Treatment Of Alcohol Misuse Research Articles

Relationships on the rocks: A meta-analysis of romantic partner effects on alcohol use.

The partner influence hypothesis postulates one partner's alcohol use influences the other partner's alcohol use over time. Although several studies have examined the partner influence hypothesis, the magnitude and gender-specific nature of partner influences on alcohol use are unclear and have yet to be examined meta-analytically. We addressed this by conducting a traditional bivariate meta-analysis and two-stage meta-analytic structural equation modeling across 17 studies (N = 10,553 couples). Studies that assessed both romantic partners' alcohol use at a minimum of two time-points were selected. Results suggest romantic partners do influence one another's drinking, to a small but meaningful degree, with women (β = .19) exerting a statistically stronger (p < .05) influence than men (β = .12). Results also suggest time lag between assessment, alcohol indicator, married, and year of publication may moderate partner influence. Thus, social influences on individual alcohol use include important partner influences. These influences can serve either risk or protective functions. Given the economic, social, and health consequences associated with alcohol misuse, advancing knowledge of social risk factors for alcohol misuse is essential. Therefore, assessment and treatment of alcohol misuse should extend beyond the person to the social context. We encourage clinicians to consider involving romantic partners when assessing and treating alcohol misuse. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Impact of Socioeconomic Differences on Distributional Cost-effectiveness Analysis.

Public health decision makers value interventions for their effects on overall health and health inequality. Distributional cost-effectiveness analysis (DCEA) incorporates health inequality concerns into economic evaluation by accounting for how parameters, such as effectiveness, differ across population groups. A good understanding of how and when accounting for socioeconomic differences between groups affects the assessment of intervention impacts on overall health and health inequality could inform decision makers where DCEA would add most value. We interrogated 2 DCEA models of smoking and alcohol policies using first national level and then local authority level information on various socioeconomic differences in health and intervention use. Through a series of scenario analyses, we explored the impact of altering these differences on the DCEA results. When all available evidence on socioeconomic differences was incorporated, provision of a smoking cessation service was estimated to increase overall health and increase health inequality, while the screening and brief intervention for alcohol misuse was estimated to increase overall health and reduce inequality. Ignoring all or some socioeconomic differences resulted in minimal change to the estimated impact on overall health in both models; however, there were larger effects on the estimated impact on health inequality. Across the models, there were no clear patterns in how the extent and direction of socioeconomic differences in the inputs translated into the estimated impact on health inequality. Modifying use or coverage of either intervention so that each population group matched the highest level improved the impacts to a greater degree than modifying intervention effectiveness. When local level socioeconomic differences were considered, the magnitude of the impacts was altered; in some cases, the direction of impact on inequality was also altered.

Testing the efficacy of a minimal-guidance online self-help intervention for alcohol misuse in Estonia: study protocol of a randomized controlled trial

BackgroundDespite an initial steep decrease in alcohol misuse among Estonians through structural intervention means and the scaling up of alcohol counselling in the mid-2000’s, most of the country’s alcohol misuse indicators remain clearly higher than European averages. Consequently, an online self-help program was launched as part of an initial behavioral intervention initiative to foster progress in alcohol prevention on a population level.MethodsA two-arm randomized controlled trial (RCT) has been designed to compare the efficacy of a culturally-adapted minimal-guidance online self-help program, the 8-week “Selge” online program against a control condition that consists of a self-administered test of alcohol use and advice regarding usual treatment in Estonia. A target sample of 600 individuals will be recruited and randomly assigned to either condition. The program will contain 10 modules based on principles of cognitive behavioural therapy (CBT) and motivational interviewing (MI). Participants in the control group will have access to the full treatment after they complete their final follow-up assessment. The primary outcome will be change in the Alcohol Use Disorders Identification Test (AUDIT) score between the 6-month follow-up and baseline assessments. Secondary outcomes will include the number of standard drinks consumed and alcohol-free days, drinking motives and motivation for change, as well as changes in mental health. Assessments will be completed at baseline, at the end of treatment, and at 6 months follow-up. Data analysis will follow the intention-to-treat principle and employ (generalised) linear mixed models.DiscussionThe “Selge” program is the first and only internet program for the intervention of alcohol misuse in Estonia. If proven effective, it will foster progress in the intervention of alcohol misuse in the Estonian population and be implemented as a standard program amidst the continuum of intervention and care.Trial registrationCurrent Controlled Trials ISRCTN48753339 registered 04/06/2019 retrospectively.

