title: Behavioral counseling after screening for alcohol misuse in primary care: a systematic review and meta-analysis for the U.S. Preventive Services Task Force.
abstract: BACKGROUND
  Alcohol misuse, which includes the full spectrum from risky drinking to alcohol dependence, is a leading cause of preventable death in the United States.
  
  
  OBJECTIVE
  To evaluate the benefits and harms of behavioral counseling interventions for adolescents and adults who misuse alcohol.
  
  
  METHODS
  MEDLINE, EMBASE, the Cochrane Library, CINAHL, PsycINFO, International Pharmaceutical Abstracts, and reference lists of published literature (January 1985 through January 2012, limited to English-language articles).
  
  
  METHODS
  Controlled trials at least 6 months' duration that enrolled persons with alcohol misuse identified by screening in primary care settings and evaluated behavioral counseling interventions.
  
  
  METHODS
  One reviewer extracted data and a second checked accuracy. Two independent reviewers assigned quality ratings and graded the strength of the evidence.
  
  
  RESULTS
  The 23 included trials generally excluded persons with alcohol dependence. The best evidence was for brief (10- to 15-minute) multicontact interventions. Among adults receiving behavioral interventions, consumption decreased by 3.6 drinks per week from baseline (weighted mean difference, 3.6 drinks/wk [95% CI, 2.4 to 4.8 drinks/wk]; 10 trials; 4332 participants), 12% fewer adults reported heavy drinking episodes (risk difference, 0.12 [CI, 0.07 to 0.16]; 7 trials; 2737 participants), and 11% more adults reported drinking less than the recommended limits (risk difference, 0.11 [CI, 0.08 to 0.13]; 9 trials; 5973 participants) over 12 months compared with control participants (moderate strength of evidence). Evidence was insufficient to draw conclusions about accidents, injuries, or alcohol-related liver problems. Trials enrolling young adults or college students showed reduced consumption and fewer heavy drinking episodes (moderate strength of evidence). Little or no evidence of harms was found.
  
  
  CONCLUSIONS
  Results may be biased to the null because the behavior of control participants could have been affected by alcohol misuse assessments. In addition, evidence is probably inapplicable to persons with alcohol dependence and selective reporting may have occurred.
  
  
  CONCLUSIONS
  Behavioral counseling interventions improve behavioral outcomes for adults with risky drinking.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.affiliation: University of North Carolina at Chapel Hill, Department of Medicine, 5034 Old Clinic Building, CB 7110, Chapel Hill, NC 27599, USA. daniel_jonas@med.unc.edu
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Jonas
authors.forename: James C
authors.initials: JC
authors.lastname: Garbutt
authors.forename: Halle R
authors.initials: HR
authors.lastname: Amick
authors.forename: Janice M
authors.initials: JM
authors.lastname: Brown
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Brownley
authors.forename: Carol L
authors.initials: CL
authors.lastname: Council
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Viera
authors.forename: Tania M
authors.initials: TM
authors.lastname: Wilkins
authors.forename: Cody J
authors.initials: CJ
authors.lastname: Schwartz
authors.forename: Emily M
authors.initials: EM
authors.lastname: Richmond
authors.forename: John
authors.initials: J
authors.lastname: Yeatts
authors.forename: Tammeka Swinson
authors.initials: TS
authors.lastname: Evans
authors.forename: Sally D
authors.initials: SD
authors.lastname: Wood
authors.forename: Russell P
authors.initials: RP
authors.lastname: Harris
mesh_terms: D000428:Alcohol Drinking; D019973:Alcohol-Related Disorders / Q000150:complications / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods*; D003376:Counseling; D006801:Humans; D011320:Primary Health Care; D016032:Randomized Controlled Trials as Topic