Alcohol brief interventions

Evidence Rating  
Evidence rating: Scientifically Supported

Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.

Disparity Rating  
Disparity rating: Inconclusive impact on disparities

Strategies with this rating do not have enough evidence to assess potential impact on disparities.

Health Factors  
Decision Makers
Date last updated

Alcohol brief intervention programs, also called alcohol screening & brief interventions, provide information and increase motivation to change or prevent problematic alcohol consumption in a short session; sessions usually last five to ten minutes, with a maximum duration of one hour. Brief interventions often include screening, feedback on clients’ behavior, and advice and decision making support to encourage change1. Such interventions can be administered in person or virtually by health care providers, trained counselors, social workers, or others2.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Reduced alcohol use

  • Reduced excessive drinking

  • Reduced underage drinking

  • Reduced alcohol-related harms

What does the research say about effectiveness?

There is strong evidence that alcohol brief interventions reduce alcohol consumption and excessive drinking among adults when administered in primary care3, 4, 5, 6, 7 and general hospital settings8, 9, 10, and reduce alcohol consumption among adolescents and young adults when administered in school and college settings1, 11, 12, 13. Such interventions have also been shown to modestly reduce alcohol-related injuries6, 14.

Brief interventions in emergency departments appear to modestly decrease alcohol consumption and heavy drinking among patients who are injured or intoxicated15, 16. Brief interventions in primary care settings may be similarly effective between men and women4, though women may be less likely to drink and more likely to pursue treatment when brief interventions are delivered in general hospital settings8. Brief interventions for pregnant women appear to modestly increase rates of abstinence from alcohol during pregnancy and prevent preterm births17. People living with HIV, a third of whom have an alcohol use disorder, appear likely to reduce the number of drinks per day and excessive drinking episodes when they receive brief interventions, which lowers their mortality risk18. Brief interventions may reduce excessive drinking in older adults, however more research is needed to understand effects19, 20. The effect of brief interventions on people with mental health conditions is unclear21.

School-based alcohol brief interventions can reduce alcohol consumption among adolescents1, especially when individually delivered22. Effects on adolescents in hospital settings are mixed and vary by type of intervention3, 23; brief interventions with motivational interviewing techniques can reduce heavy alcohol use and substance-related problems for adolescents with substance use disorders24. Brief interventions can reduce driving after drinking among college students, especially when delivered using motivational interviewing techniques with personalized feedback25. Several brief interventions programs can be effective for college students: for example, BASICS may be the most effective and better suited for students at higher risk while THRIVE and e-CHUG may work best for universal prevention efforts11.

Electronic screening and brief interventions (e-SBI) reduce alcohol consumption26, especially among youth and college students; effects are strongest in the short-term26, 27, 28. E-SBI conducted in college, health care, and community settings can also reduce excessive drinking and alcohol-related harms2.

Training physicians and nonphysician practitioners to deliver brief interventions appears to support effective implementation29. Alcohol brief interventions appear to be cost effective approaches to reduce harmful alcohol consumption and health care utilization6, 7, 30, 31. The cost-effectiveness ratio of brief interventions is calculated to be a $0.40 to $303 per drinks reduced per week, with a benefit-cost ratio of $39 per dollar invested32. Delivering brief interventions to pregnant women is likely a cost-effective approach for reducing cases of fetal alcohol spectrum disorder (FASD). Preventing one case of FASD costs just 3% of the total costs required to provide services to an individual with FASD over their lifetime17.

How could this strategy advance health equity? This strategy is rated inconclusive impact on disparities.

It is unclear what impact alcohol brief interventions can have on disparities in alcohol consumption and alcohol-related harms.

Brief interventions that utilize motivational interviewing techniques may be effective regardless of gender, race, or ethnicity38. Brief alcohol interventions delivered by community health workers may have the potential to reduce alcohol use and alcohol-related problems in Hispanic communities, who experience higher rates of unhealthy alcohol use and morbidity, and lower access to addiction treatment39. People living with HIV are particularly at risk of having an alcohol use disorder, which negatively affects their HIV treatment and increases their morbidity and mortality. It appears that individual-level brief interventions delivered in clinical and community settings are effective at improving alcohol outcomes and reducing mortality risk in people living with HIV18.

A California-based study suggests women, particularly women of color, are less likely to receive brief interventions in primary care settings than men40. A study of patients in the Veterans Administration (VA) health systems suggests that Black women and men, and Asian/Pacific Islander women are less likely to receive brief interventions34. Evidence indicates that race and ethnicity do not moderate treatment effects of brief interventions, suggesting that if disparities in receipt of brief interventions are closed, effects should be equal38. There seem to be slight differences in receiving brief screening and interventions across sexual minority and heterosexual adults: lesbian women appear to be asked about heavy drinking more often in health care settings and gay men appear to receive brief interventions less often than heterosexual men who consume similar amounts of alcohol41. Experts suggest that reducing disparities in receiving alcohol-related care may require targeted interventions34, 39.

The available evidence of the effectiveness of brief interventions in young adults appears to be representative of white college-age students, highlighting the need for additional research evaluating the effectiveness among other young adult subpopulations, such as those with minoritized identities42.

