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Interventions for preventing injuries in problem drinkers

  1. Tho Bella Dinh-Zarr1,*,
  2. Cynthia W Goss2,
  3. Elizabeth Heitman3,
  4. Ian G Roberts4,
  5. Carolyn DiGuiseppi2

Editorial Group: Cochrane Injuries Group

Published Online: 19 JUL 2004

Assessed as up-to-date: 31 MAR 2004

DOI: 10.1002/14651858.CD001857.pub2


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.

Author Information

  1. 1

    MAKE ROADS SAFE - The Campaign for Global Road Safety, Road Safety, FIA Foundation, Washington , DC, USA

  2. 2

    University of Colorado Denver, Colorado Injury Control Research Center, Colorado School of Public Health, Denver, CO, USA

  3. 3

    Vanderbilt University Medical Center, Center for Clinical and Research Ethics, Nashville, TN, USA

  4. 4

    London School of Hygiene & Tropical Medicine, Cochrane Injuries Group, London, UK

*Tho Bella Dinh-Zarr, Road Safety, FIA Foundation, MAKE ROADS SAFE - The Campaign for Global Road Safety, 336 13th Street, NE, Washington , DC, 20002, USA. dinhzarr@dinhzarr.org.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 JUL 2004

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Characteristics of included studies [ordered by study ID]
Barber 1995

MethodsRandomized controlled trial


Participants23 partners of heavy drinkers (22 women, 1 man).


Interventions1) Training partners to pressure heavy drinkers to change.
2) No intervention.


OutcomesDomestic violence:
1) 4/16 (25%)
2) 3/7 (43%)
RR=0.58 (95% CI 0.17, 1.95); p=0.63.


NotesAustralia. 3-month follow-up.

N and % fully abstinent:
1) 1/16 (6%)
2) 0/7 (0%)

% subjects taking <4 drinks (10 g etoh) per day:
1) 3/16 (19%)
2) 0/7 (0%)


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

Brown 1980

MethodsRandomized controlled trial


Participants60 males convicted of DUI.


Interventions1) Conventional education.
2) Controlled drinking.
3) No intervention.


OutcomesAccidents.
Data unavailable.


NotesNew Zealand. 12-month follow-up

Mean days abstinent/90 days:
1) 48.0
2) 58.4
3) 53.6

Average DUI incidence/year:
1) 32.40
2) 7.25
3) 23.95


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

Fitzgerald 1985

MethodsRandomized controlled trial


Participants288 alcoholics (from 2 centers, A & B).


Interventions1) Telephone aftercare contacts.
2) No or minimal aftercare intervention.


OutcomesDrinking-related injuries and accidents.
1) A: 7/86, B: 2/39 (7%)
2) A: 14/127, B: 3/40 (10%)
RR*=0.73 (95% CI 0.34, 1.58); p=0.55

Suicide attempts:
1) A; 2/86; B: 2/39 (3%)
2) A: 9/127; B: 2/40 (7%)
RR*=0.48 (95% CI 0.15, 1.51); p=0.31
*Mantel-Haenzel weighted relative risk, stratified by Center.


NotesUSA. 12-month follow-up.

N and % fully abstinent
1) 26/123 (21%)
2) 37/165 (22%)


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesA - Adequate

Fleming 1999

MethodsRandomized controlled trial


Participants158 patients >= 65 years, identified as problem drinkers (105 men, 53 women).


Interventions1) Scheduled for brief intervention by personal physician, follow-up call, and general health booklet.
2) General health booklet.


OutcomesNo significant changes in incidence of accidents or injuries for either group. (Data not reported).


NotesUSA. 12-month follow-up.

Drinks/week M(SD):
1)9.92 (6.97)
2)16.27 (12.17)
p < 0.001

% change in drinks/week:
1) -36.14%
2) 1.89%

Number of binge drinking episodes in past 30 days:
1) 1.83
2) 5.36
p < .005

N and % reporting binge drinking in past 30 days:
1) 24/78 (30.8%)
2) 33/67 (49.3%)
p < .025


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

Fleming 2002

MethodsRandomized controlled trial


Participants774 patients identified as problem drinkers, ages 18-65 (482 men, 292 women).


