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Secondary prevention of hazardous alcohol consumption in psychiatric out-patients: a randomised controlled study

Though the featured study seems the first with this precise combination of interventions and patients, similar studies have been done. Rather than psychiatric unit patients, some studies have concerned general medical patients with mental health problems, others patients with mental problems recruited in other settings. As in the featured study, generally patients were non-psychotic, not severely mentally ill. Generally too, offering them a brief motivational intervention focused on drinking helped them cut back more than usual medical or mental health care. Reviewers for the Cochrane collaboration have come to a similar conclusion. One study did also suggest that at the severer end both depression and of drinking, yet more patients would make substantial drinking cutbacks if brief interventions were followed by more extended therapy. Details below.

In Australia general hospital inpatients who drank to hazardous levels and also suffered generally non-severe psychiatric disorders cut their drinking more when offered a face-to-face brief intervention based on motivational interviewing than one which simply involved recommending safer alcohol consumption. These results six months following the interventions were not reflected in health and mental health records at five years, when it seemed that both interventions had been equally effective compared to a matched no-intervention group.

In Germany general practice outpatients with drinking problems were allocated to a series (in one group the series was completed only if necessary) of brief advice sessions delivered by telephone and based on motivational interviewing principles, while others (the control A group of people, households, organisations, communities or other units who do not participate in the intervention(s) being evaluated. Instead, they receive no intervention or none relevant to the outcomes being assessed, carry on as usual, or receive an alternative intervention (for the latter the term comparison group may be preferable). Outcome measures taken from the controls form the benchmark against which changes in the intervention group(s) are compared to determine whether the intervention had an impact and whether this is statistically significant. Comparability between control and intervention groups is essential. Normally this is best achieved by randomly allocating research participants to the different groups. Alternatives include sequentially selecting participants for one then the other group(s), or deliberately selecting similar set of participants for each group. group) were simply sent a health promotion booklet not specifically about alcohol. Though 12 months later brief advice had curbed drinking among the general run of patients, this was not the case to a statistically significant degree among those suffering from anxiety or depressive disorders. However, depressed but not anxious patients did on average make much greater reductions in drinking after brief advice than after receiving the booklet, but with just 35 patients in this category, the chances of a statistically significant result were slim. This study included dependent drinkers, who constituted about 30% of the full sample. They were even common among the anxious/depressed subsample, possibly accounting for the inconclusive impact of brief advice.

That brief advice might not be optimal for depressed people dependent on alcohol is suggested by another Australian study in which the generally severely depressed sample recruited through various channels also drank on average just over 11 UK units About 90g of alcohol. a day. Following brief face-to-face advice based on motivational interviewing, half the heavy drinkers cut their drinking by at least 50%. When this was supplemented by more extended therapy, three quarters improved to the same degree. Again, with just 41 patients in this category, the difference was not statistically significant.

A US study concerned risky drinking patients seeking mental health services at the offices of an employee assistance programme (occupational health) provider. They were allocated to usual treatment or to this plus an alcohol-focused two-session brief intervention (based on motivational interviewing) delivered during the first two routine therapy sessions. Three months later the brief advice patients had reduced their peak 'binge' drinking levels to a significantly greater degree, and their drink-related problems too had remitted but stayed the same in the usual-treatment group.

Reviewers for the Cochrane collaboration have looked at some of the same studies and at others of (generally) brief motivational interviewing among patients suffering mental illness and substance use problems, including at-risk drinking. They found some evidence that multiple sessions of motivational interviewing may lead to reductions in substance use greater than those achieved without such interventions.

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