U.S. Department of Health 

National Institutes of Health

and Alcoholism

Number 66 

& Human Services

National Institute on Alcohol Abuse 

July 2005

BRIEF INTERVENTIONS

Unlike traditional alcoholism treatment, which focuses

on helping people who are dependent on alcohol, brief

interventions—or short, one­on­one counseling sessions—

are ideally suited for people who drink in ways that are

harmful or abusive. Unlike traditional alcoholism treatment, which lasts many weeks or months, brief interventions can be given in a matter of minutes, and they

require minimal followup. 

The goals of brief interventions differ from formal alcoholism treatment. Brief interventions generally aim to

moderate a person’s alcohol consumption to sensible

levels and to eliminate harmful drinking practices (such

as binge drinking1

), rather than to insist on complete

abstinence from drinking—although abstinence may be

encouraged, if appropriate (1). Reducing levels of drinking

or changing patterns of harmful alcohol use helps to reduce

the negative outcomes of drinking, such as alcohol­related

medical problems, injuries, domestic violence, motor

vehicle crashes, arrests, or damage to a developing fetus.

Exactly what constitutes a “brief intervention” remains

a source of debate (2). Brief interventions typically consist

of one to four short counseling sessions with a trained

interventionist (e.g., physician, psychologist, social worker).

Moyer and colleagues (2) looked at 34 different studies

and found that people who received brief interventions

when they were being treated for other conditions consistently showed greater reductions in alcohol use than

comparable groups who did not receive an intervention.

1 A “binge” is a pattern of drinking alcohol that brings blood alcohol concentration

(BAC) to 0.08 gram percent or above. For a typical adult this pattern corresponds

with consuming five or more drinks (male), or four or more drinks (female) in

about 2 hours.

People seeking treatment specifically for alcohol abuse

appeared to reduce their alcohol use about the same

amount, whether they received brief interventions or

extended treatments (five or more sessions). These findings

show that brief interventions can be an effective way to

reduce drinking, especially among people who do not have

severe drinking problems requiring more intensive treatment.

The appropriate intervention depends on the patient—

that is, on the severity of his or her problems with alcohol

and whether he or she uses tobacco or other drugs, or

has a co­occurring medical or psychiatric problem. The

choice of intervention also is based on the clinical setting,

the clinician’s skills and interest, and time constraints. 

A brief intervention usually includes personalized feedback

and counseling based on the patient’s risk for harmful

drinking. Often, simply providing this feedback is enough

to encourage those at risk to reduce their alcohol intake (1).

Brief interventions may include approaches—such as

motivational interviewing—that are designed to persuade

“Brief interventions are ideally suited for 

people who drink in ways that are harmful 

or abusive.

”

people who are

resistant to moderating their alcohol intake or who

do not believe

they are drinking

in a harmful or

hazardous way. 
Motivational interviewing (3) encourages patients to

decide to change for themselves by using empathy and

warmth rather than confrontation. Clinicians also can

assist patients by helping them establish specific goals

and build skills for modifying their drinking behavior.

Screening: The First Step

People who would benefit from brief interventions may

be identified through routine medical screenings, such

as during a visit to a primary care physician. Standardized

screening instruments exist that are specifically designed

to identify alcohol use disorders. Though not as common,

a person also might be identified during a hospital stay

when lab tests reveal he or she has an alcohol­related

health problem (such as liver disease). Screening might

take place after an arrest for driving under the influence

or during a visit to an emergency department (ED) as

a result of alcohol­related injuries. Or screening might

identify a woman who could benefit from a brief intervention during a prenatal visit to her obstetrician. All

of these settings represent opportunities for clinicians

and others who offer brief interventions to work with

people who may be particularly receptive to advice to alter

their drinking. (For specific information on screening

in a variety of settings, see Alcohol Alert, Number 65,

“Screening for Alcohol Problems.”)

Administering the

Intervention

Seeking treatment for problems with alcohol can be

potentially embarrassing, stigmatizing, and inconvenient,

taking time away from work or family responsibilities.

Brief interventions give patients a simple way to receive

care in a comfortable and familiar setting. Because they

are brief, they can be easily incorporated into a variety

of medical practices. Moreover, these approaches offer

a lower cost alternative to more formal, specialist­led,

alcoholism treatment (1).

