Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials.
OBJECTIVE
Brief alcohol interventions in medical settings are efficacious in improving self-reported alcohol consumption among those with low-severity alcohol problems. Screening, Brief Intervention and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated. We estimated main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral-specific component, in increasing the utilization of alcohol-related care.


METHODS
A systematic review of English language papers published in electronic databases to 2013. We included randomized controlled trials (RCTs) of brief alcohol interventions in general health-care settings with adult and adolescent samples. We excluded studies that lacked alcohol services utilization data. Extractions of study characteristics and outcomes were standardized and conducted independently. The primary outcome was post-treatment alcohol services utilization assessed by self-report or administrative data, which we compared across intervention and control groups.


RESULTS
Thirteen RCTs met inclusion criteria and nine were meta-analyzed (n = 993 and n = 937 intervention and control group participants, respectively). In our main analyses the pooled risk ratio (RR) was = 1.08, 95% confidence interval (CI) = 0.92-1.28. Five studies compared referral-specific interventions with a control condition without such interventions (pooled RR = 1.08, 95% CI = 0.81-1.43). Other subgroup analyses of studies with common characteristics (e.g. age, setting, severity, risk of bias) yielded non-statistically significant results.


CONCLUSIONS
There is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol-related services.
School of Social Work, University of Wisconsin-Madison, Madison, WI, USA.
Joseph E
JE
Glass
Chrysalis, Inc., Madison, WI, USA.
Ashley M
AM
Hamilton
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Byron J
BJ
Powell
School of Social Work, University of Michigan, Ann Arbor, MI, USA.
Brian E
BE
Perron
Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
Randall T
RT
Brown
VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System and the Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
Mark A
MA
Ilgen
D019973:Alcohol-Related Disorders / Q000628:therapy*; D003376:Counseling / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000628:therapy
Alcohol; brief intervention; meta-analysis; referral to treatment; treatment initiation; treatment utilization