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Includes brief interventions

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Interventions; Screening and brief intervention

Seminal and key research on the effectiveness of screening for risky drinking followed by brief interventions for people screening positive. Discusses the implications of the major UK trials intended to inform government policy, questions how ‘real world’ trials have been, and how strong the evidence is for the UK. 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 First primary care study harbinger of later ‘no benefit’ findings (1987). Conducted in Dundee in 1985 and led by a researcher later involved in the crucial SIPS study listed below, this first primary care trial found similar drinking reductions whether or not screening to identify risky drinking was supplemented by a typical warning from the doctor, or a brief intervention featuring feedback on an assessment of the patient’s drinking, a self-help booklet, and further consultations – results strikingly similar to those from SIPS. For discussion click and scroll down to highlighted heading.

S Pioneering British studies question need for extended treatment (1999). Three studies from the 1970s and ’80s which showed alcohol problems could be reduced by brief interventions in alcohol clinics, hospitals and GPs’ surgeries, findings which challenged the need for the extended treatments of the time. For discussion click and scroll down to highlighted heading.

S Assessment plus feedback enough to reduce drinking (1988). Assessment (usually a screening questionnaire), feedback on assessment, and a motivational interviewing counselling style – these 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: two scientifically developed brief interventions were not shown to have been more effective than a much less expensive terse warning plus a leaflet, intended as a ‘control’ against which the brief interventions could shine – a surprise which prompted a ‘less is more’ interpretation of the findings. For discussion click and scroll down to highlighted heading.

% drinking excessively in intervention and control groups

K Violent injury plus brief advice prompts young men to moderate drinking (2003). Relative to usual care, 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 emergency patients (2004; free source for original article at time of writing). Typically very heavy drinkers who saw their emergency as alcohol-related drank less after referral for brief counselling. Conducted in London, the first study to record benefits from an almost entirely routine procedure, including 30% fewer return visits over the following year. Similar results seen in France among another set of patients (all drunk on admission) patently in need of moderating their drinking. For discussion click and scroll down to highlighted heading.

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 compared to usual emergency departments offer a conducive environment for addressing patients’ drinking. Nevertheless, only if reinforced with a follow-up phone call was brief motivational counselling found significantly more effective than minimal advice.

K Brief counselling for hospital inpatients not found more effective than handing over a booklet (2007). Compared to usual care, in Scotland handing heavy-drinking patients a guide to sensible drinking reduced consumption about as much as roughly 20 minutes of FRAMES-based advice, seemingly demonstrating the impact of simply being identified by a clinician as a risky drinker who should consider cutting back. For related discussions click here and here, and scroll down to highlighted headings.

K Student population responds minimally to routine screening/intervention (2013). Compared to offering no screening and no intervention at all, this rare ‘real-world’ trial of a routine programme found that offering web-based screening for risky drinking plus a computerised brief intervention feeding back screening results led to slightly fewer (about 45% v. 48%) university students in Sweden scoring as risky drinkers. However, on no measure did supplementing screening with the offer of the brief intervention appreciably or significantly improve outcomes. For related discussion click and scroll down to highlighted heading.

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) could not demonstrate any reductions at all. Screening too missed most risky-drinking patients. For discussions click here and here and scroll down to highlighted headings.

K Nurse-led brief intervention not found more effective than standard care in ‘real-world’ English trial (2006). Rated as the most ‘real-world’ of the primary care trials included in an influential review listed below. Did not find that practice nurses trained in a structured brief intervention reduced drinking significantly more than those instructed to offer a leaflet plus standard advice to cut down. For discussion click and scroll down to highlighted heading.

R Relatively real-world brief primary care interventions just as effective (2018). Influential synthesis of research findings concluded that brief advice in GPs’ surgeries and emergency departments reduced risky drinking even in trials assessed as closest to routine practice – but how real-world were any of these trials, and why did the most recent studies indicate zero effect? Similar results from an earlier version were considered to strengthen NICE guidance (listed below) in favour of implementing brief alcohol interventions in primary care. For discussions click here and here and scroll down to highlighted headings.

R Face-to-face brief interventions modestly effective in a range of settings (2016). Randomised trials with results published in English record modest but statistically significant drinking reductions from brief interventions in primary care, universities, and (though halved in size) emergency departments; evidence was insufficient for inpatient wards and non-clinical settings. For discussion click and scroll down to highlighted heading.

R Brief interventions patchily effective among hospital inpatients (2011). Synthesis of international studies found some significant impacts but these were inconsistent, perhaps because merely being identified as a heavy drinker has an impact which brief interventions find hard to better. Our analysis found this patchy record applied also to UK studies. A later review (2013) found single sessions unconvincing but brief interventions with booster sessions more effective than usual care/no intervention. For discussion click and scroll down to highlighted heading.

R Advanced analysis casts doubt on effectiveness of brief interventions for college students (2015; free source at time of writing). A new way to synthesise findings from studies of brief motivational interventions for college students did not find that overall they affected the probability of drinking or the amount drunk when drinking occurred. Suggests previous syntheses found such effects partly because they did not adjust for the large number of non-drinkers and for differences between individuals.

R How GPs can identify risky drinkers (2014). In the British context studies suggests the best combination of accuracy and brevity is achieved by asking patients just two questions and further confirmatory questions only if patients screen positive initially.

G NICE calls for UK to invest in screening and brief intervention (National Institute for Health and Care Excellence, 2010). UK’s official health interventions advisory body recommends investing in widespread screening and brief intervention using the FRAMES approach as part of a public health ‘invest to save’ strategy. For related discussion click and scroll down to highlighted heading.

G Practical advice and information for health professionals in England on implementing national guidance on drinking (Public Health England, 2019). National health body responsible for supporting substance use work offers advice on responding to alcohol problems, including screening and brief interventions. The advice is tailored for practitioners, service managers, and for senior or strategic leaders involved in assessing local needs and commissioning services.

G UK screening and brief intervention implementation aids and guidance (accessed July 2019). Web site offers discussion, news and a portal to screening instruments and guides on how to advise patients.

more Search for all relevant Effectiveness Bank analyses or for sub-topics go to the subject search page. See also hot topics on brief interventions and computerising therapy and advice.

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