Alcohol Treatment Matrix cell B1: Practitioners; Screening and brief intervention

2020/21 update funded by

Alcohol Change UK web site. Opens new Window

Alcohol Change UK

Previously also funded by

Society for the Study of Addiction web site Society for the Study of Addiction

Developed with

Skills Consortium web site. Opens new window

Alcohol Treatment Matrix

Effectiveness Bank Alcohol Treatment Matrix

Includes brief interventions

Drug Treatment Matrix

Effectiveness Bank Drug Treatment Matrix

Includes harm reduction

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Practitioners; Screening and brief intervention

Key studies on the impact of the practitioner in brief interventions. Highlights Swiss studies which dissected how these work and helps develop evidence-informed understanding of four issues: Why does the practitioner matter? Are some naturally effective? Does getting it wrong matter more than getting it right? What do we know about non-motivational interventions? See the rest of row 1 of the matrix for more on screening and brief interventions.

S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text Unfold supplementary text

S Confrontation provokes resistance (1993). US study which seemed to validate motivational interviewing’s empathic, client-centred style rather than the more confrontational approach typical of the era. When therapists fed back the results of an alcohol-harm check-up in a motivational style, heavy drinkers who had responded to ads were less resistant to change and later made greater cuts in their drinking. For discussion click and scroll down to highlighted heading.

K Best to stick to the script? (2012; free source at time of writing). US researchers developed a scale to measure fidelity to a commonly researched form of brief intervention. It worked well at assessing practitioners’ competence in an emergency department study – but scores on the scale were not found to be related to how much patients drank at follow-up, showing that ‘competence’ of this kind does not always make a brief intervention more effective. For discussion click and scroll down to highlighted heading.

K Nurses or doctors: who is most effective? (1997). Relatively ‘pure’ test from Australia of whether impacts are greater when a GP does the brief intervention as opposed to a practice nurse. No significant differences, but the nurses had the edge. However, neither’s two-session intervention was found more effective than much briefer and simpler advice. Related reviews below: 1 2. For related discussion click and scroll down to highlighted heading.

K Emergency patients respond to motivational style (2009). Rather than topping the league in making motivational interviewing’s recommended types of comments, practitioners’ impacts on risky drinkers at emergency departments in Switzerland depended on their ability to embody the client-centred spirit of the approach and to avoid comments inconsistent with this ethos. For discussions click here, here and here, and scroll down to highlighted headings.

K Reflective listening key to provoking intention to change (2010). Micro-analysis of interactions between heavy-drinking Swiss army conscripts and counsellors found reflective listening (when the counsellor signified their attention and understanding by selectively echoing back the young men’s feelings and comments) the key to provoking signs of an intention to reduce drinking. Counsellor comments inconsistent with motivational interviewing provoked the opposite indications. Similar findings below suggest drinking will actually have been reduced. For discussion click and scroll down to highlighted heading.

K Reflective listening related to later drinking (2014). Study of Swiss army conscripts (also participants in study above) exposed the influence of the counsellor’s proficiency in motivational interviewing on subsequent drinking reductions, especially the degree to which they reflected back the client’s remarks enriched by an additional or deeper meaning. In contrast, piling on lots of the other types of recommended comments was not associated with reductions, and even a single interjection inconsistent with the approach seemed to nullify the session’s impact. Experience seemed to count, but only if it led to proficiency, while whether the counsellor was a doctor or a psychologist was not associated with later drinking. For discussions click here and here and scroll down to highlighted headings.

K “Even one behavior inconsistent with [motivational interviewing] can be particularly damaging” (2014; free source at time of writing). Giving the examples of confrontation or unsolicited advice, that was the conclusion of a study which re-analysed session recordings from three trials (1, free source at time of writing; 2; 3, free source at time of writing) of brief interventions based on motivational interviewing. In these studies where counsellors were generally proficient in the approach, another “surprise” (free source at time of writing) was how little being yet more proficient, qualities such as acceptance and empathy, or the strength of their relationship with the client, affected subsequent drinking. Two of the trials involved Swiss army conscripts also involved in studies above (1 2). For discussion click and scroll down to highlighted heading.

R Doctors or nurses? (2016). Found that brief alcohol interventions in primary care are not significantly less effective if conducted by nurses or other primary care staff instead of doctors, and using non-physician staff means a given amount of funding would be able to pay for more interventions for more patients. Related study above and review below. For related discussion click and scroll down to highlighted heading.

R Nurses may be slightly more effective than doctors (2016). Review not confined to primary care generally did not find that impacts on drinking of brief alcohol interventions differed when conducted by interventionists from different professions, but nurses had the edge over doctors and other categories. Related study and review above. For related discussion click and scroll down to highlighted heading.

R Barriers and facilitators to implementing screening and brief intervention (2011). UK-focused review for Britain’s National Institute for Health and Care Excellence concentrating on the views of professionals and patients and the implementation process; includes the influence of staff characteristics and attitudes on whether they implement screening and brief interventions. For related discussion click and scroll down to highlighted heading.

R Implementation strategies in primary care (2011). Investigates the international literature on implementing alcohol screening and brief interventions in primary care, including the influence of staff characteristics.

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