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What do primary care clinicians think would help them bridge the ‘implementation gap’ in screening for risky drinking and brief advice, and extend the potential benefits to a greater proportion of the population? A European trial found the answer differed depending on distinctive national circumstances.
MATRIX CELL 2019 HTM file
Alcohol Treatment Matrix cell B1: 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.
Simulation study calculated health care cost savings and benefits for patients in England which make routine GP-based screening and brief advice for excessive drinking look an unmissable bargain, but the key assumptions derived from studies divorced from how interventions would routinely be implemented.
In the context of current UK policy, this is a key study, testing the ambition to extend recovery beyond formal treatment by systematically linking patients to mutual aid groups, the main way it is being suggested commissioners can square the circle of doing more (recovery is seen as a whole-life transformation) with less.
Despite a clear rationale for embedding brief interventions in community pharmacies, this UK trial found no evidence that they would reduce hazardous or harmful drinking.
Swiss study of brief alcohol interventions with a representative sample of heavy drinking young men exposed the determining influence on later drinking of the practitioner’s competence in motivational interviewing and how they behave in the session.
Seminal study that validated motivational interviewing’s empathic, client-centred style. It suggested that by not provoking resistance, the non-confrontational style mandated by motivational interviewing reduced drinking compared to the then more typical blunt and challenging approach.
Motivational interviewing’s originator has stressed how unexpected findings can force fruitful rethinking. This study may prove an example; designed to forefront the approach’s distinct active ingredients, other than fleetingly and non-significantly, these did not seem active at all among the stable, moderately dependent drinkers recruited to the trial.
Aged 16 and smoking cannabis or drinking coming up to one day in three, US youngsters identified as substance users by their schools substantially cut back in response to just two motivational counselling sessions, and even more when a third session addressed the parents at home.
STUDY 1970 HTM file
Frontiers of alcoholism
Later to become founding director of the US National Institute on Alcohol Abuse and Alcoholism, in the late 1950s Dr Morris Chafetz of the Massachusetts General Hospital conducted a remarkable series of studies which proved that an alcohol clinic's intake and performance can be transformed by the simple application of empathy and organisation.
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