title: Brief physician advice for problem drinkers: long-term efficacy and benefit-cost analysis.
abstract: BACKGROUND
  This report describes the 48-month efficacy and benefit-cost analysis of Project TrEAT (Trial for Early Alcohol Treatment), a randomized controlled trial of brief physician advice for the treatment of problem drinking.
  
  
  METHODS
  Four hundred eighty-two men and 292 women, ages 18-65, were randomly assigned to a control (n = 382) or intervention (n = 392) group. The intervention consisted of two physician visits and two nurse follow-up phone calls. Intervention components included a review of normative drinking, patient-specific alcohol effects, a worksheet on drinking cues, drinking diary cards, and a drinking agreement in the form of a prescription.
  
  
  RESULTS
  Subjects in the treatment group exhibited significant reductions (p < 0.01) in 7-day alcohol use, number of binge drinking episodes, and frequency of excessive drinking as compared with the control group. The effect occurred within 6 months of the intervention and was maintained over the 48-month follow-up period. The treatment sample also experienced fewer days of hospitalization (p = 0.05) and fewer emergency department visits (p = 0.08). Seven deaths occurred in the control group and three in the treatment group. The benefit-cost analysis suggests a 43,000 dollars reduction in future health care costs for every 10,000 dollars invested in early intervention. The benefit-cost ratio increases when including the societal benefits of fewer motor vehicle events and crimes.
  
  
  CONCLUSIONS
  The long-term follow-up of Project TrEAT provides the first direct evidence that brief physician advice is associated with sustained reductions in alcohol use, health care utilization, motor vehicle events, and associated costs. The report suggests that a patient's personal physician can successfully treat alcohol problems and endorses the implementation of alcohol screening and brief intervention in the US health care system.
authors.affiliation: Department of Family Medicine, University of Wisconsin-Madison Medical School, Madison, Wisconsin 53715, USA. mfleming@fammed.wisc.edu
authors.forename: Michael F
authors.initials: MF
authors.lastname: Fleming
authors.forename: Marlon P
authors.initials: MP
authors.lastname: Mundt
authors.forename: Michael T
authors.initials: MT
authors.lastname: French
authors.forename: Linda Baier
authors.initials: LB
authors.lastname: Manwell
authors.forename: Ellyn A
authors.initials: EA
authors.lastname: Stauffacher
authors.forename: Kristen Lawton
authors.initials: KL
authors.lastname: Barry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000191:economics* / Q000401:mortality / Q000628:therapy; D000704:Analysis of Variance; D003362:Cost-Benefit Analysis / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D013997:Time Factors; D016896:Treatment Outcome