Preventing Excessive Alcohol Consumption: Electronic Screening and Brief Intervention (e-SBI)

Traditional screening and brief intervention (SBI) to reduce excessive alcohol consumption consists of assessing patients' drinking patterns, followed by providing those who screen positive for excessive drinking with face-to-face feedback about its risks, and advice about how to change their drinking patterns.

Electronic screening and brief intervention (e-SBI) to reduce excessive alcohol consumption uses electronic devices (e.g., computers, telephones, or mobile devices) to facilitate the delivery of key elements of traditional SBI. At a minimum, e-SBI involves:

1. Screening individuals for excessive drinking, and
2. Delivering a brief intervention, which provides personalized feedback about the risks and consequences of excessive drinking.

Delivery of personalized feedback can range from being fully automated (e.g., computer-based) to interactive (e.g., provided by a person over the telephone). At least one part of the brief intervention must be delivered by an electronic device.

The brief intervention provided using e-SBI techniques may also include other common elements of SBI, such as motivational interviewing techniques (e.g., assessment of readiness to change, and emphasis on personal freedom to choose one's drinking patterns); or comparing an individual's own alcohol consumption with that of others (e.g., college students in the same school). In addition, e-SBI can be delivered in various settings, such as in health care systems, universities, or communities.

Summary of Task Force Findings & Recommendations

The Community Preventive Services Task Force (Task Force) recommends electronic screening and brief intervention (e-SBI) based on strong evidence of effectiveness in reducing self-reported excessive alcohol consumption and alcohol-related problems among intervention participants.

Task Force Finding and Rationale Statement

About the Intervention

• e-SBI can be readily integrated into standard organizational practices in various settings.
• e-SBI can be used to reach populations who would not otherwise be offered traditional SBI, by:
  • Expanding the settings within which SBI can be feasibly delivered
  • Ensuring consistent delivery to intended recipients

Results from the Systematic Review

The systematic review included 31 studies with 35 study arms.

• The studies assessed changes in excessive alcohol consumption and related harms after use of e-SBI; participants were categorized into two groups.
  • Excessive drinkers (i.e., those who reported drinking above an established threshold)
  • All participants (i.e., the entire sample of people exposed to the brief intervention, including those above and below threshold for excessive drinking)

Alcohol Consumption

Included studies showed decreases in alcohol consumption following the use of e-SBI.

• Binge drinking* frequency (i.e., number of binge drinking occasions per month)
  • Excessive drinkers: 16.5% median reduction (interquartile interval [IQI]: -35.6 to -11.8; 8 studies with 9 study arms)
  • All participants: 1.8% median reduction (2 studies)
• Mean drinking intensity (i.e., average number of drinks per occasion or estimated blood alcohol concentration [BAC])
  • Excessive drinkers: 5.5% median reduction (IQI: -14.5 to 1.1; 11 studies with 13 study arms)
  • All participants: 13.5% median reduction (2 studies)
• Peak consumption per occasion (i.e., maximum number of drinks per occasion or estimated peak BAC)
  • Excessive drinkers: 23.9% median reduction (IQI: -51.3 to -2.1; 8 studies with 9 study arms)
  • All participants: 19.1% median reduction (IQI: -42.1 to -17.7; 5 studies)
• Frequency of alcohol consumption per month (i.e., number of days per month when any amount of alcohol was consumed)
  • Excessive drinkers: 11.5% median reduction (IQI: -17.3 to -4.9; 7 studies with 8 study arms)
  • All participants: 14.4% median reduction (1 study)
• Mean number of drinks consumed per month
  • Excessive drinkers: 13.8% median reduction (IQI: -31.7 to -10.8; 13 studies with 16 study arms)
  • All participants: 16.2% median reduction (IQI: -33.4 to -8.2; 5 studies with 7 study arms)
• Proportion of participants who changed their drinking patterns
  • Proportion of participants who exceeded guidelines for binge drinking*: 3.2% median reduction (IQI: -9.5 to 3.0; 5 studies)
  • Proportion of participants who exceeded guidelines for heavy drinking*: 15.0% median reduction (IQI: -26.2 to -11.8; 4 studies)

*The definition of binge and heavy drinking varied slightly across studies. Binge drinking is typically defined as 5 or more drinks for a man, and 4 or more drinks for a woman, per occasion; heavy drinking is typically defined as more than 14 drinks for a man, and more than 7 drinks for a woman, per week.

Alcohol-Related Harms (scores from scales assessing multiple problems)

• Alcohol Use Disorders Identification Test (AUDIT) score
  • Excessive drinkers: 1.1 point decrease in AUDIT score in the favorable direction (IQI: -2.1 to 0.2; 3 studies with 4 study arms)
  • All participants: 0.9 point decrease in AUDIT score (1 study)
• Other scores were reported using various scales, such as the Rutgers Alcohol Problem Index, and could not be combined to calculate the magnitude of the effect.
  • 12 of the 17 study arms showed favorable intervention effects, 7 of which were statistically significant.
  • The remaining five study arms showed an increase in alcohol-related problems or no effect; all of these results were not statistically significant.

Nearly half of the included studies were conducted outside of the United States in European countries, Australia, and New Zealand. Studies from the U.S. were distributed fairly equally across regions.

These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to excessive alcohol consumption.

Supporting Materials

• Analytic Framework
• Summary Evidence Table
• Included Studies
• Search Strategy

Publications

The findings and results of this systematic review have not been published. Read other Community Guide publications about Preventing Excessive Alcohol Consumption in our library. You may also subscribe to be notified as new materials on this topic become available.

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