title: The effectiveness of brief alcohol interventions in primary care settings: a systematic review.
abstract: OBJECTIVE
  Numerous studies have reported that brief interventions delivered in primary care are effective in reducing excessive drinking. However, much of this work has been criticised for being clinically unrepresentative. This review aimed to assess the effectiveness of brief interventions in primary care and determine if outcomes differ between efficacy and effectiveness trials.
  
  
  METHODS
  A pre-specified search strategy was used to search all relevant electronic databases up to 2006. We also hand-searched the reference lists of key articles and reviews. We included randomised controlled trials (RCT) involving patients in primary care who were not seeking alcohol treatment and who received brief intervention. Two authors independently abstracted data and assessed trial quality. Random effects meta-analyses, subgroup and sensitivity analyses and meta-regression were conducted.
  
  
  RESULTS
  The primary meta-analysis included 22 RCT and evaluated outcomes in over 5800 patients. At 1 year follow up, patients receiving brief intervention had a significant reduction in alcohol consumption compared with controls [mean difference: -38 g week(-1), 95%CI (confidence interval): -54 to -23], although there was substantial heterogeneity between trials (I(2) = 57%). Subgroup analysis confirmed the benefit of brief intervention in men but not in women. Extended intervention was associated with a non-significantly increased reduction in alcohol consumption compared with brief intervention. There was no significant difference in effect sizes for efficacy and effectiveness trials.
  
  
  CONCLUSIONS
  Brief interventions can reduce alcohol consumption in men, with benefit at a year after intervention, but they are unproven in women for whom there is insufficient research data. Longer counselling has little additional effect over brief intervention. The lack of differences in outcomes between efficacy and effectiveness trials suggests that the current literature is relevant to routine primary care.
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK. e.f.s.kaner@newcastle.ac.uk
authors.forename: Eileen F S
authors.initials: EF
authors.lastname: Kaner
authors.forename: Heather O
authors.initials: HO
authors.lastname: Dickinson
authors.forename: Fiona
authors.initials: F
authors.lastname: Beyer
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Pienaar
authors.forename: Carla
authors.initials: C
authors.lastname: Schlesinger
authors.forename: Fiona
authors.initials: F
authors.lastname: Campbell
authors.forename: John B
authors.initials: JB
authors.lastname: Saunders
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.forename: Nick
authors.initials: N
authors.lastname: Heather
mesh_terms: D000428:Alcohol Drinking / Q000628:therapy*; D000437:Alcoholism / Q000628:therapy*; D006801:Humans; D011320:Primary Health Care / Q000379:methods*; D011614:Psychotherapy, Brief / Q000379:methods / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D012727:Sex Characteristics