The effectiveness of brief intervention among injured patients with alcohol dependence: Who benefits from brief interventions?

Background: Research investigating the differential effectiveness of Brief Motivational Interventions (BMIs) among alcohol-dependent and non-dependent patients in the medical setting is limited. Clinical guidelines suggest that BMI is most appropriate for patients with less severe alcohol problems. As a result, most studies evaluating the effectiveness of BMI have excluded patients with an indication of alcohol dependence. Methods: A randomized controlled trial of brief intervention in the trauma care setting comparing BMI to treatment as usual plus assessment (TAU+) was conducted. Alcohol dependence status was determined for 1336 patients using DSM-IV diagnostic criteria. The differential effectiveness of BMI among alcohol-dependent and non-dependent patients was determined with regard to volume per week, maximum amount consumed, percent days abstinent, alcohol problems at 6 and 12 months follow-up. In addition, the effect of BMI on dependence status at 6 and 12 months was determined. Results: There was a consistent interaction between BMI and alcohol dependence status, which indicated significantly higher reductions in volume per week at 6 and 12 months follow-up (β=-.56, p=.03, β=-.63, p=.02, respectively), maximum amount at 6 months (β=-.31, p=.04), and significant decreases in percent days abstinent at 12 months (β=.11, p=.007) and alcohol problems at 12 months (β=-2.7, p₁₂=.04) among patients with alcohol dependence receiving BMI. In addition, patients with alcohol dependence at baseline that received BMI were .59 (95% CI=.39-.91) times less likely to meet criteria for alcohol dependence at six months. Conclusions: These findings suggest that BMI is more beneficial among patients with alcohol dependence who screen positive for an alcohol-related injury.