What is the relevant historical background?

Alcohol is deeply rooted in American life and history. Prior to the American Revolution, alcohol was perceived as an invigorating and restorative beverage that did not spoil easily and was safer than water. Its taxation provided a major source of revenue for colonial governments43. After the American Revolution, the temperance and women’s rights movements shifted societal perspectives of alcohol and led efforts for its banishment. These efforts led to the adoption of the 18th Amendment in 1920, which banned the manufacture, sale, and transport of alcohol across the U.S., also known as Prohibition44. Prohibition ended in 1933 in large part because of the need to generate tax revenue and stimulate job growth during the Great Depression and gave states authority to regulate alcohol, and each have approached regulation differently43. Today, the federal government has limited authority to impose national-level rules and regulations and there continues to be a patchwork of alcohol regulations that vary by state. Some state legislatures have preempted local government from implementing certain regulations and laws45.

Throughout history, alcohol misuse was seen as a personal failing. This evolved over the 19th century as the addictive properties of alcohol were understood43. Alcohol use disorder is now seen as a chronic disease that is influenced by genetics, neighborhood disadvantage, stress, access to alcohol, drinking cultures and contexts, and alcohol-industry influences46, 47. In 1957, alcohol brief interventions were first used to allow a psychiatrist and social worker to refer patients in the emergency department to outpatient alcohol treatment. Towards the end of the 20th century, alcohol brief interventions became a more established practice in a variety of environments48.

Equity Considerations
  • What are the disparities in alcohol use disorders in your community? What groups are most affected?
  • What are the barriers to high quality linguistically and culturally appropriate alcohol screening and intervention? How are interventions tailored to reflect the cultures of people in your community?
  • How can alcohol screening and intervention be more equitably delivered in community, hospital, and primary care settings? What resources and partnership opportunities exist in your community to increase access to these services?
  • What barriers, like stigma, are preventing people from accessing information about alcohol and available treatment services? What additional strategies can be implemented to overcome those barriers?
Implementation Examples

The Substance Abuse and Mental Health Services Administration (SAMHSA)’s Screening, Brief Intervention, Referral and Treatment (SBIRT) program conducts demonstration projects across the country that assess and disseminate information on new SBIRT methods33. In the Veterans Administration (VA) health systems, the largest integrated health care system in the U.S., alcohol screening and brief intervention is universal34. Example intervention programs for college students include Brief Alcohol Screening and Intervention for College Students (BASICS), which takes a harm prevention approach35, and Alcohol eCHECKUP TO GO (eCHUG), a resource-intensive program that uses normative feedback11, 36. Additionally, there are brief interventions that focus on supporting pregnant women, such as CHOICES, that can be effectively tailored for minoritized communities, such as indigenous communities37.

Implementation Resources

Resources with a focus on equity.

SAMHSA-SBIRT - Substance Abuse and Mental Health Services Administration (SAMHSA). Screening, brief intervention, and referral to treatment (SBIRT).

IRETA-SBIRT toolkit - Institute for Research, Education, & Training in Addictions (IRETA). Screening, Brief Intervention & Referral to Treatment (SBIRT) toolkit.

CDC-SBI 2014 - Centers for Disease Control and Prevention (CDC). Planning and implementing screening and brief intervention for risky alcohol use: A step-by-step guide for primary care practices. Atlanta, GA: Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities (NCBDDD); 2014.

CDC-SBI Tribal 2018 - Centers for Disease Control and Prevention (CDC). Planning and implementing screening and brief intervention for risky alcohol use: A step-by-step guide for tribal communities. Atlanta, Georgia: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities; 2018.

NIAAA-SBI youth - National Institute on Alcohol Abuse and Alcoholism (NIAAA). Alcohol screening and brief intervention for youth: A practitioner's guide. National Institutes of Health (NIH), U.S. Department of Health and Human Services (U.S. DHHS); 2011.

NHMA-SBIRT 2006 - National Hispanic Medical Association (NHMA). NHMA screening and brief intervention toolkit for the Hispanic patient. Washington, D.C.: National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (U.S. DOT); 2006.

CDC-Higgins-Biddle 2009 - Higgins-Biddle J, Hungerford D, Cates-Wessel K. Screening and brief interventions (SBI) for unhealthy alcohol use: A step-by-step implementation guide for trauma centers. Atlanta: Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC); 2009.

APHA-SBI Manual 2008 - American Public Health Association and Education Development Center, Inc (APHA). Alcohol screening and brief intervention: A guide for public health practitioners. Washington, D.C.: National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (U.S. DOT); 2008.


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4 Cochrane-Kaner 2018 - Kaner EFS, Beyer FR, Muirhead C, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews. 2018;(2):CD004148.

5 Alvarez-Bueno 2015 - Álvarez-Bueno C, Rodríguez-Martín B, García-Ortiz L, Gómez-Marcos MÁ, Martínez-Vizcaíno V. Effectiveness of brief interventions in primary health care settings to decrease alcohol consumption by adult non-dependent drinkers: A systematic review of systematic reviews. Preventive Medicine. 2015;76(Suppl):S33-S38.

