Community-based alcohol counselling: a randomized clinical trial.
OBJECTIVE
To examine the effectiveness of a brief intervention (BI) and cognitive behaviour therapy (CBT) for alcohol abuse.


METHODS
A randomized trial with clients randomized within counsellors.


METHODS
Community-based drug and alcohol counselling in Australia.


METHODS
Of all new clients attending counselling. 869 (82%) completed a computerized assessment at their first consultation. Four hundred and twenty-one (48%) were defined as eligible, of whom 295 (70%) consented and were allocated randomly to an intervention. Of these, 13 3 (45%) were followed-up at 6 months post-test.


METHODS
BI comprised the elements identified by the acronym FRAMES:feedback, responsibility, advice, menu, empathy, self-efficacy. Face-to-face counselling time was not to exceed 90 minutes. CBT comprised six consecutive weekly sessions: introduction: cravings and urges; managing crises; saying 'no' and solving problems: emergencies and lapses: and maintenance. Total face-to-face counselling time was 270 minutes (six 45-minute sessions).


METHODS
Treatment outcomes are measured in terms of counsellor compliance, client satisfaction, weekly and binge consumption, alcohol-related problems, the AUDIT questionnaire and cost-effectiveness.


RESULTS
When analysed on an intention-to-treat basis and for those followed-up. treatment outcomes between BI and CBT were not statistically significantly different at pre- or post-test, whether considered as continuous or categorical variables. BI was statistically significantly more cost-effective than CBT and there was no difference between them in clients' reported levels of satisfaction.


CONCLUSIONS
For low-dependence alcohol abuse in community settings, BI may be the treatment of choice.
Shakeshaft
Anthony P
AP
National Drug and Alcohol Research Centre, University of NSW, Sydney, Australia. a.shakeshaft@unsw.edu.au
Bowman
Jenny A
JA
Burrows
Sally
S
Doran
Christopher M
CM
Sanson-Fisher
Rob W
RW
D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003156:Community Mental Health Services / Q000191:economics / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D016896:Treatment Outcome