Kahan M, Wilson L, Becker L
Department of Family and Community Medicine, University of Toronto, Ont.
CMAJ. 1995 Mar 15;152(6):851-9.
To review the results of randomized controlled trials on the effectiveness of brief physician interventions with problem drinkers.
The MEDLINE and EMBASE databases were searched for articles published from 1966 and 1972 respectively, with the terms "problem/controlled/responsible/moderate/risk/drink"; "advice/drink"; "physician, nurse, general practitioner"; and "random." Forty-three articles were identified in the EMBASE search and 112 articles in the MEDLINE search.
All trials examining the effectiveness of interventions by physicians in reducing alcohol consumption among problem drinkers attending a health-care facility were reviewed. Trials involving subjects attending an alcohol treatment clinic and those involving interventions delivered solely by nonphysicians were excluded. Eleven trials met the final selection criteria.
For each article, two of the authors independently assigned a score from 0 to 2 on a number of criteria for validity and generalizability.
The four trials with the highest validity scores showed that men in the intervention groups reduced their weekly alcohol consumption by five to seven standard drinks more than the men in the control groups. Results for women were inconsistent. No convincing evidence of declines in alcohol-related morbidity among men or women was found.
The trials support the use of brief interventions by physicians for patients with drinking problems. Although further studies are needed to determine their effect on morbidity and mortality, the public health impact of such interventions is potentially enormous. Further research is needed to determine which patients are best suited for brief interventions, the optimal intensity of treatment and which components of brief interventions are most effective. Research is also needed to establish which strategies are effective in inducing physicians to use brief interventions.
回顾关于医生对问题饮酒者进行简短干预有效性的随机对照试验结果。
分别检索MEDLINE和EMBASE数据库中1966年和1972年以来发表的文章，检索词为“问题/受控/负责/适度/风险/饮酒”；“建议/饮酒”；“医生、护士、全科医生”；以及“随机”。在EMBASE检索中识别出43篇文章，在MEDLINE检索中识别出112篇文章。
对所有检验医生干预措施在降低前往医疗机构就诊的问题饮酒者酒精消费量方面有效性的试验进行回顾。排除涉及酒精治疗诊所受试者的试验以及仅由非医生实施干预措施的试验。11项试验符合最终选择标准。
对于每篇文章，两位作者根据有效性和普遍性的若干标准独立给出0至2分。
有效性得分最高的四项试验表明，干预组男性每周的酒精消费量比对照组男性减少了五至七个标准饮酒单位。女性的结果不一致。未发现男性或女性与酒精相关的发病率下降的令人信服的证据。
这些试验支持医生对有饮酒问题的患者使用简短干预措施。尽管需要进一步研究来确定其对发病率和死亡率的影响，但此类干预措施对公共卫生的影响可能是巨大的。需要进一步研究以确定哪些患者最适合简短干预措施、最佳治疗强度以及简短干预措施的哪些组成部分最有效。还需要进行研究以确定哪些策略能有效促使医生使用简短干预措施。
