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For the first time this US study tried mobile phone text messaging as a way to moderate the hazardous drinking of young adults screened at emergency departments. Compared to merely monitoring, text-based advice did cut drinking – but why did the monitoring-only patients actually start to drink more?
Can you get away with asking just a single question to identify risky drinkers and even dependent drinkers? When the thresholds are suitably adjusted, asking either about frequency of heavy drinking or maximum single-occasion consumption worked remarkably well in the US general population.
In three years from 2008 Scottish national policy drove delivery of nearly 175,000 brief alcohol interventions, testament to what can be done when policy is backed by funding and infrastructure and incentive payments contingent on implementation. Leverage and acceptance were greatest in primary care, where the vast majority of the work took place.
At Australian emergency departments, screening followed by written personalised feedback mailed to risky drinkers led to at least a short-term cutback in their drinking, but only when they saw or had cause to see drink as contributing to their medical misfortune. This low cost written option demanding little of staff may make intervention more feasible.
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.
In the north of England just a few (and often just one) counselling sessions by a specialist nurse had a remarkable impact on dependent drinkers seeking medical care at an accident and emergency department.
The first European trial of an emergency department brief alcohol intervention being implemented nationally in the USA found no significant impacts either short term or a year later, but in Britain and elsewhere, different types of interventions have worked.
Seven years after the first alcohol harm reduction strategy for England, this audit finds treatment access and brief intervention work has progressed in London but funding is often precarious and GP services are surprisingly under-developed.
At over 50%, this US study's main achievement may have been to show that emergency department nurses can screen a high proportion of patients for risky drinking. After that point it suffered from a low intervention implementation rate, and no statistically significant benefits were found.
A few minutes with specially hired interventionists can curb the intake of heavy-drinking emergency patients, but in routine practice hospital staff will usually have to do this work. A US study tested this real-world scenario and found the modest drinking reductions were short-lived.
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