Typically a nonspecialist authority figure who the patient

may already trust or feel comfortable being treated by—

such as a physician, a nurse, or physician’s assistant in

a primary care setting, or nurse or physician’s assistant

on a medical unit—delivers the brief intervention (1). 

Supplemental handouts may be provided to patients

during the intervention, including pamphlets, manuals,

or workbooks to reinforce the strategies offered during

the session. Clinicians also can follow up at a later date,

either in person or through the mail, to provide additional assessment and further motivate the patient to

achieve the goals set during the initial meeting. If the

brief intervention does not motivate the patient to reduce

alcohol consumption, clinicians can recommend more

intensive treatment. 

Many of the challenges involved in administering brief

interventions—such as finding the time to administer

them in busy doctors’ offices, obtaining the extra training

that helps staff become comfortable providing interventions, and managing the cost of using interventions—

may be overcome through the use of technology.

Patients may be encouraged to use computer programs

in the doctor’s waiting room or at home, or to access

the intervention through the Internet, which offers

privacy and the ability to complete the program at any

time of day (4,5).

i le

An Update—New Clinician’s Guide

In 2005, NIAAA released Helping Patients Who

Drink Too Much: A Clinician’s Guide, featuring new

guidelines on screening and brief intervention 

for primary care and mental health practitioners.

It offers a simple screening method—a s ng

question about heavy drinking days—and includes

the AUDIT screening tool, both in English and Spanish,

as a self­report option.To order, see page 8.

Another potential tool for administering interventions

is “video doctor technology,” in which an actor–doctor

asks health questions in an interactive computer program.

Pilot results of this program indicate that although

users reported they would be most comfortable consulting with a doctor in person, they responded positively to

the “virtual” doctor intervention, which was accessible

even to those with little computer experience (6).

Putting Research Into

Practice

Research shows that brief interventions can decrease

alcohol consumption, and they work in a variety of

populations—younger and older adults, men and women

that involve

“Brief interventions give patients a simple way to  repeated contact

(7). Interventions

generally are receive care in a comfortable, familiar setting. more effective

”

2
than single­contact interventions (7). A review of studies

reported that intervention participants reduced their

alcohol consumption an average of 13 percent to 34

percent compared with a control group (8). In addition, a recent analysis concluded that brief interventions

may reduce mortality rates among problem drinkers by

an estimated 23 to 26 percent (9).

The following sections examine the use of brief interventions in a variety of settings. Although the basic

interventions may be similar, there are specific things to

keep in mind when tailoring interventions to specific

audiences and settings.

Primary Care Settings—In one study, about 20 percent

of primary care patients reported levels of consumption

that exceeded the limits recommended by the National

Institute on Alcohol Abuse and Alcoholism (10). Simple

interventions offer clinicians an ideal strategy for getting

these patients the help they need. 

Brief intervention in primary care can be simple and

short—ranging from only a few questions (with appropriate responses)—or more extensive, including referral

to a substance abuse specialist (11,12). Clinicians with

limited time may want to use a basic intervention for

all patients who use alcohol above the recommended

limits; patients who do not respond to the basic intervention can be referred to an alcohol treatment specialist at the followup visit.

The most basic level of brief intervention consists of a

simple statement or two. The clinician states that he or

she is concerned about the patient’s drinking, that it

exceeds recommended limits and could lead to alcoholrelated problems, and the clinician advises the patient

to cut down or stop drinking. 

Another brief intervention, which was studied extensively

in Project TrEAT (Trial for Early Alcohol Treatment, a

large­scale clinical trial conducted in primary care practices), involves two brief face­to­face sessions scheduled

1 month apart, with a followup telephone call 2 weeks

after each session. Patients participating in this intervention

reported reduced alcohol use, fewer days of hospitalization, and fewer emergency department visits compared

with control­group patients. This intervention may be

especially useful with patients who are experiencing

alcohol­related problems but who do not necessarily need

to be referred to an addiction treatment specialist and

may not need to stop drinking completely. This intervention was found to be effective up to 4 years later (13).

Patients who have clear symptoms of alcohol abuse or

dependence also may benefit from brief interventions

in the primary care setting. Referral to a specialist for

alcoholism treatment is a key component of this type

of intervention. These interventions typically are more

intense; the goal is abstinence from alcohol, not merely

cutting down on drinking (11). 

Despite evidence that brief interventions are useful in

primary care settings, these short counseling sessions

are not routine practice. One survey of primary care

physicians found that although most (88 percent) reported

asking their patients about alcohol use, only 13 percent

used standard screening instruments (14). A survey of

primary care patients revealed that more than 50 percent

said their primary care physician did nothing about

their substance abuse; 43 percent said their physician

never diagnosed their condition (15).

A number of strategies have been suggested to help

physicians make use of screening and brief interventions

in their practices, including using group education

strategies to hone clinicians’ skills with role­playing and

other counseling tactics (16); providing performance

feedback (17); offering training to all clinic members

(18,19); providing financial incentives to staff (20); and

offering training using credible experts (21). 

drinks*

l

NIH

Pub. No. 05–3769. Bethesda, MD: the Institute, 2005.

*

one 5­ounce glass of wine, or 1.5 ounces of distilled spirits.

▲

How Much Is Too Much

Men may be at risk for alcohol­related problems 

if their alcohol consumption exceeds 14 standard

per week or 4 drinks per day, and women

may be at risk if they have more than 7 standard

drinks per week or 3 drinks per day.

SOURCE: National Institute on Alcohol Abuse and A coholism.

Helping Patients Who Drink Too Much: A Clinician’s Guide.

A standard drink is defined as one 12­ounce bottle of beer, 

The Emergency Department—Up to 31 percent of all

patients who are treated in an ED and as many as 50

percent of severely injured trauma patients (i.e., patients

who require hospital admission, usually to an intensive

care unit) test positive when screened for alcohol 

problems (22). 

Younger people, in particular, are more likely to seek

treatment in an ED. These patients tend to be uninsured

and to use the ED as their primary source of medical

care (23).2 Young adults also have the highest prevalence

of binge or hazardous drinking in the United States

(24), putting them at particular risk for alcohol­related

injuries, often in conjunction with driving. According

to the 2001 National Household Survey on Drug

2 The terms “older” and “younger” are defined differently among various studies.

Most commonly, “younger people” are defined as those age 25 and younger.

3
Abuse (25), 3 million people ages 16 to 20 had driven

under the influence of alcohol at least once in the previous year, including 600,000 16­ and 17­year­olds.

Motor vehicle crashes are the number one cause of death

for people ages 1 to 35 (26). 

Chafetz and colleagues (27) were the first to report on

the use of brief interventions in the ED, demonstrating

that the interventions could motivate alcohol­dependent

patients to begin alcoholism treatment. In a recent

survey (28), ED practitioners reported that they considered performing a brief intervention for harmful

and hazardous drinkers feasible and acceptable in their

everyday practice. Other investigators have demonstrated

that ED residents who receive training in screening

and brief intervention in a skills­based workshop increase

their knowledge and practice of these procedures.

Fifty­eight percent of medical records of patients treated

by trained residents contained evidence of screening

and intervention, compared with 17 percent of records

of patients treated by a control group of similar residents who did not receive training (29). 

Many clinicians consider situations in which a patient

receives acute medical care for an alcohol­related injury

to be “teachable moments”—situations in which the

patient may be particularly open to an alcohol intervention. Brief interventions delivered while patients

are receiving trauma care may reduce those patients’ 

alcohol consumption and risk of subsequent alcoholrelated injuries.

In a study by Longabaugh and colleagues (30), patients

receiving emergency care who screened positive for

harmful drinking were given a brief intervention, a

brief intervention plus a booster session 7 to 10 days

later, or standard ED care. The booster session was

designed to help overcome time limitations and distractions, such as pain, treatment for injuries, waiting

family members, or the influence of alcohol, all of

which could affect the patients’ ability to benefit from

the intervention. 

One year later, patients who received the booster session

along with the brief intervention, but not the brief

intervention alone, had fewer alcohol­related problems

and alcohol­related injuries compared with patients

who received standard ED care. The booster sessions

particularly may be useful for ED patients, as people

being treated in EDs tend to leave quickly after they

are treated for their injuries. 

