[How can primary health care influence patients' alcohol drinking habits. "Simple intervention" results in a new...

A review of findings in randomised trials with at least one-year follow-up suggests that primary care physicians can intervene briefly and successfully for patients manifesting symptoms of excessive drinking but no serious dependence. The risk level can be assessed by summing the preceding week's intake of spirits, wine and beer in standard measures and then convert it into grams of pure alcohol. Denial is minimised by using a non-judgmental lifestyle approach, and defining problems in terms of lifestyle habits and its consequences. Nervous problems, hypertension and dyspepsia are the most common diagnoses in the target group. Measurement of biochemical markers can be used, the serum gamma-glutamyl transpeptidase (GGT) level being still the most useful. Questionnaires are of limited value as they are associated with high false-positive rates. To motivate patients to reduce alcohol consumption, an intervention strategy with feedback is proposed, mainly based on the monitoring of symptoms and clinical findings including biochemical markers, and a self-help pamphlet is recommended. It is emphasised that the goal should be realistic to the patient, and that controlled drinking is an acceptable goal even in cases of mild dependence.