RAND Corporation, Santa Monica, CA, USA.
Addiction. 2016 Sep;111(9):1521-7. doi: 10.1111/add.13136. Epub 2015 Oct 28.
Cochrane recently published a systematic review on motivational interviewing (MI) for alcohol misuse in young adults. The review authors concluded that 'there are no substantive, meaningful benefits of MI interventions for the prevention of alcohol misuse' (p. 2), as effect sizes were 'small and unlikely to be of any meaningful benefit in practice' (p. 27). As most of these interventions were quite brief, we wish to open a dialogue about interpreting effect sizes in this review and of (brief) alcohol interventions more generally.
We analyze four methodological aspects of the review that likely influenced the author's conclusions about intervention effects: (1) risk of bias assessments, (2) search strategies, (3) assessing the quality of the body of evidence and (4) definitions of sustainability and clinical significance.
We interpret the effect sizes found in this review to indicate modest yet beneficial and potentially meaningful effects of these interventions, given their brevity and low cost. This interpretation is consistent with other reviews on brief, MI-based interventions and brief interventions more generally. We therefore encourage the field to re-open dialogue about the clinical importance of the effects of MI on alcohol misuse by young adults. Rather than dismissing interventions with small effects, we believe a more fruitful way forward for the field would be to catalogue effect sizes for various alcohol interventions. Such a catalogue would help stakeholders themselves to choose which interventions meet their minimum desired impact, and thus may be suitable given their targeted populations, setting and resources.
Cochrane 最近发表了一篇关于动机性访谈（MI）治疗青年人群酒精使用问题的系统综述。综述作者得出结论，“MI 干预措施对于预防酒精使用问题没有实质性的、有意义的益处”（第 2 页），因为效应量“很小，在实践中不太可能有任何有意义的益处”（第 27 页）。由于这些干预措施大多非常简短，我们希望就该综述中效应量的解释以及（简短的）酒精干预措施进行更广泛的讨论。
我们分析了该综述的四个可能影响作者对干预效果结论的方法学方面：（1）偏倚风险评估，（2）搜索策略，（3）评估证据质量，以及（4）可持续性和临床意义的定义。
我们对该综述中发现的效应量进行解释，表明这些干预措施具有适度但有益且可能具有重要意义的效果，考虑到它们的简短性和低成本。这种解释与其他关于简短的、基于 MI 的干预措施和更广泛的简短干预措施的综述一致。因此，我们鼓励该领域重新开放关于 MI 对青年人群酒精使用问题影响的临床重要性的对话。我们认为，对于具有小效应的干预措施，不应一概而论地否定，而应该更富有成效的方法是为各种酒精干预措施编制效应量目录。这样的目录将帮助利益相关者自己选择哪些干预措施符合他们的最小预期影响，从而根据他们的目标人群、环境和资源来选择合适的干预措施。