Patients who are admitted to medical wards for longer

term care may have an even better outcome from brief

interventions and, because they already are admitted to

the hospital, they do not need to return for additional

booster sessions (1).

Lack of time has been cited as the main obstacle to

screening and intervention in the ED. As a result, a brief

intervention that can be performed in less than 10

minutes has been developed specifically for emergency

practitioners (31). 

Innovative methods for screening and intervention are

being developed for use in the ED, including the use

of computer­based approaches (32). These interventions are intended to help physicians use the patients’

waiting time for health promotion and to target

patients at risk for various health problems.

Prenatal Care Settings—Approximately 14 to 22.5

percent of women report drinking some alcohol during

pregnancy (33), and an estimated 1 percent of all newborns experience some prenatal alcohol­related damage

(34). Routine screening in obstetrical offices may

prove to be vital in preventing drinking during pregnancy—the leading cause of preventable birth defects. 

Brief interventions have been recommended as the first

step in approaching people with mild­to­moderate

alcohol problems.

Because pregnant

women generally

“Lack of time has been cited as the main obstacle are motivated to

change their

behaviors and

only infrequently to screening and intervention.”

4
have severe alcohol problems (35), they may be especially receptive to brief interventions. In addition, studies

show that the people who change their drinking behavior

do so within 6 months of receiving the brief intervention (2,36). Because most pregnant women seek prenatal

care during their first trimester, this is an opportune

time to help them to make the changes necessary for a

healthy pregnancy.

Research also shows that these interventions are effective.

In a recent study, 304 pregnant women were assigned

to receive an intervention or to be in a control group.

Some of these women tested positive for prenatal alcohol

use, whereas others were selected randomly to participate

in the study. A unique twist to this investigation was

that women received the intervention along with their

partners (usually their husbands or the fathers of their

unborn children). Results indicated that the women with

the highest levels of drinking had the greatest reductions

in drinking when they received the brief intervention.

The effects of the brief intervention were much greater

when a partner participated (37).

An innovative approach in the prenatal setting, the

Protecting the Next Pregnancy Project involves intervening with women who have been identified as drinking

during their last pregnancy. The goal of this approach

is to reduce alcohol use during the women’s future

pregnancies. Following the intervention, these women

not only drank significantly less than those in a control

group during their later pregnancies, they also had

fewer low­birth­weight babies and fewer premature

deliveries (35,38). Moreover, children born to women

in the brief intervention group had better neurobehavioral performance at 13 months when compared with

control group children (39).

The Criminal Justice System—Alcohol use is closely

linked to crime. According to the 2002 National Crime

Victimization Survey, 21.6 percent of victims of violent

crimes thought or knew the offender had consumed

alcohol (40). Approximately 40 percent of offenders on

probation reported that they had been using alcohol at

the time of their offense (41). In 2001, 1.4 million

driving­while­impaired (DWI3

) arrests were made, making this the number one crime related to alcohol and

other drug (AOD) use other than drug possession (42).

Few studies have evaluated the impact of brief interventions in criminal justice populations. Davis and colleagues

(43) examined whether brief motivational feedback

helped to increase offenders’ participation in treatment

after they completed their jail sentences. They found

3 “DWI,” or driving while impaired, is used generically to refer to the impaired

driving offense and includes impairment by alcohol and/or other drugs.

that offenders receiving feedback were more likely to

schedule and keep appointments for followup treatment

than were offenders in a control group. However, a study

of DWI offenders found that brief individual interventions reduced recidivism only among offenders who

showed evidence of depression, but not among offenders

who were not depressed (44). This study suggests that

brief interventions may be particularly useful in certain

subgroups of DWI offenders. More research is needed

to evaluate the effectiveness of brief interventions within

the criminal justice system, especially considering the large

number of people arrested each year for AOD­related

offenses and the high recidivism rates among them.

College Settings—Alcohol use and the resulting problems

among young adults have been widely documented

(45,46). Of particular concern is the pattern of alcohol

use among college students; in one survey, approximately

39 to 44 percent of students reported binge drinking

within the previous 2 weeks (47,48). 

