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S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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Alcohol Matrix cell A1: Interventions; Screening and brief intervention

S First primary care alcohol study harbinger of later ‘no difference’ findings (1987). Conducted in Dundee in 1985 and led by a researcher later involved in the influential 2009 SIPS study, this first primary care trial found similar drinking reductions whether or not screening questions to identify risky drinking were supplemented with a warning from the doctor or a brief intervention featuring assessment feedback, a self-help booklet and further consultations – results strikingly similar those from SIPS.

S Pioneering British studies question need for extended treatment (1999). Three studies from the ’70s and ’80s which seemed to show alcohol problems could be reduced by brief interventions in alcohol clinics, hospitals and GPs’ surgeries, casting doubt over the need for the extended treatments of the time.

S Assessment plus feedback enough to reduce drinking (1988). Assessment (usually a screening test), feedback on assessment, and a motivational interviewing counselling style – those three core components of a typical brief intervention originated in a trial of the offer of a check-up to people wondering if their drinking might be harmful.

K Whether conducted in GPs’ surgeries (2013), emergency departments (2014) or probation offices (2014), results from the SIPS trials were the same: a terse warning plus booklet intended as a ‘control’ condition against which the two scientifically developed brief interventions could shine turned out to be no less effective but much cheaper, a surprise which prompted a ‘less is more’ interpretation of the findings.

% drinking excessively in intervention and control groups

K Violent injury plus brief advice prompts young men to moderate drinking (2003). In Cardiff young men facially injured in a drunken altercation substantially cut their drinking after 20 minutes’ alcohol advice from a face-clinic nurse chart.

K Referral for counselling works for heavy-drinking London emergency patients (2004). Typically very heavy drinkers who saw their medical emergency as alcohol-related drank significantly less after referral for brief counselling in the first study to record benefits from an almost entirely routine procedure.

K Booster phone call needed to make brief counselling effective in US trauma centres (2014). Serious alcohol-related injuries are common at US trauma centres which offer a conducive environment for talking to patients about their drinking – but only if reinforced with a follow-up phone call was motivational counselling more effective than minimal advice.

K Handing booklet no less effective than brief counselling for hospital inpatients (2007). In Scotland handing heavy-drinking patients a guide to sensible drinking reduced consumption as much as more extended FRAMES-based advice, seemingly demonstrating the impact of being medically identified as a risky drinker who should consider cutting back.

K Student population responds minimally to routine screening/intervention (2013). A rare ‘real world’ trial of whether a routine brief intervention can have population-wide public health benefits found that among university students in Sweden, web-based screening had minor impacts not enhanced by feeding back the results.

K Widespread routine implementation at best marginally effective (2010). The US service for former military personnel is one of the few large health systems to have got close to universal screening and brief intervention, but this pilot study found only minor drinking reductions and others (1 2), none at all. Screening too missed most risky-drinking patients.

R Relatively real-world brief interventions still effective – but how ‘real-world’ were they? (2009). Our analysis of an article based on a freely available review (2007) which found brief advice in GPs’ surgeries and emergency departments reduced risky drinking even in the trials closest to (but arguably still divorced from) routine practice. Booster sessions seem to enhance impact.

R Drinking reduced by primary care interventions (2015). Updates review above, confirming that in GPs’ surgeries, and to a lesser extent in emergency departments, brief interventions reduce drinking. Acknowledges that trials tend to be divorced from routine practice.

R Patchy response by hospital inpatients (2011). Synthesis of studies found significant impacts were inconsistent and often lacking, and most UK studies did not find brief interventions effective. See also later review (2013) which found single sessions unconvincing but brief interventions with booster sessions more effective than usual care/no intervention.

G NICE calls for UK to invest in screening and brief intervention (National Institute for Health and Clinical Excellence, 2010). UK’s official health advisory body recommends investing in widespread routine screening and brief intervention as part of a public health ‘invest to save’ strategy. Recommends the FRAMES approach to advice-giving.

G UK guides from the charity Alcohol Concern supported by the Safe Sociable London Partnership and Public Health England for community health settings (2015) such as primary care, pharmacy, and drug services, hospitals (2015) including emergency departments, and criminal justice services (2015) including police, probation and prisons. Each recommends the FRAMES principles for advice-giving.

G UK screening and brief intervention implementation aids and guidance (accessed May 2016). Web site offers discussion, news and a portal to screening instruments and guides on how to advise patients.

G US guides for emergency departments ([US] Emergency Nurses Association, 2008), trauma centres ([US] Centers for Disease Control and Prevention and National Center for Injury Prevention and Control, 2009), primary care and mental health clinicians ([US] National Institute on Alcohol Abuse and Alcoholism, 2005) and community health workers (American Public Health Association for US Department of Transportation, 2008).

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