***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: AIMS ( i ) To evaluate the effect of receiving one of two brief interventions in reducing alcohol consumption among general hospital patients compared with usual care . ( ii ) To assess whether a brief intervention of self-efficacy enhancement was superior to a self-help booklet in reducing alcohol consumption . DESIGN A three-arm cluster r and omized controlled trial . SETTING Seven general medical , six general surgical , one dermatology and two otolaryngology wards of a large teaching hospital covering a large urban and rural area . PARTICIPANTS A total of 215 of 789 in- patients aged 18 - 75 years , who screened positive for alcohol consumption in excess of national recommended limits according to a 7-day retrospective drinking diary . INTERVENTIONS Participants were allocated to receive one of three interventions : ( i ) face-to-face self-efficacy enhancement ; ( ii ) a self-help booklet ; or ( iii ) usual care . MEASUREMENTS The primary outcome measure was change in reported alcohol consumption at 6-month follow-up as measured by a 7-day retrospective drinking diary . Secondary outcomes were change in : number of alcohol drinking days in last week ; the maximum units of alcohol consumed on any one day in last week ; and Drinking Refusal Self-efficacy Expectancy Question naire score . FINDINGS Compared to the usual care group the self-efficacy enhancement group ( -10.1 units 95 % CI -16.1 to -4.1 ) and the self-help booklet group ( -10.0 units 95 % CI -16.0 to -3.9 ) had greater reductions in self-reported weekly alcohol consumption . There was no evidence that self-efficacy enhancement was superior to the self-help booklet ( P = 0.96 ) . CONCLUSIONS Brief interventions delivered in hospital offer simple means of helping heavy drinkers to reduce their alcohol consumption Seven hundred and thirty one men admitted to medical wards were interviewed to identify problem drinkers who had not received previous treatment for alcoholism and who had some social support . One hundred and sixty one met the diagnostic criteria ; 156 agreed to a follow up interview and were allocated to one of two groups . One group received a session of counselling about their drinking habits from a nurse while the other received only routine medical care . Both groups reported a reduction in alcohol consumption when interviewed 12 months later , but the counselled group had a significantly better outcome than the control group . It is concluded that systematic screening for alcohol consumption and related problems should become a routine part of medical assessment and that advice on drinking habits is effective if given before irreversible physical or psychosocial problems have developed Context Brief interventions reduce alcohol use in out patients who drink unhealthy amounts but are not alcohol-dependent . Their effect in medical in patients is unknown . Contribution The authors screened all adult medical in patients at an urban teaching hospital and r and omly assigned 341 risky drinkers to a 30-minute motivational counseling intervention followed gy treatment planning or to usual care . By 3 months , the same proportion of patients from both groups had received alcohol assistance , and both groups had reduced their drinking to the same degree . Caution s Three quarters of the participants met Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , criteria for alcohol dependence . Implication s In this well-done study , brief intervention did not affect alcohol-related outcomes in persons who drank unhealthy amounts . The Editors Professional organizations recommend that clinicians screen their patients for unhealthy alcohol use ( that is , the spectrum from drinking risky amounts to dependence ) and conduct a brief intervention when indicated ( 1 , 2 ) . Despite this recommendation and the existence of brief , valid screening tools ( 35 ) , patients with unhealthy alcohol use often are not identified and do not receive timely care . Although widely recommended , brief intervention has proven efficacy in decreasing alcohol consumption and related consequences only in unhealthy drinkers without alcohol dependence and in outpatient setting s ( 6 ) . Its efficacy among other population s ( for example , persons with alcohol dependence ) and in inpatient setting s remains unclear ( 7 ) . Evidence suggests , however , that medical in patients a group with a high prevalence of alcohol-related problemsmay benefit from brief intervention . Some studies have demonstrated the efficacy of brief intervention in setting s similar to medical services in which alcohol-related problems are common and their related consequences are severe ( 8 , 9 ) . Further , brief interventions are well suited to medical services . Patients who otherwise might not seek care are accessible and have time for an intervention . Persons admitted because of an alcohol-related problem may recognize the link between drinking and hospitalization , thus providing a teachable moment ( 10 ) . Also , busy staff might implement a brief intervention because of its brevity and flexibility . The unmet need for alcohol screening and intervention and opportunities for implementation underscore the importance of determining the efficacy of brief intervention in medical in patients with unhealthy alcohol use . In addition , evaluating its effectiveness and practicality in real-world setting s is critical to help clinicians make informed decisions when treating their patients ( 11 ) . Therefore , we conducted a r and omized , controlled trial to examine whether screening followed by brief intervention would improve alcohol-related outcomes in typical medical in patients ( that is , a racially diverse group with a range of unhealthy alcohol use , comorbid conditions , and readiness to change ) . We hypothesized that screening and brief intervention would lead to the following : receipt of alcohol assistance ( for example , specialty treatment ) among persons with alcohol dependence and , among all persons decreased alcohol consumption , alcohol-related problems , and health care utilization and improved readiness to change and health-related quality of life . Methods Patients As previously described , we recruited patients from the inpatient medical service of a large , urban teaching hospital ( 12 ) . Trained research associates approached all patients who were age 18 years or older and whose physicians did not decline patient contact . Patients fluent in English or Spanish who gave verbal consent were asked to complete a screening interview to determine eligibility : currently ( past month ) drinking risky amounts ( defined for eligibility as > 14 st and ard drinks/wk or 5 drinks/occasion for men and > 11 drinks/wk or 4 drinks/occasion for women and persons 66 years ) ; 2 contacts to assist with follow-up ; no plans to move from the area in the next year ; and a Mini-Mental State Examination score of 21 or greater ( 13 , 14 ) . Research associates assessed demographic characteristics and administered the  Alcohol Use Disorders Identification Test ( AUDIT )  ( 15 ) by interview . To better characterize current alcohol use , they assessed the average numbers of drinking-days per week and drinks consumed on a typical day , and the maximum number of drinks consumed per occasion ( 16 , 17 ) . For the first 7 months of the study , research associates asked these additional questions only to patients with an AUDIT score of 8 or greater ( a recommended cutoff for screening ) ( 18 ) . For the remaining 22 months , research associates asked the additional questions to anyone who drank in the past 12 months to maximize identification of drinkers of risky amounts . Lastly , the research associates asked all patients who were drinking risky amounts to describe their readiness to change by using a visual analog scale ranging from 0 to 10 ( 19 ) . Enrolled patients provided written informed consent and were compensated for each completed interview . The institutional review board at Boston University Medical Center approved this study . We secured additional privacy protection with a certificate of confidentiality from the National Institute on Alcohol Abuse and Alcoholism . Assessment at Enrollment Research associates interviewed patients before r and omization to assess the characteristics shown in Table 1 . One author review ed the medical records to determine medical diagnoses ( 29 ) . Diagnoses of alcohol use disorders were based on the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( 30 ) , and were determined with the Composite International Diagnostic Interview ( CIDI ) Alcohol Module ( 31 , 32 ) . Table 1 . Characteristics at Enrollment of All Study Patients and of the Subgroup with Alcohol Dependence * R and omization and Intervention An off-site data management group generated assignments to control and intervention groups by using a permuted block ( size 8) r and omization procedure stratified by AUDIT score ( < 12 vs. 12 ) and provided us the assignments in sealed opaque envelopes . We used the AUDIT score to stratify because we could not score the CIDI before r and omization . After each baseline assessment , research associates opened an envelope and informed the patient of his or her assignment . Patients in the control group received usual care ( that is , they were told the screening results and that they could discuss their drinking with their physicians ) . Specialists were available by referral . Systematic alcohol screening and brief intervention were not routine at this hospital . We assigned patients in the intervention group to a 30-minute session of brief motivational counseling ( 19 , 33 ) conducted by counseling and clinical psychology doctoral students whom we trained and supervised . Sessions were audiotaped and included feedback , an open discussion , and construction of a change plan ( Appendix ) . Outcomes and Measurements The first primary outcome was self-reported receipt of alcohol assistance in the past 3 months by patients with CIDI-determined alcohol dependence . This outcome was measured at the 3-month follow-up visit with a st and ardized interview based on the Treatment Services Review ( 34 ) and Form 90 ( 35 ) . Assistance included residential treatment , outpatient treatment ( for example , specialty counseling or therapy ) , medications , employee assistance programs , or mutual-help groups ( for example , Alcoholics Anonymous ) . The other primary outcome was the change in the number of mean drinks per day in the past 30 days from enrollment to 12 months among all patients . We determined consumption with the Timeline Follow-back method ( 36 ) . Five secondary consumption outcomes ( past 30 days ) included changes from enrollment to 12 months in the numbers of heavy drinking episodes ( 5 drinks/occasion for men and 4 drinks/occasion for women and for persons 66 y ) and days abstinent ; and the proportions of patients drinking risky amounts ( > 14 drinks/wk or 5 drinks/occasion for men and > 7 drinks/wk or 4 drinks/occasion for women and persons 66 y ) ( 37 ) , having 1 or more heavy drinking episodes , and abstaining for all 30 days . Other secondary outcomes included the changes at 12 months in readiness to change ( Taking Steps scale on the Stages of Change Readiness and Treatment Eagerness Scale ) ( 38 ) , alcohol problems ( total score on the Short Inventory of Problems ) ( 39 ) , physical and mental health-related quality of life ( Physical and Mental Component Summary scale scores on the Short-Form Health Survey ) ( 40 ) , and emergency department visits and days of medical hospitalization ( both determined by a st and ardized interview based on the Treatment Services Review and Form 90 ) ( 34 , 35 ) . Follow-up Procedures Research associates conducted follow-up visits , which included re assessment of most domains covered at enrollment , usually in person and at 3 and 12 months ( 10 % and 13 % , respectively , by telephone ; similar by r and omized group ) . They performed  alcohol breath tests  at in-person follow-up visits ( 41 ) . Although they were involved in the r and omization assignment , research associates were not involved in the intervention . Further , 64 % of patients at 3-month follow-up and 85 % of patients at 12-month follow-up were interviewed by a different research associate than at baseline . Statistical Analysis We analyzed all patients in the groups to which they were r and omly assigned . Reported P values are 2-tailed and are considered statistically significant if they were less than 0.05 . We analyzed data with SAS/STAT software , versions 8.2 and 9.1.3 ( SAS Institute , Inc. , Cary , North Carolina ) . To describe the study sample and to compare groups , we used the chi-square test , Fisher exact test , 2- sample t test , and Wilcoxon rank-sum test , as appropriate . For the primary analyses , we used logistic and Patients admitted to an emergency surgical ward were screened for alcohol problems and r and omized between an extensive alcohol counseling and a brief assessment followed by feedback of risky alcohol consumption . Some 165 patients were assessed for risk consumption and followed up 6 to 12 months , and it was found that patients in both interventions significantly reduced the amount they drank per occasion although they drank as often as before . The patients had also moved to a stage more ready to change . No differences in effect were found between the interventions . A brief assessment with feedback about risk consumption can be done on an emergency surgical ward by the surgical staff with a few hours of training and may reduce risky alcohol consumption significantly OBJECTIVE Unhealthy alcohol use is common in medical in patients , and hospitalization has been hypothesized to serve as a " teachable moment " that could motivate patients to decrease drinking , but studies of hospital-based brief interventions have often not found decreases . Evaluating associations between physical health and subsequent drinking among medical in patients with unhealthy alcohol use could inform refinement of hospital-based brief interventions by identifying an important foundation on which to build them . We tested associations between poor physical health and drinking after hospitalization and whether associations varied by alcohol dependence status and readiness to change . METHODS Participants were medical in patients who screened positive for unhealthy alcohol use and consented to participate in a r and omized trial of brief intervention ( n = 341 ) . Five measures of physical health were independent variables . Outcomes were abstinence and the number of heavy drinking days ( HDDs ) reported in the 30 days prior to interviews 3 months after hospitalization . Separate regression models were fit to evaluate each independent variable controlling for age , gender , r and omization group , and baseline alcohol use . Interactions between each independent variable and alcohol dependence and readiness to 
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Furthermore screening , asking participants about their drinking patterns , may also have a positive impact on alcohol consumption levels and changes in drinking behaviour .
AUTHORS ' CONCLUSIONS The main results of this review indicate that there are benefits to delivering brief interventions to heavy alcohol users admitted to general hospital wards in terms of reduction in alcohol consumption and death rates .