Optimizing internet-delivered cognitive behaviour therapy for alcohol misuse: a study protocol for a randomized factorial trial examining the effects of a pre-treatment assessment interview and health educator guidance

BackgroundAlcohol misuse is a common, disabling, and costly issue worldwide, but the vast majority of people with alcohol misuse never access treatment for varying reasons. Internet-delivered cognitive behaviour therapy (ICBT) may be an attractive treatment alternative for individuals with alcohol misuse who are reluctant to seek help due to stigma, or who live in rural communities with little access to face-to-face treatment. With the growing development of ICBT treatment clinics, investigating ways to optimize its delivery within routine clinic settings becomes a crucial avenue of research. Some studies in the alcohol treatment literature suggest that assessment interviews conducted pre-treatment may improve short- and long-term drinking outcomes but no experimental evaluation of this has been conducted. Further, research on internet interventions for alcohol misuse suggests that guidance from a therapist or coach improves outcomes, but more research on the benefits of guidance in ICBT is still needed.MethodsThis study is a 2X2 factorial randomized controlled trial where all of the expected 300 participants receive access to the Alcohol Change Course, an eight-week ICBT program. A comprehensive pre-treatment assessment interview represents factor 1, and guidance from a health educator represents factor 2. All participants will be asked to respond to measures at screening, pre-treatment, mid-treatment, post-treatment and 3, 6 and 12 months after treatment completion.DiscussionThis study will provide valuable information on optimization of ICBT for alcohol misuse within routine clinic settings.Trial registrationClinicalTrials.gov, registered June 13th 2019, NCT03984786

A randomized controlled efficacy trial of an electronic screening and brief intervention for alcohol misuse in adolescents and young adults vulnerable to HIV infection: step up, test up study protocol

BackgroundYoung people account for more than a quarter of new HIV infections in the US, with the majority of cases among young men who have sex with men; young transgender women are also vulnerable to infection. Substance use, particularly alcohol misuse, is a driver of sexual transmission and a potential barrier to engagement in the HIV prevention and care continuum, however vulnerable youth are difficult to reach for substance use services due, in part, to complex social and structural factors and limited access to health care. The Community Prevention Services Task Force recommends electronic screening and brief intervention as an evidence-based intervention for the prevention of excessive alcohol consumption; however, no prior studies have extended this model to community-based populations of youth that are susceptible to HIV infection. This paper describes the study protocol for an electronic screening and brief intervention to reduce alcohol misuse among adolescents and young adults vulnerable to HIV infection in community-based settings.MethodsThis study, Step Up, Test Up, is a randomized controlled trial of an electronic alcohol screening and brief intervention among youth, ages 16–25, who are vulnerable to HIV infection. Individuals who present for HIV testing at one of three community-based locations are recruited for study participation. Eligibility includes those aged 16–25 years, HIV-negative or unknown HIV status, male or trans female with a history of sex with men, and English-speaking. Participants who screen at moderate to high risk for alcohol misuse on the Alcohol Use Disorders Identification Test (AUDIT) are randomized (1:1) to either an electronic brief intervention to reduce alcohol misuse or a time-and attention-matched control. The primary outcome is change in the frequency/quantity of recent alcohol use at 1, 3, 6 and 12-month follow-up.DiscussionTesting of evidence-based interventions to reduce alcohol misuse among youth vulnerable to HIV infection are needed. This study will provide evidence to determine feasibility and efficacy of a brief electronically-delivered intervention to reduce alcohol misuse for this population.Trial registrationClinicalTrials.gov number, NCT02703116, registered March 9, 2016.

The Role of Stress, Trauma, and Negative Affect in Alcohol Misuse and Alcohol Use Disorder in Women.

