Stepped Interventions for Problem Drinkers
Condition: Alcohol-Related Disorders; Alcohol Drinking
MeSH terms: Alcohol-Related Disorders; Alcohol Drinking
Study type: Interventional

Summary: 
      In a randomized controlled trial, patients recruited in general practices and fulfilling
      criteria for alcohol dependence, alcohol abuse, at-risk drinking or binge drinking will be
      allocated to three conditions: (1) Stepped Care intervention (SC): up to 4 interventions
      depending on the success of the previous intervention (assessed by alcohol consumption and
      self-efficacy) which start with a minimal intervention (written feedback and manuals) and are
      followed by more intensive interventions (counseling) in case of no success, (2) Fixed Care
      intervention (FC): A fixed number of counseling sessions plus written feedback and manuals,
      and (3) a control group (CG) booklet on health behavior. Outcome assessment will be conducted
      in all three groups after 12 months. The hypothesis is that SC and FC do not differ in
      effectiveness but SC is more economic.
    

Detailed description: 
      Background: A promising approach in secondary prevention of problem drinking is providing
      brief interventions in medical settings. In Germany, 80.0 % of alcohol dependent individuals
      have at least one contact per year to a general practitioner, and prevalence rates in general
      practices are high. Randomized controlled trials have shown that general practitioner
      interventions significantly reduce alcohol consumption. However, a current meta-analysis
      revealed that very brief interventions (5 - 20 minutes) showed no significant effect and
      extended brief interventions (several visits) showed homogeneous effectiveness only among
      women. On the other hand, resources are scarce and insufficient time is one main reason for
      general practitioners not to intervene. A stepped-care approach (starting with a very brief
      intervention and intensifying efforts in case of no success) could save resources and enlarge
      effectiveness; however research is lacking. Objectives: Comparing conventional brief
      interventions for patients with at-risk drinking, alcohol abuse or alcohol dependence in
      general practice with a stepped-care approach in a randomized controlled trial. Methods:
      About 7,500 screenings among consecutive general practice patients aged 18 to 64 will be
      conducted. Subjects fulfilling inclusion criteria (severe alcohol dependence excluded) will
      be randomly assigned to one of three conditions with 150 patients each: (1) Stepped Care
      intervention (SC): up to 4 interventions depending on the success of the previous
      intervention (assessed by alcohol consumption and self-efficacy) which start with a minimal
      intervention (written feedback and manuals) and are followed by more intensive interventions
      (counseling) in case of no success, (2) Fixed Care intervention (FC): A fixed number of
      counseling sessions plus written feedback and manuals, and (3) a control group (CG) booklet
      on health behavior. Outcome assessment will be conducted in all three groups after 12 months.
      Counseling will be based on Motivational Interviewing and provided by research staff. Outcome
      variables are alcohol consumption, amount of time and costs required for successful
      intervention. Expected impact: Findings are expected to provide evidence for a stepped-care
      approach to be used in primary care. This would be the first international result confirming
      such an approach in the alcohol field. If a stepped-care approach would work this could
      significantly save resources and enhance secondary prevention. Therefore, data is of great
      public health interest. Relationship to the objective of the collaboration: As in the other
      studies, empirical data on new proactive approaches to reach underserved populations in the
      addiction field will be provided. The project will add knowledge on the economical use of
      interventions
    

Intervention name(s): Brief intervention
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single
Primary purpose: Treatment
Keywords: Brief intervention; Motivational Interviewing; Primary care; Stepped-care