A brief mindfulness meditation-based stress reduction intervention delivered by audiotape during ultraviolet light therapy can increase the rate of resolution of psoriatic lesions in patients with psoriasis.

Background: There is a need for primary care providers to have brief effective methods to intervene with highrisk drinkers during a regular outpatient visit.Objective: To determine whether brief physician-and nurse practitioner-delivered counseling intervention is efficacious as part of routine primary care in reducing alcohol consumption by high-risk drinkers.Methods: Academic medical center-affiliated primary care practice sites were randomized to special intervention or to usual care. From a screened population of 9772 patients seeking routine medical care with their primary care providers, 530 high-risk drinkers were entered into the study. Special intervention included training providers in a brief (5-to 10-minute) patientcentered counseling intervention, and an office support system that screened patients, cued providers to intervene, and made patient education materials available. The primary outcome measures were change in alcohol use from baseline to 6 months as measured by weekly alcohol consumption and frequency of binge drinking episodes.Results: Participants in the special intervention and usual care groups were similar on important background variables and potential confounders except that special intervention participants had significantly higher baseline levels of alcohol usage (P = .01). At 6-month follow-up, in the 91% of the cohort who provided follow-up information, alcohol consumption was significantly reduced when adjusted for age, sex, and baseline alcohol usage (special intervention, −5.8 drinks per week; usual care, −3.4 drinks per week; P = .001). Conclusions:This study provides evidence that screening and very brief (5-to 10-minute) advice and counseling delivered by a physician or nurse practitioner as part of routine primary care significantly reduces alcohol consumption by high-risk drinkers. Med. 1999;159:2198-2205 P HYSICIANS HAVE contact with at least 80% of Americans each year, including the 20% to 25% of patients who identify themselves on outpatient screening tests as drinking alcohol at high-risk levels. Arch Intern1 Thus, several million adult high-risk drinkers could be reached annually by physicians during the course of ongoing medical care. This high contact rate, coupled with even a small absolute effect on moderation or cessation of alcohol overuse, could have substantial benefits to the health of a primary care (PC) population and to the health of the public.High-risk drinking refers to a drinking pattern that has a high probability of causing harm (eg, frequent intoxication) and is an important public health problem; one in every 10 deaths in the United States is related to alcohol, and 20% of the total national hospital costs are attributed to alcohol-related illnesses.2-5 Therefore, the development of brief efficacious alcohol counseling interventions that can be used in an outpatient setting is of national importance. Previous research, carried out predominantly in Europe, has suggested that socially stable, heavily drinking patients seen in general practitioners' ...

A group training program plus brief individual feedback can significantly improve primary care providers' counseling skills, attitudes, and knowledge regarding high-risk and problem drinkers.

OBJECTIVE:To assess the use of a brief provider-delivered alcohol counseling intervention of 5 to 10 minutes with highrisk drinking patients by primary care providers trained in the counseling intervention and provided with an office support system. DESIGN:A group randomized study design was used. Office sites were randomized to either a usual care or special intervention condition, within which physicians and patients were nested. The unit of analysis was the patient. SETTING:Primary care internal medicine practices affiliated with an academic medical center. PARTICIPANTS:Twenty-nine providers were randomized by practice site to receive training and an office support system to provide an alcohol counseling special intervention or to continue to provide usual care. INTERVENTION:Special intervention providers received 2 1/2 hours of training in a brief alcohol-counseling intervention and were then supported by an office system that screened patients, cued providers to intervene, and made patient education materials available as tip sheets. MEASUREMENTS AND MAIN RESULTS:Implementation of the counseling steps was measured by patient exit interviews (PEI) immediately following the patient visit. The interval between the date of training and the date of the PEI ranged from 6 to 32 months. Special intervention providers were twice as likely as usual care providers to discuss alcohol use with their patients. They carried out every step of the counseling sequence significantly more often than did usual care providers ( p Ͻ .001). This intervention effect persisted over the 32 months of follow-up. CONCLUSIONS:Physicians and other health-care providers trained in a brief provider-delivered alcohol intervention will counsel their high-risk drinking patients when cued to do so and supported by a primary care office system.