Interpreting the evidence on brief interventions for excessive drinkers: the need for caution

Two recent reviews of the evidence on brief interventions in the alcohol field reach highly favourable conclusions regarding their effectiveness and cost-effectiveness. However, both can be criticized on three grounds: (1) they pay insufficient regard to important differences within the family of brief interventions; (2) they do not sufficiently emphasize the crucial distinction between brief interventions among treatment seekers and non-treatment seekers; and (3) they arrive at over-optimistic and uncritical conclusions. While not wishing to dampen enthusiasm for the potential of brief interventions in reducing alcohol-related harm, the present article argues that, if the evidence is not to be misinterpreted by policy makers and purchasers of services, differences between brief interventions must be borne in mind and analyses of effectiveness in the treatment-seeking population must be clearly separated from those in the area of opportunistic interventions in the non-treatment-seeking population. The evidence for the effectiveness of opportunistic brief interventions is much stronger than for brief interventions in specialist settings for those seeking help, where their most prudent application should be restricted to patients with problems of relatively low severity.