Interventions for preventing injuries in problem drinkers.

OBJECTIVES: To assess the effect of interventions for problem drinking on subsequent injury risk. SEARCH STRATEGY: Data Sources.- Twelve computerized databases: MEDLINE (1966-8/96), EMBASE (1982-1/97), Cochrane Controlled Trials Register (1997, issue #1), PSYCHINFO (1967-1/97), CINAHL (1982-10/96), ERIC (1966-12/96), Dissertation Abstracts International (1861-11/96), IBSS (1961-1/97), ISTP (1982-1/97) and three specialized transportation databases, using terms for problem drinking combined with terms for controlled trials; bibliographies of relevant trials; and contact with authors and government agencies. SELECTION CRITERIA: Data Selection.- Randomized controlled trials of interventions among particiapnts with problem drinking, which are intended to reduce alcohol consumption or to prevent injuries or their antecedents, and which measured injury-related outcomes. Of 7014 studies identified, 19 (0. 3%) met the inclusion criteria. DATA COLLECTION AND ANALYSIS: Data Extraction.- Two authors extracted data on participants, interventions, follow-up, allocation concealment, and outcomes, and independently rated allocation concealment quality. MAIN RESULTS: Data Synthesis.- In completed trials, interventions for problem drinking were associated with reduced suicide attempts, domestic violence, falls, drinking-related injuries, and injury hospitalizations and deaths, with reductions ranging from 27-65%. Several interventions among convicted drunk drivers reduced motor vehicle crashes and injuries. Because few trials were sufficiently large to assess effects on injuries, individual effect estimates were imprecise. We did not combine the results quantitatively because the interventions, patient populations, and outcomes were so diverse. REVIEWER'S CONCLUSIONS: Conclusion.- Interventions for problem drinking may reduce injuries and their antecedents. Because injuries account for much of the morbidity and mortality from problem drinking, further studies are warranted to evaluate the effect of treating problem drinking on injuries.