Background: This report describes the 48-month efficacy and
benefit-cost analysis of Project TrEAT (Trial for Early Alcohol Treatment),
a randomized controlled trial of brief physician advice for the treatment
of problem drinking.
Methods: Four hundred eighty-two men and 292 women, ages 18–65,
were randomly assigned to a control (n = 382) or intervention (n = 392)
group. The intervention consisted of two physician visits and two nurse
follow-up phone calls. Intervention components included a review of normative
drinking, patient-specific alcohol effects, a worksheet on drinking cues,
drinking diary cards, and a drinking agreement in the form of a prescription.
Results: Subjects in the treatment group exhibited significant
reductions (p < 0.01) in 7-day alcohol use, number of binge drinking
episodes, and frequency of excessive drinking as compared with the control
group. The effect occurred within 6 months of the intervention and was
maintained over the 48-month follow-up period. The treatment sample also
experienced fewer days of hospitalization (p = 0.05) and fewer emergency
department visits (p = 0.08). Seven deaths occurred in the control group
and three in the treatment group. The benefit-cost analysis suggests a
$43,000
reduction in future health care costs for every $10,000 invested in early
intervention. The benefit-cost ratio increases when including the societal
benefits of fewer motor vehicle events and crimes.
Conclusions: The long-term follow-up of Project TrEAT provides
the first direct evidence that brief physician advice is associated with
sustained reductions in alcohol use, health care utilization, motor vehicle
events, and associated costs. The report suggests that a patient’s personal
physician can successfully treat alcohol problems and endorses the implementation
of alcohol screening and brief intervention in the US health care system.