Outpatient led intervention did not decrease heavy drinking at one year

1. In this randomized controlled trial, there was no significant difference between the CHOICE intervention (intervention led by nurse care managers) and usual care in decreasing heavy drinking and alcohol-related symptoms in outpatients that reported heavy drinking at baseline.

2. Participants in the intervention group received more alcohol-related care including alcohol-use disorder (AUD) medications.

Evidence Rating Level: 2 (Good)

Study Rundown: Alcohol use disorder (AUD) that is a public health issue where less than 20% of those with AUDs receive treatment. It is thought that management of AUD can be done in primary care however the most effective treatment plan is unknown. This randomized controlled trial aimed to test whether 12 months of alcohol care management led by nurse care managers, compared with usual care, improved drinking outcomes among patients with or at high risk of AUDs.

Despite having increased alcohol-related care (AUD medication use, motivational interviewing and shared decision making) participants in the CHOICE intervention did not have a significant difference as compared to usual care with regards to percentage of heavy drinking in the prior 28 days and no alcohol-related symptoms in the past 3 months. This was non-significant at both 3 months and 12 months post-intervention. Limitations of this study included use of multistep recruitment that may have motivated patients receiving usual care to change or seek care perhaps biasing towards the null.

Click to read the study in JAMA Internal Medicine

Relevant Reading: Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence The COMBINE Study: A Randomized Controlled Trial

In-Depth [randomized controlled trial]: This randomized trial was conducted at three Veterans Affairs (VA) primary care clinics between October 2011 and September 2014, and included 304 participants. Participants were adults who reported heavy drinking (≥ 4 drinks per day for women or ≥5 drinks per day for men). Exclusion criteria included those with acute medical or psychiatric instability, alcohol treatment in the previous 90 days, cognitive impairment, end-of-life care, current or planned pregnancy and those leaving or planning to leave the VA system. Patients were randomized 1:1 to usual VA primary care or usual care with Choosing Healthier Drinking Options in Primary Care (CHOICE) intervention (AUD medication administration, motivational interviewing). The primary outcome, which was assessed by blinded telephone interviewers at 12-months, was the percentage of heavy drinking days in the prior month and no alcohol-related symptoms in the past 3 months. Intention-to-treat analysis was used.

Of the 304 participants, 90% were male and the mean age was 51.4 years. One hundred fifty were randomized to the CHOICE intervention and 154 to usual care. Both groups reported heavy drinking on 61% of days (95% CI 56%-66%). The intervention group had nursing visits and received more alcohol-related care and AUD medication than the usual care group. Despite this, at 12 months, there were no significant differences in the primary outcome between both groups (P=0.32 to 0.44).

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