“Brief in-office counseling in a medical setting may trigger significant
behavior changes and control excessive drinking in patients who already
display alcohol-induced [liver disease],” say Charles S. Lieber,
M.D., and other researchers from Veterans Affairs Medical Centers around
the country. Reduced drinking has been shown to decrease alcohol-related
problems.
The study appears in the November issue of the journal Alcoholism:
Clinical and Experimental Research.
The 789 patients (almost all men) who began the study averaged 16 drinks
a day at its start. They all had some form of liver disease, a common consequence
of alcoholism. All patients were first referred to a standard 12-step alcoholism
treatment program but 80 percent refused to attend.
Instead, all patients were asked to visit the clinic monthly for brief
sessions with a doctor and longer sessions with a nurse. Every six months,
the physicians performed a physical exam and counseled the patients in
a more extensive encounter.
In these one-on-one meetings, the nurses and doctors emphasized feedback
about risks of drinking, advice on how to change behavior, and a menu of
alternative change options. They also tried to encourage optimism and personal
responsibility for change on the part of the participants.
During a minimum of two years, these heavy drinkers maintained a decrease
in their alcohol consumption from an average of 16 drinks a day to 2.5
drinks a day, says Lieber. Almost one in five stopped drinking entirely.
“The remarkable finding of this study is that close to 70 percent
of the patients who were heavy drinkers at entry ended up by not drinking,
or consuming two drinks a day or less per day for two years or more,” he
says. Almost half the patients dropped out before completing the study,
but the differences between those who stayed and those who left were
small.
The approach used by the VA in this study, termed “Brief Intervention,” has
been shown to be more cost effective than rigid programs that insist
on total abstinence from drinking, says Lieber.
“The Brief Intervention approach recognizes abstinence as the ultimate
goal, but accepts relapses and deviations,” he says. “Sustained
abstinence is often an elusive goal for many who suffer from episodic
relapses.”
Half the patients in the trial were also given PPC, a drug previously
shown to prevent alcoholic cirrhosis of the liver in animals. The other
half took a placebo. Lieber and his colleagues had high hopes for the drug,
which blocks the effects of alcohol on liver cells. PPC works best in heavy
drinkers, and some benefits were seen among patients who were still drinking
five or six drinks a day.
Neither the drug nor the reduction in drinking attributed to counseling
eliminated the risk of further liver injury, he says. About one in five
patients still saw a worsening of their liver disease, whether or not they
were taking the drug. Patients who cut back on their drinking did experience
a slower progression of liver disease, compared to what would have happened
had they continued drinking heavily.
