Mechanisms of Action of Brief Alcohol Interventions Remain Largely Unknown – A Narrative Review

Abstract

A growing body of evidence has shown the efficacy of brief intervention (BI) for hazardous and harmful alcohol use in primary health care settings. Evidence for efficacy in other settings and effectiveness when implemented at larger scale are disappointing. Indeed, BI comprises varying content; exploring BI content and mechanisms of action may be a promising way to enhance efficacy and effectiveness. Medline and PsychInfo, as well as references of retrieved publications were searched for original research or review on active ingredients (components or mechanisms) of face-to-face BIs [and its subtypes, including brief advice and brief motivational interviewing (BMI)] for alcohol. Overall, BI active ingredients have been scarcely investigated, almost only within BMI, and mostly among patients in the emergency room, young adults, and US college students. This body of research has shown that personalized feedback may be an effective component; specific MI techniques showed mixed findings; decisional balance findings tended to suggest a potential detrimental effect; while change plan exercises, advice to reduce or stop drinking, presenting alternative change options, and moderation strategies are promising but need further study. Client change talk is a potential mediator of BMI effects; change in norm perceptions and enhanced discrepancy between current behavior and broader life goals and values have received preliminary support; readiness to change was only partially supported as a mediator; while enhanced awareness of drinking, perceived risks/benefits of alcohol use, alcohol treatment seeking, and self-efficacy were seldom studied and have as yet found no significant support as such. Research is obviously limited and has provided no clear and consistent evidence on the mechanisms of alcohol BI. How BI achieves the effects seen in randomized trials remains mostly unknown and should be investigated to inform the development of more effective interventions.

Rethinking brief interventions for alcohol in general practice

“…21 Studies in other settings show that the mechanisms of effect are complex, with challenging implications for design of interventions. 22 Brief interventions, however, should not be expected to exert any more than short term effects, 23 although these are likely to be highly cost effective if effectiveness can be reliably ascertained. 24 Almost all identified effects are on self reported alcohol consumption 25 ; effects on other outcomes (eg, injuries, liver disease, or use of acute healthcare) are neither consistent nor convincing.…”

A text message program as a booster to in-person brief interventions for mandated college students to prevent weekend binge drinking

“…We also hypothesized that reports of weekend binge drinking would decrease over the 6 weeks of program exposure. Because change plans are key components of motivational interviewing 19 and have been shown in prior research to be active ingredients of brief interventions 20 , we hypothesized that committing to a pre-weekend drinking-limit goal would be associated with lower maximum drinks and lower odds of any binge drinking episode over that weekend. By using text responses for dependent and independent variables, we were able to reduce the biases associated with retrospective recall and uniquely examine associations between goals and alcohol consumption independent of time.…”

Factors Influencing the Implementation of Screening and Brief Interventions for Alcohol Use in Primary Care Practices: A Systematic Review Protocol

“…14,15 Furthermore, the active ingredients of SBI have yet to be determined. 16,17 Notwithstanding these discussions, it is clear that alcohol increases the risk of and/ or exacerbates many conditions that present in primary care. 3,18 Furthermore, of the many patients visiting primary care who are at-risk drinkers, [19][20][21] few currently receive any alcohol-related advice or intervention from their doctor.…”