Telephone counseling coaxes reluctant alcoholics into treatment

Telephone counseling might be an effective primary care intervention for men who are not seeking treatment for their alcohol dependence or abuse, according to a new study.

Men benefited more from the short-term telephone counseling used in the study, which appears in the August issue of the journal Alcoholism: Clinical and Experimental Research.

Lead researcher Richard Brown, M.D., said that the study could empower time-strapped doctors to persuade reluctant alcoholism patients to seek treatment.

“The study shows that we shouldn't just give up on those alcohol-dependent patients who cannot or choose not to get treatment. If we can identify these folks in primary care waiting rooms and provide telephone counseling … we can start to help many of these patients,” said Brown, of the University of Wisconsin School of Medicine and Public Health.

The researchers looked at nearly 900 men and women with alcohol abuse or dependence, recruiting study participants from primary care clinic waiting rooms in Madison and Milwaukee. The 445 people in the experimental group received up to six protocol-based phone interventions from counselors trained in a technique called motivational interviewing. The 452 members of the control group received a short pamphlet on healthy lifestyles.

Enrollment in the study was voluntary, and the researchers paid patients a small fee at each step; no participant earned more than $125. Members of the experimental group had assigned counselors who helped them identify their goals and examine how their alcohol use affected the achievement of those goals. Counselors gave feedback on the pitfalls and ramifications of alcohol use.

“Getting patients to participate in the counseling sessions was actually much easier than we thought it would be,” Brown said. “Once they had established rapport with that counselor over the phone, many patients really looked forward to their sessions.”

Of particular interest was the experimental treatment's effect on men with alcohol dependence, which — unlike alcohol abuse — results in changes in brain physiology. Alcohol-dependent men receiving the counseling reduced both their total alcohol consumption and “risky drinking days” over a three-month period, with risky drinking days declining the most, by 31.8 percent. Peers who received only the self-help literature cut back by 9.7 percent over the same period.

Women who received phone counseling reduced their drinking behaviors as well, but their improvements were not significantly different from those achieved by women in the control group.

Petros Levounis, M.D., director of the Addiction Institute of New York at St. Luke's and Roosevelt Hospitals, agreed with the study conclusions. “This is exactly the direction that we should be working toward. We can actually help our patients through the phone and provide support and counseling with different methods, not just with the more traditional one-to-one psychotherapy.” Levounis, who was not involved with the study, said the prevalence of alcohol disorders makes screening and brief intervention in primary care settings necessary.

The authors noted that the study enrollment interview itself had an effect on drinking behaviors — independent of the counseling intervention — and said that patient tracking and follow-up posed a challenge. The researchers are currently studying the durability of treatment benefits over a 12-month period.