Full length articleEfficacy of brief motivational intervention in reducing binge drinking in young men: A randomized controlled trial
Introduction
In many countries in the developed world, heavy drinking is a leading cause of morbidity and mortality in young people. In Switzerland, 75.5% of young men binge at least monthly (Gmel et al., 2008), a finding which applies to the three linguistic regions of the country (Daeppen et al., 2005). It is estimated that heavy drinking is responsible for 31.5% of all deaths and 26.6% of disability-adjusted life years lost in people aged 15–29 years (Toumbourou et al., 2007). Moreover, longitudinal cohort studies show that early initiation to alcohol among young people increases the risk of progression to more frequent and problematic use in later life (Agrawal et al., 2009, Toumbourou and Catalano, 2005). However, many adolescents who drink heavily tend to grow out of their heavy drinking behavior patterns as they enter adulthood (Baer et al., 2001). Thus, prevention approaches, including brief motivational intervention (BMI), could open opportunities for encouraging this process early on.
BMI is an adaptation of motivational interviewing (MI) administered as single, short sessions lasting 15–45 min (Baer et al., 2001, Rollnick et al., 1992). BMI was adapted for young people using various substances (McCambridge and Strang, 2003). Reviews of strategies targeting alcohol consumption show that BMI is one of the few effective preventive strategies (along with structural measures such as driving while intoxicated regulations and control of prices and taxes) and is the most cost-effective strategy among individual-centered approaches (Babor et al., 2010). BMI has demonstrated the effectiveness of preventive action mainly in primary care and university settings, although its applicability seems to be broader and appropriate for early interventions across gender and age groups, particularly in populations where individuals are not actively seeking treatment. BMI with adolescents and young adults has shown mixed results. Each study included in a review of BMI applied with adolescents and young adults evaluating the efficacy of single face-to-face sessions described some benefit from BMI in terms of reduced alcohol use or related consequences (Grenard et al., 2006). Three of the studies demonstrated reductions in alcohol use, but claimed no additional advantages or gains for BMI (plus personalized feedback) versus control (personalized feedback-only) (Baer et al., 1992, Handmaker et al., 1999, Murphy et al., 2004). These mixed findings suggest conducting additional studies designed to put special emphasis on stricter controls; most of the reviewed studies included some minimal form of intervention in addition to assessing control groups. Moreover, BMI typically is conducted with heavy drinking subjects; very few researchers chose BMI as a primary prevention strategy among low-risk drinkers, although one study did include them and found positive effects in a personalized mailed feedback for college drinking prevention. This study involved low-risk drinkers as well as abstainers (Larimer et al., 2007). Finally, most studies with young people available today were conducted within college campus milieus (e.g. O’Malley and Johnston, 2002, Vik et al., 2000). Outside the college milieu, a randomized trial including young workers found no additional impact on drinking levels in subjects who had a 15-min BMI in addition to computerized feedback, compared to computerized feedback-only in controls (Doumas and Hannah, 2008). In contrast, our study aimed to test the efficacy of BMI in a wider, more heterogeneous population, compared to the college milieu or the workplace, where groups of individuals may have more education than their counterparts do in the general population.
Most BMI studies focus on drinking levels as a main outcome, but there are questions about whether the presence of consequences or the severity of alcohol use affects counseling efficacy. Conflicting data have been published, since the presence of consequences of alcohol use can enhance counseling efficacy (Blow et al., 2009, Walton et al., 2008), or decrease MI efficacy (Moyer et al., 2002, Saitz et al., 2007). Therefore, in secondary analyses, in order to investigate whether the presence of baseline alcohol consequences may impact BMI efficacy, we evaluated the BMI impact on drinking outcomes in individuals reporting one or more alcohol consequences, compared to counterparts without such adverse experiences.
The primary aims of this study were to evaluate the efficacy of BMI in reducing alcohol use among binge drinkers (subjects reporting typical drinking episodes of 60 g pure alcohol at least once a month) 6 months after the intervention, compared to subjects in a control group without intervention, and to maintain low-risk drinking in non-bingers among 20-year-old French-speaking Swiss men within a representative community sample of conscripts.
Section snippets
Methods
The study protocol was approved by the Ethics Committee for Clinical Research of the Lausanne University Medical School (Protocol No. 15/07) and registered in the International Standard Randomized Controlled Trial Number Register, number ISRCTN78822107, http://www.controlled-trials.com/ISRCTN78822107.
Results
Inclusion took place over 19 weeks between September 2007 and August 2008, alternating every other week to accommodate the enrollment of subjects into another study. During this period, 3460 subjects visited the recruitment centre, and of these, 629 (18.2%) were eliminated by the army before encountering any of the researchers (Fig. 1). The remaining 2831 were randomized into three groups: 2209 were not invited to participate in the study (logistic constraints permitted only two BMIs per group
Discussion
At army conscription in Switzerland, BMI reduces alcohol use in binge drinkers. This benefit from BMI is heightened in subjects who recently experienced certain alcohol-related adverse consequences. Although BMI demonstrated a 20% reduction in weekly alcohol use among binge drinkers, it is particularly relevant considering that individuals in this age group largely view drinking as a mostly positive experience. A majority of them increase their consumption between the ages of 18 and 25, and
Role of funding source
The study was funded by the “Dîme de l’alcool du Canton de Vaud”. There were no contractual constraints on publishing imposed by the funder.
Contributors
All authors have approved the final manuscript. Dr Daeppen, Dr Gmel, and J Gaume designed the study and wrote the protocol. Dr Daeppen and Dr Gmel managed the literature searches and summaries of previous related work. Dr Faouzi undertook the statistical analysis, and Dr Daeppen and J. Game wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.
Conflict of interest
Dr Daeppen declares a connection with pharmaceutical industry related to a study without link to the present paper. Dr Gmel has participated in scientific meetings co-sponsored by the pharmaceutical industry. He has received funding for research projects that were indirectly financed through sales of the alcohol and tobacco industry via taxes (i.e., funds from the Swiss Alcohol Monopoly or the Tobacco Prevention Fonds). He has never received direct research funding from any industry. He cannot
Acknowledgments
We thank Lt. Col. Gaetan Membrez, Dr Jean-Pierre Kulling and all the staff at the Lausanne recruitment centre for their kind collaboration, Chantal Villiger, and Nathalie Sanchez for the fieldwork (data collection and conduction of the interventions) at the recruitment centre, Alicia Seneviratne for the psychologists supervision, and George Danko for the careful editing of the manuscript.
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