Ugrás a tartalomhoz

Tényeken Alapuló Orvostudomány Módszertani Ajánlások

Nyirkos Péter dr. (2005)

Melania Kiadói Kft.

Brief interventions for heavy use of alcohol

Brief interventions for heavy use of alcohol

ebm00891

Rationale

  • It is often possible to influence the patient's drinking by guidance and advice . Brief intervention is a tool for health care personnel.

Epidemiology

  • Excessive use of alcohol for men is more than 24 drinks and for women more than 16 drinks per week.

  • 10% of the heaviest drinkers account for more than half of the total consumption of alcohol. In practice, this means 7–8 bottles of beer every day or four bottles of vodka per week.

  • 90% of heavy drinkers are men, the majority of them between 20 and 39 years of age. Up to 20% of men and 10% of women in working age are heavy drinkers.

  • The majority of heavy drinkers are employed.

  • The risk of alcohol-induced problems is high in heavy drinkers. About 20–25% of them are clearly dependent on alcohol.

Recognition of heavy drinking

  • See article on recognition of alcohol and drug abuse (Lásd: ebm00889) .

  • Heavy drinking is recognized by combining the patient history with the clinical picture and laboratory tests. Multiple choice questionnaires may also be used.

Brief intervention

  • Mini-intervention consists of questions, discussions, and guidance to urge the individual to reduce his/her alcohol consumption to a safer level.

  • Moderate alcohol consumption is often a more realistic goal than abstinence. However, abstinence is recommended during the first few weeks.

  • Mini-intervention includes 3–4 sessions at intervals of 2–4 weeks.

  • Mini-intervention is successful only if the patient admits his/her excessive use of alcohol.

  • In addition to spoken and written instructions, the outcome of laboratory tests and general physical inspection are a valuable means of influencing the patient.

  • During the sessions the following subjects may be discussed:

    • How does the patient feel about his or her drinking?

    • Analysis of the situation (amount of alcohol consumed weekly, impact on health, alcohol-related problems at home and at work, development of tolerance).

    • Results of the laboratory tests (liver enzymes, MCV, other if necessary). Emphasize that the changes are reversible.

    • The patient's consumption of alcohol compared with average consumption.

    • The patient's consumption of alcohol compared with that of his/her friends.

    • The risks of alcohol (obesity, hypertension, liver diseases, headache, hangover, insomnia, sexual dysfunction, accidents).

    • Benefits of reduced alcohol consumption (tolerance and risk of dependence decrease, safety aspects, economic benefit).

    • Written information (risks of heavy drinking, how to estimate one's own drinking, limits of safe drinking, how to reduce drinking).

    • Guidelines and limits: guidelines can be regarded as a prescription. Set clear limits with the patient: a limit of daily use and a limit of days per week and month when alcohol is consumed. The patient must not drink on consecutive days.

    • Further sessions at about two week intervals (a drinking diary if necessary, new laboratory tests). Tell the patient that drinking will be discussed again at the next meeting.

    • Motivate the patient to change his/her drinking habits.

    • Emphasize the patient's personal responsibility and encourage him with optimism.

Who benefits from brief intervention?

  • Heavy drinkers (and those approaching the limits of heavy drinking) who do not yet have severe problems caused by alcohol abuse. They may not yet have noticed their excessive use of alcohol, or looked for help to reduce their drinking.

  • The patients are identified by family doctors, in outpatient clinics and at health check-ups when the doctor pays attention to symptoms or laboratory test results that indicate alcohol abuse, and when heavy drinking is recognized as a possible cause of symptoms.

  • Carefully consider whether it is useful to start talking about alcohol abuse when the patient has come for some other reason than alcohol abuse. The motivation of the patient may be insufficient.

  • In case of emergency situations it is not very realistic to try to influence the patient's drinking habits, especially if he/she is intoxicated. It is better to offer a new appointment time. When testing a driver's blood for alcohol, inform the individual where to find professional help. Interventions for drunken drivers have been shown to be moderately effective .

  • A heavy drinker with clear dependence seldom benefits from mini-intervention. If they cannot reduce alcohol consumption during, for example, three months' intervention, they should be forwarded to a unit specializing in alcohol-related diseases.

Irodalom

  • [1]University of York. Centre for Reviews and Dissemination. Brief interventions and alcohol use. Effective Health Care 1993;1:13

  • [2]The Database of Abstracts of Reviews of Effectiveness (University of York), Database no.: DARE-950035. In: The Cochrane Library, Issue 4, 1999. Oxford: Update Software

  • [3]Kahan M, Wilson L, Becker L. Physician-based interventions with problem drinkers. Can Med Ass J 1995;152:851-859

  • [4]The Database of Abstracts of Reviews of Effectiveness (University of York), Database no.: DARE-954003. In: The Cochrane Library, Issue 4, 1999. Oxford: Update Software

  • [5]Poikolainen K. Effectiveness of brief interventions to reduce alcohol intake in primary health care populations. Preventive Medicine 1999;28:503-509

  • [6]The Database of Abstracts of Reviews of Effectiveness (University of York), Database no.: DARE-999258. In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software

  • [7]Freemantle N, Song F, Sheldon T, Long A. Brief interventions and alcohol use. York: NHS Centre for Reviews and Dissemination. NHS Centre for Reviews and Dissemination (NHSCRD). ISBN: 0965 0288. Effectiv Health Car. 1993. 13.

  • [8]The Health Technology Assessment Database, Database no.: HTA-950035. In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software

  • [9]Wells-Parker E, Bangert-Drowns R, McMillen R, Willians M. Final results from a meta-analysis of remedial interventions with drink/drive offenders. Addiction 1995;90:907-926

  • [10]The Database of Abstracts of Reviews of Effectiveness (University of York), Database no.: DARE-950357. In: The Cochrane Library, Issue 4, 1999. Oxford: Update Software