Interventions1) Two brief intervention visits one month apart by personal physician, two follow-up calls by nurse, and general health booklet.
2) General health booklet.


OutcomesInjury-related deaths:
1) 1/392 (suicide).
2) 2/382 (motor vehicle crashes)
RR (95% CI) = 0.49 (0.04, 5.35), p = .56

Motor vehicle crashes with fatalities:
1) 0/1568
2) 2/382
p = .24, Fisher's Exact Test, two-tailed

Motor vehicle crashes with non-fatal injuries:
1) 20/1568 person-years
2) 31/1528 person-years
RR=0.63 (0.36, 1.10)

Motor vehicle crashes with property damage only:
1) 67/1568 p-y
2) 72/1528 p-y
RR=0.91 (0.66, 1.26)

Motor vehicle crashes:
1) 87/1568 p-y
2) 105/1528 p-y
RR=0.81 (0.61, 1.06)

Assault/battery/child abuse:
1) 8/1568 p-y
2) 11/1528 p-y
RR=0.71 (0.29, 1.76).


NotesUSA. 48-month follow-up.

48 months
Mean drinks/week: No differences between groups, although there was an overall reduction in the intervention group across all time points up to 48 months, p =.0018

% reporting binge drinking in past 30 days:
1) 63.8%
2) 70.4%

Mean number of binge drinking episodes/30 days (est from graph):
1) 4.2
2) 5.1

Arrests for operating while intoxicated:
1) 25/1568 person-years
2) 25/1528 person-years
RR=0.97 (0.56, 1.69)

12 months
Number of drinks/7days M(SD):
1) 11.48(11.31)
2) 15.46 (12.93)
p < .001

Number of binge episodes/30 days M(SD):
1) 3.07(5.23)
2) 4.21 (5.52)
p < .005

N and % reporting binge drinking in past 30 days:
1) 188 (55.8%)
2) 261 (71.3%)
p < .001


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

Gallant 1968

MethodsRandomized controlled trial


Participants78 male alcoholics.


Interventions1) Metronidazole (125 mg qid)
2) chlordiazepoxide (10 mg qid).


OutcomesSuicides.
1) 0/39
2) 0/39
Relative risk undefined.


NotesUSA. 6-month follow-up

N and % fully abstinent
1) 6/39 (15%)
2) 8/39 (21%)


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

Gentilello 1999

MethodsRandomized controlled trial


Participants762 adult patients admitted to hospital for trauma and identified as problem drinkers (82% male).


Interventions1) One-hour motivational interview with psychologist
2) Standard care.


OutcomesHospitalization for an injury up to 3 years post-intervention:
Adjusted Hazard ratio (95% CI) = .52 (0.21, 1.29), p = .16

Visit to emergency department or hospital for a new injury up to 12 months post intervention:
Adj. Hazard ratio (95% CI) = 0.53 (0.26, 1.07), p = .07


NotesUSA. Up to 3 years follow-up.

Mean change in drinks/wk M(SE):
1) -21.8(3.7)
2) -6.7(5.8)
p = .03

DUI violations:
OR (95% CI est from graph) = 0.77(0.25, 1.55)

Alcohol-related arrest OR (95% CI est from graph):
0.50 (0.1, 1.4)


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

Kristenson 2002

MethodsRandomized controlled trial


Participants667 men born 1927-1937, ages 46-49 at screening, identified as heavy drinkers (based on GGT).


Interventions1) Test results, invited for further assessment (liver tests, physical examination) and brief intervention by physician
2) Test results and invited for laboratory checkups in 2 years.


