Wilk A I, Jensen N M, Havighurst T C
Department of Medicine, University of Wisconsin Medical School, Madison, USA.
J Gen Intern Med. 1997 May;12(5):274-83. doi: 10.1046/j.1525-1497.1997.012005274.x.
To assess the effectiveness of brief interventions in heavy drinkers by analyzing the outcome data and methodologic quality.
(1) Qualitative analysis of randomized control trials (RCTs) using criteria from Chalmers' scoring system; (2) calculating and combining odds ratios (ORs) of RCTs using the One-Step (Peto) and the Mantel-Haenszel methods. STUDY SELECTION AND ANALYSIS: A MEDLINE and PsycLIT search identified RCTs testing brief interventions in heavy alcohol drinkers. Brief interventions were less than 1 hour and incorporated simple motivational counseling techniques much like outpatient smoking cessation programs. By a single-reviewer, nonblinded format, eligible studies were selected for adult subjects, sample sizes greater than 30, a randomized control design, and incorporation of brief alcohol interventions. Methodologic quality was assessed using an established scoring system developed by Chalmers and colleagues. Outcome data were combined by the One-Step (Peto) method; confidence limits and chi 2 test for heterogeneity were calculated.
Twelve RCTs met all inclusion criteria, with an average quality score of 0.49 + or - 0.17. This was comparable to published average scores in other areas of research (0.42 + or - 0.16). Outcome data from RCTs were pooled, and a combined OR was close to 2 (1.91; 95% confidence interval 1.61-2.27) in favor of brief alcohol interventions over no intervention. This was consistent across gender, intensity of intervention, type of clinical setting, and higher-quality clinical trials.
Heavy drinkers who received a brief intervention were twice as likely to moderate their drinking 6 to 12 months after an intervention when compared with heavy drinkers who received no intervention. Brief intervention is a low-cost, effective preventive measure for heavy drinkers in outpatient settings.
通过分析结果数据和方法学质量，评估简短干预对重度饮酒者的有效性。
（1）使用查尔默斯评分系统的标准对随机对照试验（RCT）进行定性分析；（2）使用单步（佩托）法和曼特尔-亨塞尔法计算并合并RCT的比值比（OR）。研究选择与分析：通过医学文献数据库（MEDLINE）和心理学文摘数据库（PsycLIT）检索，确定对重度饮酒者进行简短干预测试的RCT。简短干预时长少于1小时，并采用类似于门诊戒烟项目的简单动机咨询技术。由一名单盲评审员以非盲法形式，选择符合条件的研究，研究对象为成年人，样本量大于30，采用随机对照设计，并纳入简短酒精干预措施。使用查尔默斯及其同事开发的既定评分系统评估方法学质量。结果数据采用单步（佩托）法合并；计算置信区间和异质性的卡方检验。
12项RCT符合所有纳入标准，平均质量评分为0.49±0.17。这与其他研究领域公布的平均评分（0.42±0.16）相当。汇总RCT的结果数据，合并后的OR接近2（1.91；95%置信区间1.61 - 2.27），表明简短酒精干预优于无干预。在性别、干预强度、临床环境类型以及高质量临床试验中均一致。
与未接受干预的重度饮酒者相比，接受简短干预的重度饮酒者在干预后6至12个月减少饮酒量的可能性高出两倍。简短干预是门诊环境中针对重度饮酒者的低成本、有效预防措施。