Recent evidence indicates that the United States is facing a public health crisis of alcohol misuse and alcohol use disorder (AUD), which has been fueled in part by dramatic rises in binge and heavy drinking and prevalence of AUD in women. Historically, alcohol misuse and AUD have been more prevalent in men than in women. However, recent evidence on data from the past decade shows increases in AUD prevalence rates that are associated with substantially higher binge and heavy drinking and AUD prevalence in women compared to men. This paper first addresses the key roles of stress, trauma, childhood maltreatment, negative affect, and mood and anxiety disorders; sex differences in the presentation of these psychosocial and psychological factors; and their contributions to alcohol misuse, escalation to binge and heavy drinking, and transition to AUD in women. Also examined are potential central and peripheral biological mechanisms by which stressors and traumatic experiences, as well as chronic stress states—including depression and anxiety—may facilitate differential pathways to alcohol misuse, escalation, and transition to AUD in women. Finally, this paper discusses major gaps in the literature on sex differences in these areas as well as the need for greater research on sex-specific pathways to alcohol misuse and transition to AUD, so as to support a more comprehensive understanding of AUD etiology and for the development of new strategies for prevention and treatment of alcohol misuse and AUD in women.

Implementing and Evaluating SBIRT for Alcohol Use at a Level 1 Trauma Center: A Behavioral Medicine Approach.

To facilitate the early identification and treatment of alcohol misuse among trauma patients, the American College of Surgeons (ACS) requires ACS-accredited level 1 trauma centers to have an active alcohol screening and brief intervention program. The development, implementation, and evaluation of a screening, brief intervention, and referral to treatment as a new institutional standard of care for alcohol misuse at a level 1 trauma center is described. The Division of Behavioral Medicine, a health psychology-based service, was nominated to manage this initiative as a result of clinical training and expertise in assessment, evidence-based psychological interventions, and case management. Trauma patients with elevated blood alcohol concentrations were screened at the time of admission and several months post-hospitalization. Clinical data suggest that screening for alcohol misuse can help identify patients at risk for, and struggling with, alcohol use disorders, encourage positive changes in alcohol consumption patterns, and increase access to treatment. Recommendations for enhancing the effectiveness of this process, associated challenges and limitations, and considerations for future clinical and research endeavors are discussed.

Clinical and demographic patient characteristics, alcohol treatment goal preference and goal attainment during computer-assisted therapy with Breaking Free Online

ABSTRACTBackground: Few alcohol misuse interventions can be tailored to the individual and allow individuals to set personalized treatment goals, including reduction/moderation or abstinence. This study examined outcomes from a tailorable computer-assisted therapy program, Breaking Free Online (BFO), which prompts users to set personalized goals. Methods: Participants completed baseline and post-treatment assessments of alcohol dependence and use and biopsychosocial functioning. Whether baseline clinical and demographic participant characteristics predicted preferred treatment goal, and whether these characteristics and preferred treatment goal then predicted treatment goal attainment, were examined. Results: Participants who prioritized abstinence were more likely to be abstinent at baseline and to have received previous treatment, than participants who prioritized reduction/moderation. Participants who preferred reduction/moderation demonstrated better biopsychosocial functioning and lower alcohol dependence at baseline than those who preferred abstinence. Lower biopsychosocial impairment, lower alcohol dependence, and lower alcohol consumption were associated with a higher likelihood of achieving treatment goals, as was having abstinence as a goal. There were significant interactions between baseline alcohol consumption/severity of alcohol dependence and treatment goal preference. Conclusions: Findings may inform guidance around recommended treatment goals for individuals engaging with treatment for alcohol misuse.

Telehealth Treatment for Alcohol Misuse: Reviewing Telehealth Approaches to Increase Engagement and Reduce Risk of Alcohol-Related Hypertension.

Telehealth interventions for alcohol misuse may be especially impactful in hypertensive populations because of the increased blood pressure associated with alcohol overconsumption. This review examines emerging telehealth interventions for alcohol misuse and categorizes them according to phases of the treatment process. Evidence for telehealth cognitive behavioral therapy (CBT) is preliminary but suggests it is efficacious and increased access to treatment. Evidence for contingency management (CM) is growing, and mobile adaptation of CM for alcohol misuse suggests it is efficacious in initial abstinence induction. Evidence for mobile health (mHealth) texts and applications is large and variable but generally suggests it is efficacious for reducing alcohol misuse and relapse prevention. Variability in telehealth interventions for alcohol misuse may hinder conclusion implementation. Matching specific telehealth interventions with phases of alcohol misuse treatment and focusing on high-impact populations (i.e., those with hypertension) may maximize benefits on population health.

Assessing the Interest and Cultural Congruence of Contingency Management as an Intervention for Alcohol Misuse Among Younger American Indian Adults.