OutcomesUnintentional injury deaths while intoxicated: 1) 0/365
2) 0/302
RR undefined

Suicides among known alcoholics:
1) 1/365
2) 0/302
RR cannot be calculated, p = 0.55, one-tailed Fisher's Exact Test.


NotesSweden. Follow-up 10-16 years (median 13 years).


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

Kuchipudi 1990

MethodsRandomized controlled trial


Participants114 alcoholics hospitalised for medical illness.


Interventions1) Motivational intervention and medical care
2) Medical care only.


OutcomesSuicides and violent deaths:
1) 3/59 (5%)
2) 5/55 (9%)
RR=0.56 (95% CI 0.08, 1.43); p=0.48

Injury hospitalisations:
1) 2/59 (3%)
2) 3/55 (5%)
RR=0.62 (95% CI 0.11, 3.58); p=0.67

Falls:
1) 3/59 (5%)
2) 4/55 (7%)
RR=0.70 (95% CI 0.16, 2.98); p=0.71.


NotesUSA. 10 to 16-wk follow-up.

N and % fully abstinent:
1) 21/59 (36%)
2) 20/55 (36%)

N and % Driving Under The Influence:
1) 8/59 (14%)
2) 5/55 (9%)


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

Landrum 1981

MethodsRandomized controlled trial


Participants3425 persons convicted of DUI


Interventions1) Monthly probation.
2) Rehabilitation (group therapy/ structured intervention).
3) Probation & rehabilitation
4) No intervention.


OutcomesMotor vehicle crashes
1) 41/552 (7%)
2) 42/504 (8%)
3) 38/431 (9%)
4) 48/490 (10%)
RR (95% CI); p-value
1) 0.76 (0.51, 1.13); p=0.21
2) 0.85 (0.57, 1.26); p=0.49
3) 0.90 ( 0.60, 1.35); p=0.69
4) 1.0

Motor vehicle crash injuries
1) 8/552 (1%)
2) 9/504 (2%)
3) 14/431 (3%)
4) 15/490 (3%)
RR (95% CI); p-value
1) 0.47 (0.20, 1.11); p=0.12
2) 0.58 (0.26, 1.32); p=0.27
3) 1.06 (0.52, 2.17); p=0.98
4) 1.0.


NotesUSA. 24-month follow-up

DUI repeat arrestees
1) 179/552 (32%)
2) 168/504 (33%)
3) 132/431 (31%)
4) 162/490 (33%)


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

Longabaugh 2001

MethodsRandomized controlled trial


Participants539 adult injury patients seen in emergency department and identified as hazardous drinkers (78% male)


Interventions1) Brief motivational interview by interventionist plus booster session 7-10 days later.
2) brief motivational interview by interventionist
3) standard care.


OutcomesAlcohol-related injuries (after reciprocal transformation) M(SE):
1) 0.863 (.026)
2) 0.807 (.025)
3) 0.800 (.024)
1 v 3, one-tailed p = .04; 2 v 3, one-tailed p > .4

Actual injuries in past year estimated from transformations (change from baseline):
1) 0.165 ( -36%)
2) not stated
3) 0.240 ( -6%)

All injuries Mean(change from baseline):
1) 0.67 (-64%)
2) Not stated
3) 0.72 (-53%)
1 v 3, one-tailed p = .17

Injuries requiring medical treatment: No group differences, p > .05 (group data not reported)


NotesUSA. 12-month follow-up.

Number of heavy drinking days in past year M(SE):
1) 1.68 (1.15) 2) 1.72 (1.23) 3) 1.70 (1.09) 1 v. 3, one-tailed p = .41
2 v. 3, one-tailed p = .43

Negative consequences from drinking, logged total score M(SE):
1) 2.24(.082)
2) 2.40(.078)
3) 2.52(.076)
1 v 3, one-tailed p <= .005
2 v 3, one-tailed p = 0.133


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

Mann 1994

MethodsRandomized controlled trial


Participants347 men twice convicted of DUI


Interventions1) Rehabilitation program.
2) No program.


