Does Screening and Brief Intervention for Alcohol Use in Medical Settings Increase Receipt of Substance Use Disorder Services?

Background and Purpose: Brief alcohol interventions in medical settings are efficacious in improving self-reported alcohol consumption among those with low-severity unhealthy alcohol use. Screening, Brief Intervention, and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but the evidence for this conclusion has not been sufficiently validated. We estimated the effect of brief alcohol interventions in increasing the utilization of alcohol-related care.

Methods: A systematic review and meta-analysis of articles published in electronic databases through 2013. We included randomized controlled trials of brief alcohol interventions in medical settings including adult and adolescent samples. We only included studies that reported alcohol services utilization as an outcome. We conducted independent standardized extractions of study characteristics and outcomes. Our primary outcome was post-treatment alcohol services utilization, including formal treatment or mutual help, which was assessed by self-report or administrative data in these studies. We compared alcohol services utilization across intervention and control groups.

Results: Of the fifteen randomized controlled trials that met inclusion criteria, eleven were included in the meta-analysis (n = 1,183 in intervention groups and n = 1,197 in control groups). The pooled risk ratio was RR=1.16 (95% CI=0.96-1.40). In subgroup analyses, seven studies compared referral-specific interventions to a control group that did not employ similar referral interventions (pooled RR=1.32, 95% CI=0.91-1.90). No subgroup analyses of studies (stratified by age, setting, severity, risk of bias) yielded statistically significant results.

Conclusion and Implications: There is an overall lack of efficacy of brief alcohol interventions, as currently implemented, in increasing alcohol service utilization. Of the interventions we evaluated, the most promising one demonstrated the benefit of administering brief alcohol interventions over multiple sessions. There is a need to develop and implement more intensive care for alcohol use disorders into medical and non-specialty service settings in which individuals with substance use problems already seek services. Efficacious referral to treatment interventions remain needed, and future intervention research should evaluate multiple-session brief interventions as a means to facilitate treatment referral.