Very brief alcohol interventions (approx. 5 min.) are recommended for implementation in Danish municipalities by the The Danish Health and Medicines Authority. We have investigated the evidence supporting this recommendation. A lack of clarity remains about the active components in brief interventions and the extent to which the existing evidence base can be interpreted as efficacy or effectiveness studies. This has important implications for the generalizability of the trials. There is insufficient evidence on the effectiveness of very brief alcohol interventions and implementation is premature.