A qualitative study was conducted to assess interest in contingency management (CM) for younger American Indian (AI) adults (18-29 years old), how to culturally and developmentally adapt CM for younger AI adults, and interest in CM relative to culturally grounded treatment approaches. We conducted a total of four focus groups with younger adults and families in two AI communities: a rural reservation and an urban Indian health clinic (n = 32). Four overarching themes emerged suggesting that offering prizes, cultural activities, and activities that capture the attention of younger adults integrated into the CM intervention is ideal for enhancing engagement.

Information standards for recording alcohol use in electronic health records: findings from a national consultation

BackgroundAlcohol misuse is an important cause of premature disability and death. While clinicians are recommended to ask patients about alcohol use and provide brief interventions and specialist referral, this is poorly implemented in routine practice. We undertook a national consultation to ascertain the appropriateness of proposed standards for recording information about alcohol use in electronic health records (EHRs) in the UK and to identify potential barriers and facilitators to their implementation in practice.MethodsA wide range of stakeholders in the UK were consulted about the appropriateness of proposed information standards for recording alcohol use in EHRs via a multi-disciplinary stakeholder workshop and online survey. Responses to the survey were thematically analysed using the Consolidated Framework for Implementation Research.ResultsThirty-one stakeholders participated in the workshop and 100 in the online survey. This included patients and carers, healthcare professionals, researchers, public health specialists, informaticians, and clinical information system suppliers. There was broad consensus that the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-Consumption (AUDIT-C) questionnaires were appropriate standards for recording alcohol use in EHRs but that the standards should also address interventions for alcohol misuse. Stakeholders reported a number of factors that might influence implementation of the standards, including having clear care pathways and an implementation guide, sharing information about alcohol use between health service providers, adequately resourcing the implementation process, integrating alcohol screening with existing clinical pathways, having good clinical information systems and IT infrastructure, providing financial incentives, having sufficient training for healthcare workers, and clinical leadership and engagement. Implementation of the standards would need to ensure patients are not stigmatised and that patient confidentiality is robustly maintained.ConclusionsA wide range of stakeholders agreed that use of AUDIT-C and AUDIT are appropriate standards for recording alcohol use in EHRs in addition to recording interventions for alcohol misuse. The findings of this consultation will be used to develop an appropriate information model and implementation guide. Further research is needed to pilot the standards in primary and secondary care.

Are veterans different? Understanding veterans' help-seeking behaviour for alcohol problems.

Alcohol misuse in the United Kingdom's veteran community is not an isolated phenomenon. Internationally, alcohol and wider substance misuse would appear to be an historic and current global issue within veteran communities. Although research has been undertaken both in the United Kingdom and the United States into why veterans are reluctant to seek help for mental health problems, little is understood as to why veterans encounter difficulties in engaging with treatment for alcohol misuse. The aim of this study was to understand why veterans in the United Kingdom are either reluctant or have difficulty in accessing help for alcohol problems. An applied social policy research methodology was used, employing in-depth semi-structured interviews with 19 UK veterans in the North East of England, who had a history of alcohol misuse. The findings showed that participants appeared to excuse or normalise their excessive alcohol consumption, which led to a delay in meaningful engagement in substance misuse services, resulting in complex and complicated presentations to health and social care services. The findings of this study clearly suggest that veterans who misuse alcohol have a range of distinctive and unique difficulties that subtly differentiate them from the wider civilian substance misuse population, and that the use of peer-support models would appear to mitigate against them disengaging from alcohol treatment services.

What Doesn’t Work to Reduce Reoffending?

Abstract. This paper describes a review of meta-analyses and systematic reviews, to explore what appears to be ineffective in reducing reoffending among people convicted of crime. The focus of this review is on secondary or tertiary crime prevention initiatives, concentrating on interventions aiming to reduce offending among adults serving sentences in custody or the community. Twenty-one reviews met the inclusion criteria, covering interventions aiming to reduce violence, domestic violence, sexual offending, drug misuse, driving under the influence, and general reoffending. Fourteen of these reviews identified interventions that have no impact on criminal recidivism, and three identified interventions that in at least one study were actively harmful by increasing the risk of recidivism of participants. Findings suggest that ineffective interventions may comprise drug testing as a stand-alone strategy, insight-oriented and behavioral interventions for sexual offending, brief interventions for alcohol misuse, and in prison in the longer-term, agonist pharmacological treatment alone for drug misuse. Those interventions that had demonstrated, in at least one of the evaluations reviewed, that they were associated with negative behaviors were court-mandated treatment for domestic violence, boot camps, incarceration-based agonist drug treatment and custodial (when compared to noncustodial) sanctions. Taken together with the findings of previous reviews in this area, the authors identify features of interventions which are likely to be ineffective in reducing reoffending. Explanations for these interventions’ likely failure to reduce reoffending draw on criminological and social psychological research and behavioral science. The authors also note that this review may not include all relevant evidence and findings should therefore be considered indicative.

