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Introduction: Efforts at widespread implementation of alcohol screening and brief intervention (SBI) in developing countries are now underway. This paper reviews four such projects from Brazil and South Africa. Methods: Authors reviewed presentations from a 2008 International Society for Biomedical Research on Alcoholism symposium, written project summaries and previously-published journal articles and compared findings with similar reports from industrialized countries. Results: Projects trained healthcare teams from primary care facilities, then gathered qualitative feedback from trainees and quantitative data on SBI services provided. Most programs showed modest increases in alcohol screening rates. Some showed increases in referrals to alcohol specialty treatment. Non-physicians reported greater SBI activity than physicians. In Brazil, health administrators actively disseminated SBI services after seeing data on early SBI successes. Researchers worked with politicians and health officials to promote policies mandating SBI services and funding SBI training. Barriers included stigma regarding alcohol misuse, social acceptance of recreational intoxication, competing demands of other priority government health services, lack of emphasis on prevention and reluctance to provide SBI to patients without major alcohol-related consequences. Discussion: Future efforts may benefit from focusing efforts on increasing intervention as well as screening levels, addressing specific training needs of non-physicians, linking to formal and informal treatment services, utilizing quality improvement approaches, and including SBI projects in broader efforts at alcohol policy change. Project leaders should seek avenues for promoting health policies which emphasize alcohol SBI as a top priority in primary care.

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