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7 WHO-SBI - World Health Organization (WHO). Screening and brief intervention for alcohol problems in primary health care.

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21 Boniface 2018 - Boniface S, Malet-Lambert I, Coleman R, et al. The effect of brief interventions for alcohol among people with comorbid mental health conditions: A systematic review of randomized trials and narrative synthesis. Alcohol and Alcoholism. 2018;53(3):282-293.

22 Hennessy 2015 - Hennessy EA, Tanner-Smith EE. Effectiveness of brief school-based interventions for adolescents: A meta-analysis of alcohol use prevention programs. Prevention Science. 2015;16(3):463-474.

23 Samson 2019 - Samson JE, McHugh RM. Brief alcohol interventions for adolescents and young adults in emergency department settings: A descriptive review and meta-analysis. Adolescent Research Review. 2019;4(3):313-327.

24 Steele 2020 - Steele DW, Becker SJ, Danko KJ, et al. Brief behavioral interventions for substance use in adolescents: A meta-analysis. Pediatrics. 2020;146(4):e20200351.

25 Mun 2022 - Mun EY, Li X, Lineberry S, et al. Do brief alcohol interventions reduce driving after drinking among college students? A two-step meta-analysis of individual participant data. Alcohol and Alcoholism. 2022;57(1):125-135.

26 Sohi 2023 - Sohi I, Shield KD, Rehm J, Monteiro M. Digital interventions for reducing alcohol use in general populations: An updated systematic review and meta-analysis. Alcohol, Clinical and Experimental Research. 2023;47(10):1813-1832.

27 Campbell-Smedslund 2017 - Smedslund G, Wollscheid S, Fang L, et al. Effect of early, brief computerized interventions on risky alcohol and cannabis use among young people. Campbell Systematic Reviews. 2017;6.

28 Donoghue 2014 - Donoghue K, Patton R, Phillips T, Deluca P, Drummond C. The effectiveness of electronic screening and brief intervention for reducing levels of alcohol consumption: A systematic review and meta-analysis. Journal of Medical Internet Research. 2014;16(6):e142.

29 Loughran 2021 - Loughran TA, Scharer JL, Rodriguez L, et al. Brief alcohol interventions in U.S. medical settings: A systematic review of the implementation literature. Journal of Substance Abuse Treatment. 2021;131:108456.

30 Barbosa 2020 - Barbosa C, McKnight-Eily LR, Grosse SD, Bray J. Alcohol screening and brief intervention in emergency departments: Review of the impact on healthcare costs and utilization. Journal of Substance Abuse Treatment. 2020;117:108096.

31 IAS-Anderson 2006 - Anderson P, Baumberg B. Alcohol in Europe: A public health perspective. London, UK: Institute of Alcohol Studies (IAS); 2006.

32 Le 2023a - Le LK-D, Faller J, Chatterton M Lou, et al. Interventions to prevent alcohol use: Systematic review of economic evaluations. BJPsych Open. 2023;9(4):e117.

33 SAMHSA-SBIRT - Substance Abuse and Mental Health Services Administration (SAMHSA). Screening, brief intervention, and referral to treatment (SBIRT).

34 Chen 2020b - Chen JA, Glass JE, Bensley KMK, et al. Racial/ethnic and gender differences in receipt of brief intervention among patients with unhealthy alcohol use in the U.S. Veterans Health Administration. Journal of Substance Abuse Treatment. 2020;119:108078.

35 Blueprints-BASICS - Blueprints for healthy youth development: Brief Alcohol Screening and Intervention for College Students (BASICS).

36 eCHUG - Alcohol eCHECKUP TO GO. Strengthen a culture of safety and well-being at your institution by reducing harms from alcohol use.

37 Deutsch 2021 - Deutsch AR, Lustfield R, Hanson JD. Where there’s a will, there’s a way? Strategies to reduce or abstain from alcohol use developed by Northern Plains American Indian women participating in a brief, alcohol-exposed pregnancy preconceptual intervention. Alcoholism: Clinical and Experimental Research. 2021;45(11):2383-2395.

38 Contreras-Perez 2024 - Contreras-Pérez ME, Wagner E, Hospital M, et al. Outcomes of a brief motivational intervention for heavy alcohol use in racial or ethnic minority compared to white emerging adults. Journal of Evidence-Based Social Work. 2024;21(1):75-89.

39 Carson 2023 - Carson M, Fernandez A, Martin M. A review of community health worker interventions for Latinx/o/a individuals with unhealthy alcohol use. Journal of Addiction Medicine. 2023;17(6):717-721.

40 Parthasarathy 2023 - Parthasarathy S, Chi FW, Metz V, et al. Disparities in the receipt of alcohol brief intervention: The intersectionality of sex, age, and race/ethnicity. Addiction. 2023;118(7):1258-1269.

41 Lehavot 2017 - Lehavot K, Blosnich JR, Glass JE, Williams EC. Alcohol use and receipt of alcohol screening and brief intervention in a representative sample of sexual minority and heterosexual adults receiving health care. Drug and Alcohol Dependence. 2017;179:240-246.

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