2004). The evidence is strongest http://www.selleckchem.com/products/Sunitinib-Malate-(Sutent).html for nondependent heavy drinkers who present for primary care services in ambulatory settings. Unfortunately, a recent meta-analysis of studies of SBI in primary care settings failed to show significant reductions in subsequent health care utilization (Bray et al. 2011). The efficacy of SBI in other settings, such as emergency departments (EDs) or hospitals, has not been established, although several randomized controlled trials have been conducted (Field et al. 2010). One explanation for the observed differences may be the patient populations analyzed. Thus, in most of the outpatient primary care studies, participants with alcohol dependence were excluded from the analysis, whereas that generally was not the case for studies conducted in EDs or hospital settings.

Moreover, patients with alcohol dependence are much more commonly encountered in ED and hospital settings than in primary ambulatory care. In summary, at this time, SBI in primary care ambulatory settings for adults can be strongly recommended as highly efficacious, whereas SBI in EDs or hospitals cannot. SBI also seems to be effective among select groups when delivered through internet-based or computerized applications. In particular, there is strong evidence that digital SBI can effectively reduce drinking and associated consequences among college students (Moreira et al. 2009). It is not clear whether or to what extent this finding might generalize to other population subgroups, but it is certainly plausible that it could, provided the target population has easy access to computers and is computer literate.

The same holds true for other methods, such as telephone-based SBI or use of the relatively new publication and Web site called Rethinking Drinking, which is published by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Despite the evidence supporting its effectiveness, SBI is not yet being implemented widely (Hingson et al. 2012). Widespread dissemination of information about recommended drinking limits and easy access to screening and brief counseling has the potential to make a significant public health impact. Because at-risk drinkers are much more numerous than alcohol-dependent people, at-risk drinking contributes a much greater disease burden than alcohol dependence.

Accordingly, widespread implementation of SBI has the potential to reduce a greater proportion of disease burden than even very effective treatment, a concept known as the prevention paradox (Rose 1981). Therefore, more research is needed to expand the implementation of SBI in the at-risk population and further increase its effectiveness. Estimating Entinostat the effectiveness and cost-effectiveness of treatment is more complex. Most reviews conclude that treatment is effective at reducing drinking and associated consequences.