Selecting and Interpreting Alcohol Biomarker Tests: Enough to Drive You to Drink.

Alcohol use disorders (AUDs)2 are common and lead to unintentional and intentional health consequences from liver disease to death. Approximately 4% of deaths worldwide are because of an AUD and up to 20% of hospital inpatients have an AUD (1). Treatment of alcohol-dependent individuals varies by clinical setting and physician type (e.g., general practitioners vs addiction specialists). Routine screening and behavioral intervention for alcohol misuse is one of the most cost-effective clinical preventative services and is recommended by the US Preventive Services Task Forces (2, 3). Although various interview formats are used to quantify alcohol intake, such as the Alcohol Use Disorders Identification Test Consumption, laboratory tests for alcohol biomarkers are seen as complementary objective measures to supplement self-reporting and comprehensive patient history/physical examination (4). One of the challenges is selecting an alcohol biomarker and applying appropriate cutoff concentrations to monitor alcohol use/abstinence and …

Evaluation of the Peninsula Alcohol and Violence Programme (PAVP) with violent offenders

There is clear experimental evidence for a causal link between alcohol misuse and violent behaviour. Treatments for alcohol misuse with offenders are therefore justified on the grounds that they may reduce violent behaviour and thus re-offending. The current paper tested whether a 10-session CBT intervention with offenders still in prison would produce improvements across three time points (pre, post and follow up) in self-reported alcohol expectancies, aggressiveness, impulsivity, and self-efficacy in managing alcohol use and violent behaviour. The programme focussed on educating participants on the relationship between alcohol use and violence, modifying unhelpful cognitions, and providing skills based training to manage potential triggers. Data from 49 offenders in prison were collected pre-intervention, post-intervention, and at three month follow up. Long term improvements (from pre- to post-intervention and follow up) were observed with respect to alcohol expectancies (in terms of sociability and liquid courage), impulsive responding to negative affect triggers, trait anger, and confidence in managing alcohol use and offending behaviour. These findings provide preliminary evidence for the efficacy of the CBT programme in reducing harmful alcohol use and associated violence. Limitations and recommendations for future evaluation of the intervention are discussed.

Peer, social media, and alcohol marketing influences on college student drinking

ABSTRACTObjective: To investigate how alcohol marketing and peers may promote college students' alcohol use through social media. Participants: College students (N = 682) aged 18 to 22 years from a large Southern university completed paper surveys in April 2014. Methods: Structural equation modeling was used to investigate relationships among variables as well as moderation by gender and race. Results: Drinking behavior was directly related to perceived norms and attitudes toward alcohol that develop, in part, from direct and indirect interactions with their online and offline peers, as well as engagement with alcohol-related content on social media. Gender and ethnicity moderated some effects. Conclusions: College student drinking is influenced by friends' alcohol-related content posted on social networking sites and by greater engagement with traditional and online alcohol marketing. College campus alcohol misuse interventions should include components to counter peer influences and alcohol marketing on social media.

Finding the optimal treatment model: A systematic review of treatment for co-occurring alcohol misuse and depression.

Alcohol misuse and depression are commonly co-occurring conditions. To date, no review has examined the most efficacious treatment model for psychosocial treatment of co-occurring alcohol misuse and depression. This systematic review determined the: (i) methodological quality of publications examining psychosocial treatment of co-occurring alcohol misuse and depression using a sequential, parallel or integrated treatment model; and (ii) effectiveness of each dual treatment model compared to single treatment for those with co-occurring alcohol misuse and depression. PubMed, Medline and PsycInfo databases were searched for studies which were included if they involved treatment for alcohol misuse and depression and could be classified into one of the three treatment models. Included studies were assessed using the Cochrane's Effective Practice and Organisation of Care risk of bias criteria. Relevant study characteristics and outcomes were extracted and are presented in a narrative review format. Seven studies met inclusion criteria. None were categorised as low risk on the risk of bias criteria. No studies examined a sequential model of treatment, three examined a parallel model and four examined an integrated model of dual-focussed treatment. The studies examining the parallel model and two out of four studies examining the effectiveness of an integrated model demonstrated greater improvement for alcohol or depression outcomes compared to control conditions. Evidence for the psychosocial treatment of co-occurring alcohol misuse and depression is limited to a handful of studies. The evidence has several methodological limitations, which impact the interpretation of the findings. Therefore, while international guidelines recommend integrated dual-focussed treatment for co-occurring conditions, there is little evidence supporting the superiority of this treatment format for co-occurring alcohol misuse and depression. High-quality research demonstrating improvements in patient outcomes is required to ensure recommendations for clinical practice are based on strong empirical evidence.

