["Drinking less is better". Combining early identification and brief intervention for patients at risk]

Above 210 grams a week in men and 140 grams a week in women, alcohol consumption is a risk factor for avoidable mortality in the general population. Beyond specific risk situations (for example, pregnancy, medication that interferes with alcohol, operating machinery, or a history of alcohol-dependence) in which abstinence is recommended, consumption of levels below these thresholds (which represent respectively an average of 3 and 2 drinks a day) involves little risk. Above these thresholds, the frequency of secondary disease (principally cancers and cardiovascular, neurologic, hepatologic, and gastroenterologic disorders) contributes to reducing life expectancy in drinkers. Early identification of excessive but not dependent alcohol consumption is the only means of avoiding the morbidity and mortality associated with drinking. Health providers too often confound alcoholism with alcohol-related problems. Half of the deaths associated with alcohol, however, concern people who are not dependent on it. Excessive drinkers must be identified early if they are to be counseled and helped to reduce their consumption. The brief intervention is a counseling practice easy to learn. When practiced wisely (in people who drink to excess but are not alcohol-dependent), this brief intervention takes 10 minutes and provides information, motivational and behavioral counseling. It can be learned in two evenings and is immediately transposable into daily practice. The brief intervention is effective. It leads to a reduction in consumption below the risk thresholds in 10-50% of cases. Any trained care giver in primary care, hospital, or preventive medicine can provide it. Tools for identification and intervention are available. Two screening questionnaires have been validated in French, the AUDIT (a self-administered questionnaire) and the FACE (a questionnaire completed by the doctor). The procedures and philosophy of interventions are defined and validated, and training is available for all providers who want to acquire this practice. This original research activity leads to a new public health effort. WHO, the national association for prevention of alcoholism and addiction, and various public health agencies have developed the experimental program 'Drinking less is better', intended to adapt WHO tools for early identification and brief intervention (EIBI) to French medical practice. This research-activity was conducted in close association with its targets (especially general practitioners) and has contributed to defining the conditions for the diffusion of this EIBI in France. Based on its conclusions, the health authorities have launched a national training strategy.