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Brief Patient-Centered Clinician-Delivered Counseling for High-Risk Drinking: 4-Year Results

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Annals of Behavioral Medicine



The purpose of this study is to determine the effect at 48 months of a screening and brief patient-centered physician- and nurse practitioner-delivered intervention implemented during a routine primary care visit on the reduction of alcohol consumption by high-risk drinkers.


Participants seen in primary care practices previously randomized to special intervention (SI) or usual care (UC) were reconsented for long-term follow-up. From the initial cohort, 63% reconsented to participate and provided follow-up at 48 months between November 1996 and March 2002. The data for this paper were analyzed in June 2004.


At 48 months, SI participants maintained significant reductions in drinks per week seen at 6 and 12 months. However, there were no longer significant differences in drinks per week, binges per month, percentage of low-risk drinking, relapse rates, and new quits between the SI and UC groups at 48 months that had been seen at earlier follow-up. There was a significant effect of prior low-risk drinking status at 12 months; those who were low-risk drinkers at 12 months were more likely to stay low-risk drinkers at 48 months regardless of treatment group.


With a single brief intervention, SI participants had significantly greater reductions in their drinking levels at 6 and 12 months compared to UC participants and maintained the lower-risk levels at 48 months resulting in a reduction in health risk exposure time. However, the significant group differences in treatment effect seen in earlier follow-ups were not maintained.

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  1. Institute of Medicine. Broadening the Base of Treatment for Alcohol Problems. Washington, DC: National Academies; 1990.

    Google Scholar 

  2. National Institute on Alcohol Abuse and Alcoholism. The physician’s guide to helping patients with alcohol problems: USDHHS, PHS, NIH; 1995. Report No.: NIH Publication No. 95-3769.

  3. Department of Health and Human Services. The tenth special report to the U.S. congress on alcohol and health from the secretary of health and human services. Washington, DC: National Institutes of Health; 2000. Report No.: 00-1583.

  4. Whitlock EP, Polen MR, Green CA, Orleans T, Klein J. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004; 140: 557-568.

    PubMed  Google Scholar 

  5. Fleming M, Mundt M, French M, Manwell L, Stauffacher E, Barry K. Brief physician advice for problem drinkers: Long-term efficacy and benefit-cost analysis. Alcohol Clin Exp Res. 2002; 26: 36-43.

    PubMed  Google Scholar 

  6. Wutzke S, Conigrave K, Saunders J, Hall W. The long-term effectiveness of brief interventions for unsafe alcohol consumption: A 10-year follow-up. Addiction. 2002; 97: 665-675.

    Article  PubMed  Google Scholar 

  7. Ockene J, Adams A, Hurley T, Wheeler E, Hebert J. Brief physician- and nurse practitioner-delivered counseling for high-risk drinkers: Does it work? Arch Intern Med. 1999; 159: 2198-2205.

    Article  PubMed  CAS  Google Scholar 

  8. Reiff-Hekking S, Ockene J, Hurley T, Reed G. Brief physician and nurse practitioner-delivered counseling for high-risk drinking: Results at 12 month follow-up. J Gen Intern Med. 2005; 20: 7-13.

    Article  PubMed  Google Scholar 

  9. Ockene J, Kristeller J, Goldberg R, et al. Increasing the efficacy of physician-delivered smoking interventions: A randomized clinical trial. J Gen Intern Med. 1991; 6: 1-8.

    Article  PubMed  CAS  Google Scholar 

  10. Fleming M, Barry K. A three sample test of a masked screening questionnaire. Alcohol Alcohol. 1991; 26: 81-91.

    PubMed  CAS  Google Scholar 

  11. Sobell L, Sobell M. Self-report issues in alcohol abuse. Behav Assess. 1990; 12: 77-90.

    Google Scholar 

  12. Littell R, Milliken G, Stroup W, Wolfinger R. SAS System for Mixed Models. Cary, NC: SAS Institute; 1996.

    Google Scholar 

  13. SAS Institute Inc. SAS/STAT Software. In 8.2 ed. Cary, NC.

  14. Shao J, Zhong B. Last observation carry-forward and last observation analysis. Stat Med. 2003; 22: 2429-2441.

    Article  PubMed  Google Scholar 

  15. Ware JH. Interpreting incomplete data in studies of diet and weight loss. N Engl J Med. 2003; 348(21): 2136-2137. May 22.

    Article  PubMed  Google Scholar 

  16. Verbeke G, Molenberghs G. Chapter 15: Joint Modeling of Measurements and Missingness. Linear Mixed Models for Longitudinal Data. New York, NY: Springer; 2000.

    Google Scholar 

  17. Fleming MF. Brief interventions and the treatment of alcohol use disorders: Current evidence. Recent Dev Alcohol. 2003; 16: 375-390.

    Article  PubMed  Google Scholar 

  18. Timko C, Debenedetti A, Moos BS, Moos RH. Predictors of 16-year mortality among individuals initiating help-seeking for an alcoholic use disorder. Alcohol Clin Exp Res. 2006; 30(10): 1711-1720.

    Article  PubMed  Google Scholar 

  19. Barclay L. Medicaid will reimburse for alcohol, drug screening and brief intervention. Medscape Medical News. 2006;September.

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This project was supported by grant 5-RO1-AA09153 from the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIAAA.

Conflict of Interest Statement

The authors certify that all financial and material support for this research and work are clearly identified in the manuscript. They have not been engaged in any financial or personal conflicts of interest as a result of the research described in this manuscript. The authors had full access to all of the study data and accept full responsibility for the integrity of the data and the accuracy of the data analysis. As noted in the acknowledgements, the research described in this manuscript was supported by grant 5-RO1-AA09153 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institutes of Health, Bethesda, MD. NIAAA was not involved in the study design, collection, analysis, or interpretation of this data.

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Correspondence to Judith K. Ockene Ph.D., M.Ed..

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Ockene, J.K., Reed, G.W. & Reiff-Hekking, S. Brief Patient-Centered Clinician-Delivered Counseling for High-Risk Drinking: 4-Year Results. ann. behav. med. 37, 335–342 (2009).

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