are closed, effects should be equal (Contreras-Perez 2024). There seem to be slight differences in receiving brief screening and interventions across sexual minority and heterosexual adults: lesbian women appear to be asked about heavy drinking more often in health care settings and gay men appear to receive brief interventions less often than heterosexual men who consume similar amounts of alcohol (Lehavot 2017). Experts suggest that reducing disparities in receiving alcohol-related care may require targeted interventions (Chen 2020b, Carson 2023).

The available evidence of the effectiveness of brief interventions in young adults appears to be representative of white college-age students, highlighting the need for additional research evaluating the effectiveness among other young adult subpopulations, such as those with minoritized identities (Cronce 2022).

Alcohol is deeply rooted in American life and history. Prior to the American Revolution, alcohol was perceived as an invigorating and restorative beverage that did not spoil easily and was safer than water. Its taxation provided a major source of revenue for colonial governments (Olson 1985). After the American Revolution, the temperance and women’s rights movements shifted societal perspectives of alcohol and led efforts for its banishment. These efforts led to the adoption of the 18th Amendment in 1920, which banned the manufacture, sale, and transport of alcohol across the U.S., also known as Prohibition (Aaron 1981). Prohibition ended in 1933 in large part because of the need to generate tax revenue and stimulate job growth during the Great Depression and gave states authority to regulate alcohol, and each have approached regulation differently (Olson 1985). Today, the federal government has limited authority to impose national-level rules and regulations and there continues to be a patchwork of alcohol regulations that vary by state. Some state legislatures have preempted local government from implementing certain regulations and laws (APIS-State Preemption).

Throughout history, alcohol misuse was seen as a personal failing. This evolved over the 19th century as the addictive properties of alcohol were understood (Olson 1985). Alcohol use disorder is now seen as a chronic disease that is influenced by genetics, neighborhood disadvantage, stress, access to alcohol, drinking cultures and contexts, and alcohol-industry influences (Zapolski 2014, Sudhinaraset 2016). In 1957, alcohol brief interventions were first used to allow a psychiatrist and social worker to refer patients in the emergency department to outpatient alcohol treatment. Towards the end of the 20^th century, alcohol brief interventions became a more established practice in a variety of environments (McCambridge 2014).

• What are the disparities in alcohol use disorders in your community? What groups are most affected?
• What are the barriers to high quality linguistically and culturally appropriate alcohol screening and intervention? How are interventions tailored to reflect the cultures of people in your community?
• How can alcohol screening and intervention be more equitably delivered in community, hospital, and primary care settings? What resources and partnership opportunities exist in your community to increase access to these services?
• What barriers, like stigma, are preventing people from accessing information about alcohol and available treatment services? What additional strategies can be implemented to overcome those barriers?

The Substance Abuse and Mental Health Services Administration (SAMHSA)’s Screening, Brief Intervention, Referral and Treatment (SBIRT) program conducts demonstration projects across the country that assess and disseminate information on new SBIRT methods (SAMHSA-SBIRT). In the Veterans Administration (VA) health systems, the largest integrated health care system in the U.S., alcohol screening and brief intervention is universal (Chen 2020b). Example intervention programs for college students include Brief Alcohol Screening and Intervention for College Students (BASICS), which takes a harm prevention approach (Blueprints-BASICS), and Alcohol eCHECKUP TO GO (eCHUG), a resource-intensive program that uses normative feedback (eCHUG, Hennessy 2019). Additionally, there are brief interventions that focus on supporting pregnant women, such as CHOICES, that can be effectively tailored for minoritized communities, such as indigenous communities (Deutsch 2021).

‡ Resources with a focus on equity.

APHA-SBI Manual 2008 - American Public Health Association and Education Development Center, Inc (APHA). Alcohol screening and brief intervention: A guide for public health practitioners. Washington, D.C.: National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (U.S. DOT); 2008.

CDC-Higgins-Biddle 2009 - Higgins-Biddle J, Hungerford D, Cates-Wessel K. Screening and brief interventions (SBI) for unhealthy alcohol use: A step-by-step implementation guide for trauma centers. Atlanta: Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC); 2009.

