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Alcohol – Excessive Consumption: Electronic Screening and Brief Interventions (e-SBI)

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 31 studies with 36 study arms (search period 1970–October 2011).

The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to preventing excessive alcohol consumption.

Context

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Summary of Results

Detailed results from the systematic review are available in the Task Force Finding and Rationale Statement pdf icon [PDF - 257 kB].

The systematic review included 31 studies with 36 study arms.

  • Included 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
  • The definition of binge and heavy drinking varied slightly across studies. Binge drinking is typically defined as five or more drinks for a man, and four or more drinks for a woman, per occasion; heavy drinking is typically defined as more than 14 drinks for a man, and more than seven drinks for a woman, per week.

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 (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 (11 studies with 14 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 (8 studies with 9 study arms)
    • All participants: 19.1% median reduction (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 (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 (13 studies with 16 study arms)
    • All participants: 16.2% median reduction (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 (5 studies)
    • Proportion of participants who exceeded guidelines for heavy drinking: 15.0% median reduction (4 studies)

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

  • Alcohol Use Disorders Identification Test this link is to an external website (AUDIT) score
    • Excessive drinkers: 1.1 point decrease in the favorable direction (3 studies with 4 study arms)
    • All participants: 0.9 point decrease (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.
    • Favorable intervention effects were reported in 12 of the 17 study arms, and seven of the effects were statistically significant.
    • The remaining five study arms showed an increase in alcohol-related problems or no effect; none of the results were statistically significantcant.

Summary of Economic Evidence

Detailed results from the systematic review are available in the Task Force Finding and Rationale Statement pdf icon [PDF - 257 kB].

The economic review included three studies. Two studies from the Netherlands reported costs and benefits, and one study from the United States reported benefits only in terms of annual costs averted. All values are reported in 2011 U.S. dollars.

  • One study estimated e-SBI would save the U.S. military $136 million annually through healthcare costs averted, increased productivity, decreased non-deployability, and decreased early separation.
  • Another study estimated the average cost per user per year to be $57, with a benefit-to-cost ratio of 12:1, and a net savings of $468 per capita.
  • A third study estimated the cost per user would vary from $12 to $258, depending on intervention intensity. The study found that partially substituting face-to-face interventions with e-Health interventions would result in similar disability adjusted life years (DALY) averted while decreasing costs of alcohol interventions by $84.8 million per year.

Although the available evidence indicates e-SBI has the potential to be cost-saving, additional studies in a broader range of contexts are necessary to adequately assess the economic merits of this intervention.

Applicability

Based on settings and populations from included studies, the CPSTF finding should be applicable to the following.

  • Interventions implemented in university settings, healthcare settings, and communities
  • Adults of all ages
  • Men and women

Included studies reported limited data on effectiveness by race/ethnicity, and only one study provided information about program effectiveness among adolescents.

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base.

  • How effective is e-SBI in settings other than colleges and healthcare organizations (e.g., military, worksites, public health organizations) and among specific populations (e.g., adolescents, racial and ethnic groups)?
  • What are the relative benefits of e-SBI and traditional alcohol screening and brief intervention?
  • What is the optimal level of intervention intensity? What is the relative effectiveness of different types of feedback?
  • What is the long-term effectiveness of e-SBI (i.e., beyond 12 months)?
  • Do “booster sessions” improve the long-term effectiveness of e-SBI?
  • What are the costs of developing and implementing e-SBI in the United States?
  • What is the cost-effectiveness of e-SBI in communities that have widely implemented this intervention?

Study Characteristics

  • All included studies used randomized control trials, and most had follow-up periods of 6 –12 months.
  • Studies provided results for excessive drinkers only (24 studies with 28 study arms) or all drinkers (7 studies with 8 study arms).
  • Nearly two-thirds of the studies used probability sampling designs or attempted to recruit everyone willing to participate.
  • In approximately 60% of the studies, participants were screened for excessive consumption through automated methods (most often through the internet).
  • More than 80% of the brief interventions were delivered solely through automated methods.
  • Evaluated interventions were conducted in universities (17 studies), healthcare settings (11 studies), and communities (8 studies).
  • Nearly half (17 studies) were conducted in the United States.

Publications

Tansil KA, Esser MB, Sandhu P, et al. Alcohol electronic screening and brief intervention: a Community Guide systematic review. American Journal of Preventive Medicine. 2016;51(5):801–11.
Community Preventive Services Task Force. Alcohol electronic screening and brief intervention: recommendation of the Community Preventive Services Task Force. American Journal of Preventive Medicine. 2016;51(5):812–3.

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