Fleming MF et al. Brief Physician Advice for Problem Alcohol Drinkers. A Randomized Controlled Trial in Community-Based Primary Care Practices. JAMA 1997;277:1039-1045
This paper answers one of the most fundamental questions of medical practice. Like two other recent large trials, it confirms that simple education by the family doctor can substantially reduce alcohol consumption in problem drinkers. It gives cause for optimism and should banish forever the attitude that "there is nothing we can offer drunks or drug addicts".
A simple questionnaire identified general practice patients who were drinking excessively. These were then randomised to receive a general health booklet or the brief intervention protocol. Two 15 minute sessions were followed up by a reinforcement telephone call from the practice nurse. These included information on the adverse effects of alcohol, drinking cues and an alcohol diary.
Follow up was done at 6 and 12 months, ultimately showing a reduction from 19 to 12 drinks weekly in the 'brief intervention' group and 19 to 16 in the controls. This was highly statistically significant. A weakness of the study was that there was no physiological corroboration such as GGT or 'reduced transferrin' estimation. A large proportion of patients, however had their self-reported consumption checked by interviews with a relative or associate. The authors chose not to expand on the intriguing ethical consequences of this practice!
Hence research has shown clearly that education works. And doctors in the course of normal medical practice are in the ideal position to do it. Most Australians attend the doctor from time to time and heavy drinkers do so more often. What we must do is to identify them and then dispel a few myths, reinforce some goals and increase their awareness of the risks of excessive drinking. As little as five minutes has been shown to work. Similar effectiveness has been shown with smoking as well as 'therapeutic compliance'.
The AA philosophy of 'all or nothing' for alcoholics may apply to some, but we now know that large numbers of problem drinkers are able to reduce their drinking without becoming abstinent. If we can encourage this in a low key manner, then there will be a reduction in long term sequelae of liver, stomach, cardiac and other complications.