OutcomesAccidental and violent deaths:
1) 3/220 (1%)
2) 5/127 (4%)
RR=0.35 (95% CI 0.08, 1.43); p=0.15


NotesCanada. 8 to 13-year follow-up.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

Monti 1999

MethodsRandomized controlled trial


Participants94 patients ages 18-19 y, seen in emergency department for alcohol-related event (64% male)


Interventions1) Brief motivational interview by interventionist and drunk-driving handout
2) drunk driving handout.


OutcomesAlcohol-related injuries:
1) 21%
2) 50%
Adj OR (95% CI) = 0.25 (0.09, 0.69), p < 0.01


NotesUSA. 6-month follow-up.

Alcohol consumption scores:
No group differences (data not shown)

Self-reported drinking and driving:
1) 62%
2) 85%
OR (95% CI) = 0.26(0.08, 0.83)

Alcohol-related problems, adjusted M(SD):
1) 0.89 (1.18)
2) 1.44 (1.43)
Effect size=0.23, p < .05


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

Potamianos 1986

MethodsRandomized controlled trial


Participants151 problem drinkers aged 18-60


Interventions1) Community- based day center treatment
2) conventional in- and out-patient management.


OutcomesAccidents.
Aggressive behavior.
Motor vehicle crashes
(Data Unavailable)


NotesUK. 12-months follow-up

Mean alcohol consumption:
1) 89 g/d (55% reduction)
2) 106 g/d (37% reduction)


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesA - Adequate

Reis 1982a

MethodsRandomized controlled trial


Participants4639 persons once convicted of DUI


Interventions1) in-class education
2) Home study education
3) no intervention.


OutcomesAlcohol-related crashes & injuries ('Cumulative accident rate')
1) 0.084
2) 0.098
3) 0.101
Overall: p=0.58.


NotesUSA. 3-year follow-up

Mean change in drinking score:
1) -12.40
2) -18.53
3) -16.36

DUI recidivism rate
1) 0.24
2) 0.25
3) 0.28


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesA - Adequate

Reis 1982b

MethodsRandomized controlled trial


Participants1103 persons convicted more than once of DUI


Interventions1) Biweekly contacts (BWC)
2) educational counselling
3) educational counselling with disulfiram
3) no intervention


OutcomesAlcohol-related crashes & injuries ('Cumulative accident rate')
1) 0.086
2) 0.087
3) 0.055
4) 0.076
Overall: p=0.49


NotesUSA. 2-year follow-up

Mean change in drinking score:
1) -49.53
2) -40.91
3) -72.87
4) -16.73

DUI recidivism rate
1) 0.25
2) 0.23
3) 0.21
4) 0.29


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesA - Adequate

Sitharthan 1996

MethodsRandomized controlled trial


Participants121 'low-dependent' problem drinkers compliant with therapy


Interventions1) Cognitive behavioural therapy by correspondence.
2) Minimum intervention by correspondence.


OutcomesAssaults
Data unavailable


NotesAustralia. 4-month follow-up

Mean alcohol consumption:
Men
1) 24.7 ±16.8 g/wk
2) 37.2 ± 24.4 g/wk
Women:
1) 16.4 ±10.5 g/wk
2) 23.7 ±10.3 g/wk


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

Sitharthan 1997

MethodsRandomized controlled trial


Participants52 problem drinkers


Interventions1) Cue exposure therapy.
2) Cognitive behavioural therapy.


OutcomesAssaults
1) 5/27 (19%)
2) 0/25 (0%)
RR=infinity (95% CI 0.91, infinity); p=0.06
(Confidence interval based on odds ratio approximation.)


NotesAustralia. 12-month follow-up

Days/month when any drink taken:
1) 6.23 d/mo
2) 11.93 d/mo


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

Toteva 1996

MethodsRandomized controlled trial


Participants118 alcoholics


Interventions1) Acupuncture.
2) Medical detoxification.


OutcomesSuicides.
Data unavailable.


