Brief counselling reduces hazardous drinking

Ann Intern Med2012; published online 25 September

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Brief counselling, repeated at least once, could be the best way to help adults cut down their hazardous drinking, according to a meta-analysis of 23 randomised trials.⇑ A single episode of behavioural counselling also worked, but not as well. Together, behavioural counselling by primary care providers reduced adults’ drinking by an average 3.6 drinks a week over 12 months (95% CI 2.4 to 4.8 drinks a week), reduced the proportion of adults reporting binges, and increased the proportion of adults sticking within recommended limits. All the changes were significant relative to controls, who generally had contact with health professionals but no counselling.

Brief counselling usually lasted about 15 minutes and could include advice, education, cognitive therapy techniques, feedback, drinking diaries, and self help exercises to do at home. All participants in the review had been identified as problem drinkers through screening in primary care. Most had risky or hazardous levels of drinking, not dependence or misuse. Behavioural counselling helped control their drinking for 12 months, but the authors couldn’t tell whether changes in behaviour meant fewer injuries, admissions to hospital, a lower risk of liver damage, or a longer life. Other important gaps in the evidence included how best to help pregnant women with drinking problems and adults with comorbid anxiety, depression, or chronic pain.