Larimer and Cronce (49) reviewed individual intervention efforts among college students between 1984 and

1999 and found strong evidence to support the use of

brief motivational interventions. These interventions

are especially useful in college settings because they

often focus on moderating a person’s alcohol consumption to sensible levels and eliminating harmful drinking

practices (such as binge drinking). Brief interventions

may be used in campus health centers, counseling centers,

or local hospital emergency rooms. Incorporating these

interventions into campus judicial systems has several

advantages: Many campuses already have policies in

place that require students cited for alcohol policy 

violations to complete an assessment and intervention

(50), and trained staff usually are available to respond

to policy violators.

Two key questions to consider when implementing

brief interventions in college populations are: Who

5
should deliver the interventions—peer or professional

counselors? And how can students be encouraged to

participate in the interventions?

Peer counseling has a long history on college campuses

and generally has been found to be effective for solving

both academic and health problems (51). Although

few studies have looked at the effectiveness of brief

interventions for alcohol problems, research indicates

that trained peer counselors (i.e., college undergraduates)

are as effective as professionals in encouraging drinking

changes among college students (52–54). A disadvantage

is that peer providers require considerable training and

supervision; most research protocols recommend weekly

individual or group supervision by a trained therapist.  

Studies have found that students who most need alcoholrelated interventions may be least likely to participate

in these sessions (55). So motivating students to receive

brief interventions, especially interventions delivered

outside the health center and mandated contexts, is key

to reducing alcohol consumption on campus. One

solution may be to treat students as consumers of brief

intervention services and then to market the intervention “product” accordingly. Larimer and Cronce (49)

reviewed research suggesting that social marketing

techniques may improve recruitment of students to

alcoholism prevention and intervention services. Calling

students when they miss appointments and using

other program reminders may increase participation

by heavier drinkers (56). 

Support also is emerging for the use of mailed or computerized feedback in place of personalized, individual

feedback. Such approaches have been successful in

producing at least short­term reductions in students’

alcohol consumption (57).

Another approach to implementing brief interventions

is to use different levels or steps of care (58), perhaps

starting with assessing and providing feedback through

the Internet (59), then moving to in­person interventions for those students who have more severe alcoholrelated problems or those who do not respond to the

initial intervention. 

Conclusion

Brief interventions can be useful in a variety of settings

and are potentially cost­effective in reducing hazardous

or harmful alcohol consumption. Medical settings such

as emergency departments or trauma centers also may

provide opportunities, or “teachable moments,” when

people may be open to making changes in their alcohol

consumption. New technology, such as computerized

interventions, may offer an effective means for implementing brief interventions, especially in settings in

which time constraints or lack of resources or training

in intervention techniques are issues. 

Research is yielding new information on the efficacy

of various brief interventions at a rapid pace; practitioners, clinicians, college administrators, and others

responsible for initiating screening and brief interventions should consider this new scientific evidence when

deciding which strategies best fit their situations.

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Alcohol Research & Health

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Resour ces

Source material for this Alcohol Alert originally appeared in 

,Volume 28, Numbers 1 and 2, 2004/2005.

For more information on providing brief interventions for 

alcohol problems, see also:

Assessing Alcohol Problems: A Guide for Clinicians and 

Researchers. Second Edition, Revised 2003. NIH Publication 

No. 03–3745. Describes a range of screening instruments,

including their target audiences, reliability, clinical 

utility, and research applications.

Helping Patients Who Drink Too Much:A Clinician’s 

Guide. 2005 Edition. NIH Publication No. 05–3769.

Provides useful materials for screening, assessing,

and administering brief interventions. Includes 

medication information and handy pocket guide.

For these and other resources, visit 

NIAAA’s Web site, www.niaaa.nih.gov

Full text of this publication is available on NIAAA’s World Wide Web site at http://www.niaaa.nih.gov

All material contained in the Alcohol Alert is in the public domain and may be used or reproduced

without permission from NIAAA. Citation of the source is appreciated.

Copies of the Alcohol Alert are available free of charge from the National Institute on Alcohol Abuse and Alcoholism

Publications Distribution Center, P.O. Box 10686, Rockville, MD 20849–0686.

U.S. DEPARTMENT OF 

PRSRT STD

HEALTH AND HUMAN SERVICES POSTAGE AND FEES PAID

NIH/NIAAA NIAAA Publications Distribution Center PERMIT NO. G­824

Attn.: Alcohol Alert

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