Alcohol interventions: do the best things come in small packages?

Several extensive reviews have highlighted the effectiveness of brief alcohol interventions. The same reviews were pessimistic about the role of more intensive, specialist treatments. It is argued here that the research evidence should be interpreted with caution. There are problems of generalizability of the research, and studies focusing on brief interventions in the primary health care field are largely not comparable with clinical trials conducted in the specialist setting. The efficacy of brief interventions as a routine mass intervention approach has been exaggerated. Even after extensive research, little is known of the effective ingredients and the most effective methods of delivery. Reviews of brief interventions have been overly selective, and meta analysis in this area is problematic. It is argued that such reviews lead to overgeneralization and turn attention away from promising specialist treatment approaches. More research is needed into identifying the target group most likely to benefit from brief interventions, cost effectiveness, and into shared care and stepped care approaches, before embarking on a major shift in treatment policy towards brief interventions.