CDC-SBI 2014 - Centers for Disease Control and Prevention (CDC). Planning and implementing screening and brief intervention for risky alcohol use: A step-by-step guide for primary care practices. Atlanta, GA: Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities (NCBDDD); 2014.

CDC-SBI Tribal 2018^‡ - Centers for Disease Control and Prevention (CDC). Planning and implementing screening and brief intervention for risky alcohol use: A step-by-step guide for tribal communities. Atlanta, Georgia: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities; 2018.

IRETA-SBIRT toolkit - Institute for Research, Education, & Training in Addictions (IRETA). Screening, Brief Intervention & Referral to Treatment (SBIRT) toolkit.

NHMA-SBIRT 2006 - National Hispanic Medical Association (NHMA). NHMA screening and brief intervention toolkit for the Hispanic patient. Washington, D.C.: National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (U.S. DOT); 2006.

NIAAA-SBI youth - National Institute on Alcohol Abuse and Alcoholism (NIAAA). Alcohol screening and brief intervention for youth: A practitioner's guide. National Institutes of Health (NIH), U.S. Department of Health and Human Services (U.S. DHHS); 2011.

SAMHSA-SBIRT - Substance Abuse and Mental Health Services Administration (SAMHSA). Screening, brief intervention, and referral to treatment (SBIRT).

* Journal subscription may be required for access.

Aaron 1981 - Aaron P, Musto D. Temperance and prohibition in America: A historical overview. In: Alcohol and public policy: Beyond the shadow of prohibition. Moore MH, Gerstein DR eds. Washington, D.C.: The National Academies Press; 1981.

Alvarez-Bueno 2015* - Álvarez-Bueno C, Rodríguez-Martín B, García-Ortiz L, Gómez-Marcos MÁ, Martínez-Vizcaíno V. Effectiveness of brief interventions in primary health care settings to decrease alcohol consumption by adult non-dependent drinkers: A systematic review of systematic reviews. Preventive Medicine. 2015;76(Suppl):S33-S38.

APIS-State Preemption - Alcohol Policy Information System (APIS). About alcohol policy.

Barata 2017 - Barata IA, Shandro JR, Montgomery M, et al. Effectiveness of SBIRT for alcohol use disorders in the emergency department: A systematic review. Western Journal of Emergency Medicine. 2017;18(6):1143-1152.

Barbosa 2020 - Barbosa C, McKnight-Eily LR, Grosse SD, Bray J. Alcohol screening and brief intervention in emergency departments: Review of the impact on healthcare costs and utilization. Journal of Substance Abuse Treatment. 2020;117:108096.

Blueprints-BASICS - Blueprints for healthy youth development: Brief Alcohol Screening and Intervention for College Students (BASICS).

Boniface 2018 - Boniface S, Malet-Lambert I, Coleman R, et al. The effect of brief interventions for alcohol among people with comorbid mental health conditions: A systematic review of randomized trials and narrative synthesis. Alcohol and Alcoholism. 2018;53(3):282-293.

Campbell-Smedslund 2017 - Smedslund G, Wollscheid S, Fang L, et al. Effect of early, brief computerized interventions on risky alcohol and cannabis use among young people. Campbell Systematic Reviews. 2017;6.

Carson 2023 - Carson M, Fernandez A, Martin M. A review of community health worker interventions for Latinx/o/a individuals with unhealthy alcohol use. Journal of Addiction Medicine. 2023;17(6):717-721.

CG-Alcohol - The Guide to Community Preventive Services (The Community Guide). Excessive alcohol consumption.

Chen 2020b - Chen JA, Glass JE, Bensley KMK, et al. Racial/ethnic and gender differences in receipt of brief intervention among patients with unhealthy alcohol use in the U.S. Veterans Health Administration. Journal of Substance Abuse Treatment. 2020;119:108078.

Cochrane-Carney 2016 - Carney T, Myers BJ, Louw J, Okwundu CI. Brief school-based interventions and behavioural outcomes for substance-using adolescents (Review). Cochrane Database of Systematic Reviews. 2016;(1):CD008969.

