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Is there really no evidence of the efficacy of brief alcohol interventions for increasing subsequent utilization of alcohol-related services? Commentary on the paper by Glass et al. (2015)

Abstract : Recently, a meta‐analysis of randomized controlled trials (RCTs) on utilization of substance abuse services following brief alcohol interventions in general health‐care settings by Glass et al. 1 has been published in Addiction. The authors aimed to estimate the main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral‐specific component, in increasing the utilization of alcohol‐related care. To identify RCTs, the authors performed a systematic review of English‐language papers published in three electronic databases to 2013. Inclusion of studies was not limited to any specific country. Thirteen RCTs met the inclusion criteria and nine RCTs were included in the analysis (n = 993 and n = 937 intervention and control group participants, respectively). The meta‐analysis retrieved no statistically significant results, even in subgroup analyses of the studies based on study characteristics (i.e. age, setting, intervention intensity and population severity), or when studies on referral‐specific interventions were solely considered. Given their findings, the authors have concluded that there is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol‐related services. In light of the existing literature, the reading of this manuscript raises two main comments. First the authors reported that they performed a systematic review in MEDLINE, PsycINFO and CNIAHL Plus to July 2013. The authors also stated that although there was no evidence for publication bias, their hand search to identify grey literature could have missed unpublished reports. Because RCTs with positive results tend to be published, the authors concluded it was unlikely that their findings would be altered substantively by unidentified unpublished research. However, the search and screening processes of their systematic review did not apparently identify three RCTs on referral‐specific interventions. Two of these three RCTs are indexed in MEDLINE and/or in PsycINFO (Apodaca et al., 2007 2; Liu et al., 2011 3), and one is an unpublished report (Runge et al., 2002 4). All three RCTs exhibited favourable findings for the effectiveness of brief interventions in increasing subsequent alcohol treatment utilization. For instance, the RCT by Runge et al. [4] (n = 388) showed that brief advice could increase significantly receipt of specialist evaluation for further treatment at 6 months by injured patients from two emergency departments compared with an inactive control condition [19.2% compared with 4.5%; odds ratio (OR) = 5.1, 95% confidence interval (CI) = 2.1–12.2]. The RCT by Apodaca et al. [2] reported an increase in further treatment‐seeking at 5 months among a sample of in‐patients from a trauma centre with a mean Alcohol Use Disorders Identification Test (AUDIT) score of 20 for brief advice, compared with the control group [6 of 15 (40%) versus two of 15 (13%)], but this increase was not found statistically significant given the small sample size (n = 40). The study by Liu et al. [3] (n = 616) also reported that brief intervention with post‐discharge sessions was associated significantly with treatment utilization at 12 months in in‐patients from medical/surgical wards [8.3 versus 2.1%, P =  0.01 (OR) = 4.2, 95%, CI = 1.4–12.4)]. Given the positive findings for alcohol treatment utilization after alcohol interventions reported by these three RCTs, and considering their sample size, including them in the analysis may have yielded different results. In addition, as discussed by the authors, most included RCTs discarded dependent drinkers and/or mainly recruited hazardous and harmful drinkers for whom referral to treatment is not necessarily required. Given that brief interventions target individuals with a broad range of alcohol use severity, focusing on the most severe stages of alcohol misuse may be the most valid approach to evaluating the efficacy of brief alcohol intervention in increasing the receipt of alcohol‐related services 5, 6.
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Soumis le : lundi 9 mars 2020 - 16:49:55
Dernière modification le : mercredi 23 mars 2022 - 15:51:20

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Nicolas Simioni, Benjamin Rolland, Olivier Cottencin. Is there really no evidence of the efficacy of brief alcohol interventions for increasing subsequent utilization of alcohol-related services? Commentary on the paper by Glass et al. (2015). Addiction (Abingdon, England), 2016, Addiction (Abingdon, England), 111 (1), pp.180-181. ⟨10.1111/add.13145⟩. ⟨hal-02503055⟩



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