A rapid review of evidence on the effectiveness and implementation of conversation-based interventions about alcohol in primary care settings

Dr. Andrea Mohan¹, Shona Shinwell² and Dr. Paul Toner¹

¹Substance Use Research Group, School of Health Sciences, Faculty of Health, University of Dundee

²School of Health and Wellbeing, University of Glasgow

1.0 Executive summary

1.1 Background

Alcohol Brief Interventions (ABIs) are short, structured conversations delivered by health and social care professionals, which aim to motivate people to reduce their alcohol consumption. Evidence shows that ABIs are most effective for people who consume hazardous or harmful amounts of alcohol, and can be effectively delivered in most primary care settings. However, recent research has put into question how feasible and effective ABIs are within evolving healthcare settings, where health professionals have less time to spend with patients, and have less incentive to deliver ABIs. A recent review of Scotland’s ABI strategy recommended moving away from the use of traditional ABIs, and instead, having flexible conversations about alcohol which can be embedded into routine appointments with patients. Given that the last evidence review on the effectiveness of ABIs in primary care was published in 2018, there is a need to explore what more recent evidence is suggesting in terms of the effectiveness of ABIs in primary care.

1.2 Aim and research questions

This rapid review aimed to explore evidence on effective conversation-based interventions about alcohol, and the factors influencing their implementation. The three research questions were:

What are the types of conversation-based interventions that have been shown to be effective in reducing patients’ alcohol consumption in different primary care settings?
What outcomes were used to determine the effectiveness or success of these interventions?
What are the barriers and facilitators that influenced the implementation of these interventions?

1.3 Methods

A systematic search of the literature was conducted to identify studies published between 2015 and August 2025, which detailed Randomised Controlled Trials (RCTs) of effective conversation-based interventions about alcohol and process evaluations of RCTs that explored factors influencing the implementation of these interventions. Data relevant to the research questions were extracted. A narrative synthesis approach was used to summarise and interpret quantitative data, while thematic analysis was used to summarise and interpret qualitative data. The risk of bias of the included studies was assessed using validated tools.

1.4 Main results

Nine RCTs and three process evaluations were included in this review. Collectively, they reported on three types of conversation-based interventions that were delivered in general primary care/public health, antenatal, pharmacy and dental practice settings:

brief interventions comprising at least one brief motivational interviewing session and sometimes paired with personalised feedback on participants’ alcohol screening results
brief advice comprising advice on decreasing alcohol consumption levels, the benefits of this and/or the consequences of risky alcohol consumption; and
Brief psychological therapy comprised counselling sessions aimed at developing participants’ behavioural skills to manage their drinking behaviour and potential relapses

Most interventions were delivered outside of routine appointments, by professionals who were specifically trained to deliver the intervention. There was an inconsistent approach to how alcohol consumption was measured, and the most common outcome measure was the AUDIT score. Overall, most interventions were successful in significantly reducing intervention participants’ alcohol consumption, and sustaining this reduction at different follow-up points up to 12 months. Several intrapersonal, interpersonal, structural and process-level factors were identified as influencing the implementation of the interventions. These included participants’ intentions to change their drinking behaviour; trust and rapport between participants and professionals delivering the interventions; the time the professionals had to deliver the interventions; and the training they received.

1.5 Authors’ conclusions

Conversation-based interventions about alcohol in different primary care settings can reduce patients’ alcohol consumption levels, however, there is low to moderate confidence in the strength of this evidence. It is possible to embed conversations about alcohol into primary care appointments, but there needs to be sufficient resources and capacity to enable this. A systems thinking approach should be adopted, where all multi-level factors that influence the implementation of these conversations are considered and addressed, to ensure these conversations are embedded in routine appointments.

1.6 Recommendations

Conversations about alcohol should be tailored to the reasons why patients attend their primary care appointments, and include discussions on how their drinking may affect their health and wellbeing.
Primary care professionals should identify patients’ intentions to change their drinking behaviour and perceptions of how problematic their drinking is as early as possible, to understand how to frame conversations about alcohol and address these factors.
Validated and feasible outcome measures of alcohol consumption like the AUDIT-C should be used consistently to meaningfully assess the effectiveness of these conversations at each follow-up appointment.
Wellbeing and/or quality of life should be measured using validated indicators, to supporting understanding of how these correlate to alcohol consumption over time.
Primary care teams should explore innovative ways of building and maintaining trust and rapport with patients to increase the likelihood of implementing conversations about alcohol into appointments.
Primary care teams should consistently use a structured approach and identify opportunities for increasing the capacity and time to screen patients, have conversations with them, and follow them up over time. This includes identifying members of the team who can be responsible for different stages e.g. screening and follow-up, in order to divide the workload.
Primary care leaders need to foster a positive culture where the importance of having these conversations is understood by primary care teams, and provide tailored training for healthcare professionals to confidently identify and take opportunities to have these conversations with patients.

Read the full report below.

September 2026

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