Alcohol and Alcoholism Advance Access originally published online on October 10, 2006
Alcohol and Alcoholism 2006 41(6):624-631; doi:10.1093/alcalc/agl078
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BRIEF INTERVENTIONS FOR AT-RISK DRINKING: PATIENT OUTCOMES AND COST-EFFECTIVENESS IN MANAGED CARE ORGANIZATIONS
University of Connecticut Health Center, Farmington, CT and Research Triangle Institute, Durham, NC, USA
* Author to whom correspondence and requests for reprints should be addressed at: Department of Community Medicine and Health Care, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-6325,USA; Tel.: +1 860 679 5482. Fax: +1 860 679 5451; E-mail: talamini{at}up.uchc.edu
(Received 17 February 2006; first review notified 22 March 2006; in revised form 25 August 2006; accepted 25 August 2006)
Aims: Evaluate effectiveness and costs of brief interventions for patients screening positive for at-risk drinking in managed health care organizations (MCOs). Methods: A pre-post, quasi-experimental, multi-site evaluation conducted at 15 clinic sites within five MCO settings. At-risk drinkers (N = 1329) received either: (i) brief intervention delivered by licensed practitioners; or (ii) brief intervention delivered by mid-level professional specialists (nurses); or (iii) usual care (comparison condition). Clinics were randomly assigned to three study conditions. Data were collected on the cost of screening and brief intervention. Follow-up interviews were conducted at 3 and 12 months. Results: Participants in all three study conditions were drinking significantly less at 3-month follow-up, but the decline was significantly greater in the two intervention groups than in the control group. There were no significant differences between the two intervention conditions. Of the patients in the intervention conditions 60% reduced their alcohol consumption by 
1 drink per week, compared with 53% of those in the control condition. No differences were found on a measure of the quality of life. Differential reductions in weekly alcohol consumption between intervention and control groups were significant at 12-month follow-up. Average incremental costs of the interventions were $4.16 USD per patient using licensed practitioners and $2.82 USD using mid-level specialists. Conclusion: Alcohol screening and brief intervention when implemented in managed care organizations produces modest, statistically significant reductions in at-risk drinking. Interventions delivered to a common protocol by mid-level specialists are as effective as those delivered by licensed practitioners at about two-thirds the cost.
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