Cochrane-Dinh-Zarr 2004* - Dinh-Zarr TB, Gross CW, Heitman E, Roberts IG, DiGuiseppi C. Interventions for preventing injuries in problem drinkers. Cochrane Database of Systematic Reviews. 2004;(3):CD001857.

Cochrane-Kaner 2018 - Kaner EFS, Beyer FR, Muirhead C, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews. 2018;(2):CD004148.

Cochrane-McQueen 2011* - McQueen J, Howe TE, Allan I, Mains D, Hardy V. Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database of Systematic Reviews. 2011;(8):CD005191.

Contreras-Perez 2024 - Contreras-Pérez ME, Wagner E, Hospital M, et al. Outcomes of a brief motivational intervention for heavy alcohol use in racial or ethnic minority compared to white emerging adults. Journal of Evidence-Based Social Work. 2024;21(1):75-89.

Cronce 2022 - Cronce JM, Marchetti MA, Jones MB, Ehlinger PP. A scoping review of brief alcohol interventions across young adult subpopulations. Psychology of Addictive Behaviors. 2022;36(6):648-663.

Deutsch 2021* - Deutsch AR, Lustfield R, Hanson JD. Where there’s a will, there’s a way? Strategies to reduce or abstain from alcohol use developed by Northern Plains American Indian women participating in a brief, alcohol-exposed pregnancy preconceptual intervention. Alcoholism: Clinical and Experimental Research. 2021;45(11):2383-2395.

Donoghue 2014 - Donoghue K, Patton R, Phillips T, Deluca P, Drummond C. The effectiveness of electronic screening and brief intervention for reducing levels of alcohol consumption: A systematic review and meta-analysis. Journal of Medical Internet Research. 2014;16(6):e142.

eCHUG - Alcohol eCHECKUP TO GO. Strengthen a culture of safety and well-being at your institution by reducing harms from alcohol use.

Ghosh 2023* - Ghosh A, Singh GK, Yadav N, Singh P, Kathiravan S. Brief interventions for alcohol misuse among people living with HIV: A meta-analysis. American Journal of Drug and Alcohol Abuse. 2023;49(6).

Hennessy 2015 - Hennessy EA, Tanner-Smith EE. Effectiveness of brief school-based interventions for adolescents: A meta-analysis of alcohol use prevention programs. Prevention Science. 2015;16(3):463-474.

Hennessy 2019 - Hennessy EA, Tanner-Smith EE, Mavridis D, Grant SP. Comparative effectiveness of brief alcohol interventions for college students: Results from a network meta-analysis. Prevention Science. 2019;20(5):715-740.

IAS-Anderson 2006 - Anderson P, Baumberg B. Alcohol in Europe: A public health perspective. London, UK: Institute of Alcohol Studies (IAS); 2006.

Kelly 2018 - Kelly S, Olanrewaju O, Cowan A, Brayne C, Lafortune L. Interventions to prevent and reduce excessive alcohol consumption in older people: A systematic review and meta-analysis. Age and Ageing. 2018;47(2):175-184.

Le 2023a - Le LK-D, Faller J, Chatterton M Lou, et al. Interventions to prevent alcohol use: Systematic review of economic evaluations. BJPsych Open. 2023;9(4):e117.

Lehavot 2017* - Lehavot K, Blosnich JR, Glass JE, Williams EC. Alcohol use and receipt of alcohol screening and brief intervention in a representative sample of sexual minority and heterosexual adults receiving health care. Drug and Alcohol Dependence. 2017;179:240-246.

Loughran 2021 - Loughran TA, Scharer JL, Rodriguez L, et al. Brief alcohol interventions in U.S. medical settings: A systematic review of the implementation literature. Journal of Substance Abuse Treatment. 2021;131:108456.

McCambridge 2014 - McCambridge J, Cunningham JA. The early history of ideas on brief interventions for alcohol. Addiction. 2014;109(4):538-546.

Mun 2022 - Mun EY, Li X, Lineberry S, et al. Do brief alcohol interventions reduce driving after drinking among college students? A two-step meta-analysis of individual participant data. Alcohol and Alcoholism. 2022;57(1):125-135.

