Interventions for preventing injuries in problem drinkers
Editorial Group: Cochrane Injuries Group
Published Online: 19 JUL 2004
Assessed as up-to-date: 31 MAR 2004
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Dinh-Zarr TB, Goss CW, Heitman E, Roberts IG, DiGuiseppi C. Interventions for preventing injuries in problem drinkers. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001857. DOI: 10.1002/14651858.CD001857.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 19 JUL 2004
Alcohol consumption has been linked with injuries through motor vehicle crashes, falls, drowning, fires and burns, and violence. In the US, half of the estimated 100,000 deaths attributed to alcohol each year are due to intentional and unintentional injuries. The identification of effective interventions for the reduction of unintentional and intentional injuries due to problem drinking is, therefore, an important public health goal.
To assess the effect of interventions for problem drinking on subsequent injury risk.
We searched 12 twelve computerized databases: MEDLINE (1966 to 2002), EMBASE (1982 to 2002), CENTRAL (The Cochrane Library 2002, Issue 2), PsycINFO (1967 to 2002), CINAHL (1982 to10/96), ERIC (1966 to12/96), Dissertation Abstracts International (1861 to11/96), IBSS (1961 to 2002), ISTP (1982 to 2002) and three specialized transportation databases (Transport 1988 to 2002/03). Bibliographies of relevant trials were searched and authors were contacted. Government agencies were also contacted for further information and grey literature. Most of the electronic and bibliographic database searches were last run in May 2002.
Randomized controlled trials of interventions among participants with problem drinking, which are intended to reduce alcohol consumption or to prevent injuries or their antecedents, and which measured injury-related outcomes.
Data collection and analysis
Two authors extracted data on participants, interventions, follow-up, allocation concealment, and outcomes, and independently rated allocation concealment quality.
Of 23 eligible trials identified, 22 had been completed and 17 provided results for relevant outcomes. Completed trials comparing interventions for problem drinking to no intervention reported reduced motor-vehicle crashes and related injuries, falls, suicide attempts, domestic violence, assaults and child abuse, alcohol-related injuries and injury emergency visits, hospitalizations and deaths. Reductions ranged from 27% to 65%. Because few trials were sufficiently large to assess effects on injuries, individual effect estimates were generally imprecise. We did not combine the results quantitatively because the interventions, patient populations, and outcomes were so diverse. The most commonly evaluated intervention was brief counseling in the clinical setting. This was studied in seven trials, in which injury-related deaths were reduced: relative risk (RR) 0.65; 95% confidence interval (CI) 0.21 to 2.00. However, this reduction may have been due to chance. The majority of trials of brief counseling also showed beneficial effects on diverse non-fatal injury outcomes.
Interventions for problem drinking appear to reduce injuries and their antecedents (e.g. falls, motor vehicle crashes, suicide attempts). Because injuries account for much of the morbidity and mortality from problem drinking, larger studies are warranted to evaluate the effect of treating problem drinking on injuries.
Plain language summary
Action with problem drinkers can cut risk of injury
Drinking too much alcohol can be dangerous, and injuries (both intentional and unintentional) are one of the most important ways in which excess alcohol use can result in harm. Are there ways of working with people known to be "problem drinkers" that can reduce the number of these injuries? The reviewers found 17 studies of programs that reported whether working with problem drinkers reduced injuries. Several different approaches were evaluated, the most common being brief counseling by health workers. The evidence from these studies suggests that action with problem drinkers is effective in reducing both injuries and events that lead to injury (such as falls, motor vehicle crashes, and suicide attempts). However, more research is needed to calculate the level of effectiveness accurately and to determine which type of program works best.
我們檢索12個電腦化資料庫：MEDLINE (1966 – 8/96)，EMBASE (1982 – 1/97)，Cochrane Controlled Trials Register (1997，第1期), PsycINFO (1967 – 1/97)，CINAHL (1982 – 10/96)，ERIC (1966 – 12/96)，Dissertation Abstracts International (1861 – 11/96)，IBSS (1961 – 1/97)，ISTP (1982 – 1/97)及三個專門的交通運輸資料庫，採用問題性飲酒合併對照試驗等詞語進行檢索；相關試驗的參考書目；並連絡作者及政府機構。於2002年5月更新電子與參考書目的檢索結果。
確定23篇合格的試驗，22篇已被完成而其中17篇提供相關的結果。完成的試驗其比較介入措施與沒有介入措施對於減少問題性飲酒之機車事故與相關的受傷，跌倒，企圖自殺，家庭暴力，攻擊與虐待兒童，酒精相關的受傷與受傷緊急就醫，住院與死亡的報告。減少的範圍從27%至65%。由於幾乎沒有大型的試驗足以評估對於受傷的影響，因此個別效果的估計普遍是不精確的。由於介入措施，病患族群，及結果大不相同，因此我們不將結果量化地整合。最常見的評估介入措施為臨床機構的簡易諮詢。七篇研究這項介入措施的試驗發現，受傷相關的死亡減少了：relative risk (RR)為0.65；95% confidence interval (CI)為0.21至2.00。然而，這種減少的效果也許是隨機的。大多數的試驗也顯示簡易諮詢對於各種非致死性受傷結果具有利的效果。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。