Sylwer fod y cymhwysiad hwn dan ddatblygiad. Os ydych chi'n gweld unrhyw gamgymeriadau neu os nad yw rhywbeth yn gweithio, cysylltwch â ni yn evidence.service@wales.nhs.uk.
Adolygiad Systematig
To assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings.
We included 69 studies that randomised a total of 33,642 participants. Of these, 42 studies were added for this update (24,057 participants). Most interventions were delivered in general practice (38 studies, 55%) or emergency care (27 studies, 39%) settings. Most studies (61 studies, 88%) compared brief intervention to minimal or no intervention. Extended interventions were compared with brief (4 studies, 6%), minimal or no intervention (7 studies, 10%). Few studies targeted particular age groups: adolescents or young adults (6 studies, 9%) and older adults (4 studies, 6%). Mean baseline alcohol consumption was 244 g/week (30.5 standard UK units) among the studies that reported these data. Main sources of bias were attrition and lack of provider or participant blinding. The primary meta‐analysis included 34 studies (15,197 participants) and provided moderate‐quality evidence that participants who received brief intervention consumed less alcohol than minimal or no intervention participants after one year (mean difference (MD) ‐20 g/week, 95% confidence interval (CI) ‐28 to ‐12). There was substantial heterogeneity among studies (I² = 73%). A subgroup analysis by gender demonstrated that both men and women reduced alcohol consumption after receiving a brief intervention.
We found moderate‐quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD ‐0.08, 95% CI ‐0.14 to ‐0.02; 15 studies, 6946 participants); drinking days per week (MD ‐0.13, 95% CI ‐0.23 to ‐0.04; 11 studies, 5469 participants); or drinking intensity (‐0.2 g/drinking day, 95% CI ‐3.1 to 2.7; 10 studies, 3128 participants).
We found moderate‐quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (‐20 g/week, 95% CI ‐40 to 1; 6 studies, 1296 participants). There was little difference in binges per week (‐0.08, 95% CI ‐0.28 to 0.12; 2 studies, 456 participants; moderate‐quality evidence) or difference in days drinking per week (‐0.45, 95% CI ‐0.81 to ‐0.09; 2 studies, 319 participants; moderate‐quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI ‐26 to 9; 1 study, 158 participants; low‐quality evidence).
Extended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI ‐42 to 45; 3 studies, 552 participants; low‐quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (‐0.5, 95% CI ‐1.2 to 0.2; 147 participants; low‐quality evidence). Results from this trial also suggested very little impact on drinking intensity (‐1.7 g/drinking day, 95% CI ‐18.9 to 15.5; 147 participants; very low‐quality evidence).
Only five studies reported adverse effects (very low‐quality evidence). No participants experienced any adverse effects in two studies; one study reported that the intervention increased binge drinking for women and two studies reported adverse events related to driving outcomes but concluded they were equivalent in both study arms.
Sources of funding were reported by 67 studies (87%). With two exceptions, studies were funded by government institutes, research bodies or charitable foundations. One study was partly funded by a pharmaceutical company and a brewers association, another by a company developing diagnostic testing equipment.
We found moderate‐quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness.