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STUDY 2008 HTM file
Reducing alcohol harm: health services in England for alcohol misuse
Official audit of work by the Department of Health and NHS to address the health effects of alcohol misuse. Describes a system whose infrastructure is clearly inadequate compared to the size of the task, but one recently taking steps in the right direction.
MATRIX CELL 2019 HTM file
Alcohol Treatment Matrix cell D1: Organisational functioning; Screening and brief intervention
Seminal and key studies on how organisational functioning affects screening and brief intervention. Highlights a striking illustration of the importance of organisational context emerging from the unprecedented implementation drive at the US health care system for ex-military personnel. See the rest of row 1 of the matrix for more on screening and brief interventions.
REVIEW 2015 HTM file
Prevention of addictive behaviours
Based largely on existing reviews, this report for the German Federal Centre for Health Education comprehensively assesses substance use prevention approaches. Among its many conclusions are that approaches based solely on information provision are ineffective, in contrast to the more positive evidence for lifeskills and multi-component community programmes.
UK-focused review for Britain's National Institute for Health and Clinical Excellence of what impedes or promotes the implementation of brief alcohol interventions at the level of the organisation, the staff doing the work, and the patients targeted by the programme.
At three London hospitals 4% of inpatients completed a brief alcohol intervention after being screened for hazardous drinking by ward staff. Staff were positive and on one ward nearly half the patients were screened and one in ten counselled, but the overall results are unlikely to dent the public health burden imposed by risky drinking.
REVIEW 2015 HTM file
A comparison of the efficacy of brief interventions to reduce hazardous and harmful alcohol consumption between European and non-European countries: a systematic review and meta-analysis of randomized controlled trials
Amalgamation of results from relevant studies finds that in high-income nations brief alcohol advice to emergency or primary care patients remains effective whether trials take place in European or non-European drinking cultures and health service contexts. Impacts were however small and may not be duplicated in routine practice.
US trauma centres dealing with serious and often alcohol-related injuries ought to offer an environment conducive to brief alcohol interventions, but this first multi-site trial found motivational counselling more effective than minimal advice only when combined with a follow-up ‘booster’ phone call.
When a patient has screened positive for risky drinking, up pops a computerised prompt to remind the clinician to consider counselling. In one service for US ex-military personnel, this resulted in nearly three quarters of patients being counselled and a hint of consequentially reduced drinking; at another, findings were negative. Why the difference?
From Brazilian primary care clinics a rare confirmation that a positive organisational climate featuring commitment to staff professional development and good links with the local community is associated with overcoming barriers to widely implementing screening and brief intervention programmes.
Applying a systematic and comprehensive framework to map the strategies trialled in attempts to implement screening and counselling for risky drinking primary care patients gives some clues to what it has taken to achieve a high screening rate, the essential first step in the process.
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