NICE-Jackson 2010 - Jackson R, Johnson M, Campbell F, et al. Screening and brief interventions for prevention and early identification of alcohol use disorders in adults and young people. Sheffield: School of Health and Related Research (ScHARR) Public Health Collaborating Centre, University of Sheffield; 2010.

O'Connor 2018 - O’Connor EA, Perdue LA, Senger CA, et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2018;320(18):1910-1928.

Olson 1985* - Olson S, Gerstein DR. Alcohol in America: Taking action to prevent abuse. Washington, D.C.: The National Academies Press; 1985.

Parthasarathy 2023* - Parthasarathy S, Chi FW, Metz V, et al. Disparities in the receipt of alcohol brief intervention: The intersectionality of sex, age, and race/ethnicity. Addiction. 2023;118(7):1258-1269.

Popova 2023 - Popova S, Dozet D, Pandya E, et al. Effectiveness of brief alcohol interventions for pregnant women: A systematic literature review and meta-analysis. BMC Pregnancy and Childbirth. 2023;23:61.

Purser 2022* - Purser GL, Lemieux CM. Brief alcohol interventions with older adults: A systematic review of literature. Journal of Social Work Practice in the Addictions. 2022;22(2):120-136.

SAMHSA-SBIRT - Substance Abuse and Mental Health Services Administration (SAMHSA). Screening, brief intervention, and referral to treatment (SBIRT).

Samson 2019 - Samson JE, McHugh RM. Brief alcohol interventions for adolescents and young adults in emergency department settings: A descriptive review and meta-analysis. Adolescent Research Review. 2019;4(3):313-327.

Scharer 2022 - Scharer JL, Funderburk JS, De Vita MJ, Rother Y, Maisto SA. Treatment-as-usual control groups in brief alcohol intervention trials: A systematic review and meta-analysis. Journal of Studies on Alcohol and Drugs. 2022;83(6):934-943.

Schmidt 2016* - Schmidt CS, Schulte B, Seo HN, et al. Meta-analysis on the effectiveness of alcohol screening with brief interventions for patients in emergency care settings. Addiction. 2016;111(5):783-794.

Schweer-Collins 2023 - Schweer-Collins ML, Parr NJ, Saitz R, Tanner-Smith EE. Investigating for whom brief substance use interventions are most effective: An individual participant data meta-analysis. Prevention Science. 2023;24(8):1459-1482.

Seigers 2010* - Seigers DKL, Carey KB. Screening and brief interventions for alcohol use in college health centers: A review. Journal of American College Health. 2010;59(3):151-8.

Sohi 2023* - Sohi I, Shield KD, Rehm J, Monteiro M. Digital interventions for reducing alcohol use in general populations: An updated systematic review and meta-analysis. Alcohol, Clinical and Experimental Research. 2023;47(10):1813-1832.

Steele 2020 - Steele DW, Becker SJ, Danko KJ, et al. Brief behavioral interventions for substance use in adolescents: A meta-analysis. Pediatrics. 2020;146(4):e20200351.

Sudhinaraset 2016 - Sudhinaraset M, Wigglesworth C, Takeuchi DT. Social and cultural contexts of alcohol use: Influences in a social–ecological framework. Alcohol Research: Current Reviews. 2016;38(1):35-45.

Tanner-Smith 2016* - Tanner-Smith EE, Risser MD. A meta-analysis of brief alcohol interventions for adolescents and young adults: Variability in effects across alcohol measures. The American Journal of Drug and Alcohol Abuse. 2016;42(2):140-151.

WHO-SBI - World Health Organization (WHO). Screening and brief intervention for alcohol problems in primary health care.

WI DHS-SBIRT - Wisconsin Department of Health Services (WI DHS). Screening, Brief Intervention, and Referral to Treatment (SBIRT).

Zapolski 2014 - Zapolski TCB, Pedersen SL, McCarthy DM, Smith GT. Less drinking, yet more problems: Understanding African American drinking and related problems. Psychological Bulletin. 2014;140(1).