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MATRIX CELL 2019 HTM file
Alcohol Treatment Matrix cell C1: Management/supervision; Screening and brief intervention
Seminal and key studies on management and supervision in screening and brief interventions for risky drinking. Highlights UK guidance which insists health service managers “must” support this work and the quandary over whether to insist on these procedures (taking time which could have been used in other ways) or to let practitioners and patients decide their priorities. See the rest of row 1 of the matrix for more on screening and brief interventions.
REVIEW 2018 HTM file
Effectiveness of brief alcohol interventions in primary care populations
Update of a key document forming the basis of claims that brief interventions work in ‘real-world’ settings. Combined findings from randomised trials confirm that brief advice in primary care can reduce drinking, but will those reductions be realised in contemporary routine practice?
Can a brief intervention delivered by trained GPs impact on young patients’ excessive drinking and cannabis use? Set in French-speaking Switzerland, this study examines outcomes over a 12-month period.
Brief interventions conducted by alcohol treatment specialists reduced alcohol-affected readmission rate by nearly half among patients admitted to a French emergency department when drunk or in need of withdrawal.
‘Inconclusive’ was the verdict of a review which aimed to assess the effectiveness of brief alcohol interventions among patients aged 11 to 21 attending for emergency care in the USA. Most promising targets seem to have been the more heavy or irresponsibly drinking among patients who were young adults rather than adolescents.
STUDY 2014 HTM file
The clinical effectiveness and cost-effectiveness of brief intervention for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial (SHEAR)
A major study conducted in London did not find clinically important reductions in drinking among excessive drinkers offered a brief intervention while attending sexual health clinics, nor did brief intervention seem a cost-effective use of health service resources.
Review of studies of interventions for heavy drinkers identified among general hospital inpatients concluded that multi-session brief interventions could reduce drinking. “Could” is an important qualifier: yet to be pinned down is why though sometimes they work, brief interventions often fail to produce significant effects.
Evaluated across an entire region, a determined effort to implement alcohol screening and brief intervention in the US health system for ex-military personnel led to no significant reductions in drinking – results seen as a prime example of the disappointing impacts of alcohol brief interventions in real-world conditions.
Across six European countries, during normal consultations primary care doctors correctly identified 65% of their adult patients as current drinkers, and diagnosed as problem drinkers under a third of those whose responses during interviews with researchers were indicative of risky drinking.
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.
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