NotesBulgaria. 6-month follow-up

N and % fully abstinent ('Total remission rate')
1) 11/15 (73%)
2) 10/21 (48%)


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

Walsh 1991

MethodsRandomized controlled trial


Participants227 alcohol-abusing workers.


Interventions1) Compulsory inpatient treatment.
2) Compulsory Alcoholics Anonymous attendance.
3) choice of optional treatment


OutcomesSuicides and homicides:
1) 2/73 (3%)
2) 0/83 (0%)
3) 0/71 (0%)
RR (95% CI); p-value
1) infinity (0.18, infinity)*; p=0.51
2) undefined
3) 1.0
*confidence interval based on odds ratio approximation.

Accidents: Data unavailable.


NotesUSA. 2-year follow-up

N and % Fully Abstinent
1) 27/73 (37%)
2) 13/83 (16%)
3) 12/71 (17%)


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

WHO BISG 1996

MethodsRandomized controlled trial


Participants1559 heavy drinkers in 10 countries.


Interventions1) Simple advice.
2) Brief counselling.
3) No intervention.


OutcomesInjuries.
Data unavailable.


Notes10 countries. 9-month follow-up

N and % fully abstinent:
Men
1) 19/387 (5%)
2) 38/471 (8%)
3) 8/403 (2%)
Women
1) 8/109 (7%)
2) 13/105 (12%)
3) 3/83 (4%)

Mean alcohol consumption:
Men
1) 5.18 cl ETOH/d
2) 5.29 cl ETOH/d
3) 6.29 cl ETOH/d
Women
1) 3.39 cl ETOH/d
2) 2.99 cl ETOH/d
3) 3.80 cl ETOH/d


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

Öjehagen 1997

MethodsRandomized controlled trial.


Participants72 alcoholics


Interventions1) Psychiatric outpatient treatment - 1 yr
2) Psychiatric outpatient treatment - 2 yr
3) Multi-modal behavioural outpatient treatment -1 yr
4) Multi-modal behavioural outpatient treatment - 2 year.


Outcomes9 years.
Suicides.
1+2) 2/36
3+4) 3/36
RR (95% CI) = 1.50 (.27, 8.45),
p = .65

36 months
Suicides:
1+2) 2/36 (6%)
3+4) 1/36 (3%)
RR=2.0 (95% CI 0.19, 21.09); p=1.00


NotesSweden. 9-year follow-up.

36 months
% subjects taking >4 drinks (3.8 cl 40% etoh) per day on 14 or fewer days/yr:
1) 44%
2) 40%
3) 41%
4) 42%


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Anderson 1992The 'injury' outcome measure was found to include alcohol-related illness; the data on injuries could not be separated from the illness data.

McCrady et al 1982The 'injury' outcome measures were found to include criminal behaviour. These data did not differentiate between criminal behaviour related to injury (e.g., assault) and other types of criminal behaviour (e.g., shop lifting), nor could the injury-specific data be extracted.

Wells-Parker 2002At the time of the original review, this study was in progress. Motor vehicle crashes were the intended 'injury' outcome measure, but the researchers did not report this measurement because motor vehicle crash records were found to be incomplete. DUI arrests were measured instead.

 
Characteristics of ongoing studies [ordered by study ID]
Bohn, in prog

Trial name or title

Methods

Participants140 heavy drinkers

Interventions1) naltrexone and extended brief counseling
2) naltrexone and simple advice
3) placebo and extended brief counseling
4) placebo and simple advice

OutcomesAll injuries, including falls, burns, violence, fractures, sprains, other injuries, and motor crashes

Starting date

Contact information

NotesUSA.
Drinking outcomes: drinks/drinking day, total drinks, heavy drinking days, days abstinent, drinking frequency, alcohol craving.

 
Comparison 1. Brief intervention for problem drinking vs control

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Injury-Related Deaths31555Risk Ratio (M-H, Random, 95% CI)0.65 [0.21, 2.00]