Abstract
BackgroundExtended brief interventions (EBIs) are effective in targeting alcohol misuse in the general population. However, little is known of the effects of EBI in adults with intellectual (also known as learning) disabilities. In this feasibility trial we compared EBI with usual care for alcohol misuse in adults with mild to moderate Intellectual Disability (ID).MethodsThe study took place in three community ID networks of services in England. Participants aged 18–65 years with reported alcohol problems, a score ≥8 on the Alcohol Use Disorder Identification Test (AUDIT), and IQ <70 (+/5%CI) were recruited and were randomly allocated to either EBI (five weekly sessions and one follow-up at 8 weeks) and usual care or usual care alone. Research assistants were blind to arm allocation. Research assessments took place at baseline, 2 and 3 months. The primary outcome was reduction in alcohol consumption measured by the AUDIT. Preliminary health economic analysis was performed to investigate the costs of delivering EBI and the feasibility of a cost-effectiveness analysis in a full trial. The trial is closed.ResultsParticipants were recruited from January 2014 to August 2015. Thirty individuals were randomised (15 in each arm) and provided primary outcome data. In regard to harmful drinking, at baseline, all the participants exceeded the relevant threshold. At 8 weeks, the proportion of participants with harmful drinking had decreased to 60% for both groups, and at 12 weeks it had decreased by 66°7% and 46°7% for the intervention and the control groups, respectively. The unit cost for the delivery of EBI is £430.ConclusionsRecruitment to this trial has been proven challenging as prevalence of alcohol misuse in the targeted population was lower than anticipated. EBI may provide an effective low-intensity treatment for this population. Participants’ and carers’ feedback on their experience was overall positive. Further work needs to be undertaken to ascertain the group of participants that should be participating in a future definitive trial.Trial registrationPsychological Intervention Alcohol Misuse Learning Disability; isrctn.com, identifier: ISRCTN58783633. Registered on 17 December 2013.
Highlights
Extended brief interventions (EBIs) are effective in targeting alcohol misuse in the general population
Assessments Participant and family/paid carer assessments were conducted at baseline and at 2 (Alcohol Use Disorder Identification Test (AUDIT) only) [16] and 3 months by the research assistants (RAs) who were trained in assessing capacity and obtaining consent, promoting the study, administering the questionnaires, and interviewing participants with Intellectual Disability (ID)
Recruitment strategies used were based on those used in a previous study conducted by CK and VP suggesting a prevalence of alcohol misuse of 22.5%, the study was initially publicised only in the National Health Service (NHS) participating services
Summary
Extended brief interventions (EBIs) are effective in targeting alcohol misuse in the general population. Following the closure of long-stay hospitals, adults with ID have increasingly lived more independently in the community [2]. This has increased their exposure to environmental stressors, substance misuse [3] and alcohol misuse [4]. There is substantial literature on brief interventions (BIs) and extended brief interventions (EBIs) targeting alcohol misuse in the general population [9]. In a systematic review of alcohol-related interventions, the authors found only one randomised controlled trial (RCT) evaluating educational materials about substance misuse in groups of adults with ID recruited from both community and hospital settings [10]
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