Predictors of Longitudinal Trajectories of Alcohol Consumption in People with HIV.

Our aim was to describe alcohol consumption trajectories in a cohort of people living with HIV and determine clinical and sociodemographic predictors of each trajectory. This is a prospective cohort study of 7,906 patients in the 7 Centers for AIDS Research Network of Integrated Clinical Systems sites. Alcohol consumption was categorized as none, moderate, and alcohol misuse. Predictors included age, race/ethnicity, depressive or anxiety symptoms, illicit drug use (opioids, methamphetamines, cocaine/crack), marijuana use, hepatitis C virus (HCV) infection, HIV transmission risk factor, and HIV disease progression. We estimated sex-stratified alcohol consumption trajectories and their predictors. We found 7 trajectories of alcohol consumption in men: stable nondrinking and increased drinking (71% and 29% of initial nondrinking); stable moderate, reduced drinking, and increased alcohol misuse (59%, 21%, and 21% of initial moderate alcohol use); and stable alcohol misuse and reduced alcohol misuse (75% and 25% of initial alcohol misuse). Categories were similar in women, except lack of an increase to alcohol misuse trajectory among women that begin with moderate use. Older men and women were more likely to have stable nondrinking, while younger men were more likely to increase to or remain in alcohol misuse. Minorities, people with depressive or anxiety symptoms, HCV-infected individuals, and people who injected drugs were more likely to reduce use. Illicit drug use was associated with a reduction in overall drinking, while marijuana use was associated with stable moderate drinking or misuse. Longitudinal trajectories of increasing alcohol use and stable misuse highlight the need to integrate routine screening and alcohol misuse interventions into HIV primary care.

The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder.

The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder.

Information standards for recording alcohol use in electronic health records: findings from a national consultation

BackgroundClinicians are advised to ask patients about their alcohol use and provide brief interventions and specialist referral, but this is poorly implemented in practice. We undertook a national consultation to develop appropriate standards for recording information about alcohol use in electronic health records in the UK. MethodsA wide range of stakeholders in the UK was consulted about recording alcohol use in electronic health records via a multidisciplinary stakeholder workshop and online survey. Stakeholders were identified by the Royal College of Physicians Health Informatics Unit and the project team. Notes were taken at the workshop and used to inform the survey. The survey asked participants about the appropriateness of the proposed information standards, implementation barriers and facilitators, potential applications for patient care, and patient safety concerns. Responses were thematically analysed using the Consolidated Framework for Implementation Research. Findings31 stakeholders participated in the workshop and 105 in the online survey. Participants included patients, health-care professionals, researchers, public health specialists, informaticians, and clinical information system suppliers. There was broad consensus that the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-Consumption (AUDIT-C) questionnaires were the optimal tools for recording alcohol use in electronic health records but that information should also be captured on relevant interventions. Stakeholders highlighted various factors that could influence implementation, including having clear care pathways and implementation guidance, information sharing between health service providers (potentially through summary care records), resourcing the implementation process, integrating alcohol screening with existing clinical pathways, having accessible clinical information systems (including a simple interface that aids understanding of alcohol units), financial incentives, training of health-care professionals, and strong clinical leadership and engagement. Implementation of the standards would need to ensure patients are not stigmatised and that patient confidentiality is maintained. InterpretationA wide range of stakeholders agreed that AUDIT and AUDIT-C are appropriate standards for recording alcohol use in electronic health records with the addition of recording interventions for alcohol misuse. The findings of this consultation will be used to develop an appropriate information model and implementation guide. Further research is needed to pilot the standards in primary and secondary care electronic health records. FundingFunding for patient involvement was provided by the National Institute for Health Research Patient Involvement Fund.