Effectiveness Of Alcohol Brief Interventions Research Articles

Alcohol brief intervention, specialty treatment and drinking outcomes at 12 months: Results from a systematic alcohol screening and brief intervention initiative in adult primary care

BackgroundAlcohol screening, brief intervention and referral to treatment (SBIRT) in adult primary care is an evidence-based, public health strategy to address unhealthy alcohol use, but evidence of effectiveness of alcohol brief intervention (ABI) in real-world implementation is lacking. MethodsWe fit marginal structural models with inverse probability weighting to estimate the causal effects of ABI on 12-month drinking outcomes using longitudinal electronic health records data for 312,056 adults with a positive screening result for unhealthy drinking between 2014 and 2017 in a large healthcare system that implemented systematic primary care-based SBIRT. We examined effects of ABI with and without adjusting for receipt of specialty alcohol use disorder (AUD) treatment, and whether effects varied by patient demographic characteristics and alcohol use patterns. ResultsReceiving ABI resulted in significantly greater reductions in heavy drinking days (mean difference [95% CI] = −0.26 [−0.45, −0.08]), drinking days per week (−0.04 [−0.07, −0.01]), drinks per drinking day (−0.05 [−0.08, −0.02]) and drinks per week (−0.16 [−0.27, −0.04]). Effects of ABI on 12-month drinking outcomes varied by baseline consumption level, age group and whether patients already had an AUD, with better improvement in those who were drinking at levels exceeding only daily limits, younger, and without an AUD. ConclusionsSystematic ABI in adult primary care has the potential to reduce drinking among people with unhealthy drinking considerably on both an individual and population level. More research is needed to help optimize ABI, in particular tailoring it to diverse sub-populations, and studying its long-term public health impact.

The \u2018Outcome Reporting in Brief Intervention Trials: Alcohol\u2019 (ORBITAL) framework: protocol to determine a core outcome set for efficacy and effectiveness trials of alcohol screening and brief intervention

BackgroundThe evidence base to assess the efficacy and effectiveness of alcohol brief interventions (ABI) is weakened by variation in the outcomes measured and by inconsistent reporting. The ‘Outcome Reporting in Brief Intervention Trials: Alcohol’ (ORBITAL) project aims to develop a core outcome set (COS) and reporting guidance for its use in future trials of ABI in a range of settings.Methods/designAn international Special Interest Group was convened through INEBRIA (International Network on Brief Interventions for Alcohol and Other Drugs) to inform the development of a COS for trials of ABI. ORBITAL will incorporate a systematic review to map outcomes used in efficacy and effectiveness trials of ABI and their measurement properties, using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. This will support a multi-round Delphi study to prioritise outcomes. Delphi panellists will be drawn from a range of settings and stakeholder groups, and the Delphi study will also be used to determine if a single COS is relevant for all settings. A consensus meeting with key stakeholder representation will determine the final COS and associated guidance for its use in trials of ABI.DiscussionORBITAL will develop a COS for alcohol screening and brief intervention trials, with outcomes stratified into domains and guidance on outcome measurement instruments. The standardisation of ABI outcomes and their measurement will support the ongoing development of ABI studies and a systematic synthesis of emerging research findings. We will track the extent to which the COS delivers on this promise through an exploration of the use of the guidance in the decade following COS publication.

A rapid systematic review of what we know about alcohol use disorders and brief interventions in the criminal justice system.

The purpose of this paper is to review the evidence of alcohol use disorders within the different stages of the criminal justice system in the UK. Furthermore it reviewed the worldwide evidence of alcohol brief interventions in the various stages of the criminal justice system. A rapid systematic review of publications was conducted from the year 2000 to 2014 regarding the prevalence of alcohol use disorders in the various stages of the criminal justice system. The second part of the work was a rapid review of effectiveness studies of interventions for alcohol brief interventions. Studies were included if they had a comparison group. Worldwide evidence was included that consisted of up to three hours of face-to-face brief intervention either in one session or numerous sessions. This review found that 64-88 per cent of adults in the police custody setting; 95 per cent in the magistrate court setting; 53-69 per cent in the probation setting and 5,913-863 per cent in the prison system and 64 per cent of young people in the criminal justice system in the UK scored positive for an alcohol use disorder. There is very little evidence of effectiveness of brief interventions in the various stages of the criminal justice system mainly due to the lack of follow-up data. Brief alcohol interventions have a large and robust evidence base for reducing alcohol use in risky drinkers, particularly in primary care settings. However, there is little evidence of effect upon drinking levels in criminal justice settings. Whilst the approach shows promise with some effects being shown on alcohol-related harm as well as with young people in the USA, more robust research is needed to ascertain effectiveness of alcohol brief interventions in this setting. This paper provides evidence of alcohol use disorders in the different stages of the criminal justice system in the UK using a validated tool as well as reviewing the worldwide evidence for short ( < three hours) alcohol brief intervention in this setting.

Effectiveness of Alcohol Brief Intervention in a General Hospital: A Randomized Controlled Trial.

The purpose of this study was to examine the effectiveness of an alcohol brief intervention (ABI) on alcohol consumption in hazardous or harmful drinkers compared with screening alone within a general hospital setting. Following screening, 124 hazardous or harmful drinkers (103 men, ages 18-80 years, score of 3-12 on the Fast Alcohol Screening Test [FAST]) admitted to medical and orthopedic wards during the 13-month recruitment period were randomized to receive an ABI or control. The intervention group received an ABI where they were supported to set their own personalized alcohol reduction goals, and both groups received a health information leaflet. Retrospective alcohol consumption for 7 days was reported for the week, before hospital admission and 6 months after it. Demographics and clinical characteristics at baseline showed no statistical differences between the two groups on all variables except FAST score, which was higher in the intervention group (p ≤ .05). A reduction of 85 grams of alcohol per week (95% CI [162.46, 7.54]) was observed between groups in favor of the intervention group based on changes from baseline. However, there was no significant difference between groups for absolute grams of alcohol per week at 6 months. A significant mean difference in favor of the intervention group (U = 1,537, p = .043) was observed for weekly heavy drinking episodes. Our results suggest screening with delivery of ABI for harmful/hazardous drinkers in a general hospital is beneficial in reducing alcohol consumption compared with screening alone.

Interpreting null findings from trials of alcohol brief interventions.

The effectiveness of alcohol brief intervention (ABI) has been established by a succession of meta-analyses but, because the effects of ABI are small, null findings from randomized controlled trials are often reported and can sometimes lead to skepticism regarding the benefits of ABI in routine practice. This article first explains why null findings are likely to occur under null hypothesis significance testing (NHST) due to the phenomenon known as “the dance of the p-values.” A number of misconceptions about null findings are then described, using as an example the way in which the results of the primary care arm of a recent cluster-randomized trial of ABI in England (the SIPS project) have been misunderstood. These misinterpretations include the fallacy of “proving the null hypothesis” that lack of a significant difference between the means of sample groups can be taken as evidence of no difference between their population means, and the possible effects of this and related misunderstandings of the SIPS findings are examined. The mistaken inference that reductions in alcohol consumption seen in control groups from baseline to follow-up are evidence of real effects of control group procedures is then discussed and other possible reasons for such reductions, including regression to the mean, research participation effects, historical trends, and assessment reactivity, are described. From the standpoint of scientific progress, the chief problem about null findings under the conventional NHST approach is that it is not possible to distinguish “evidence of absence” from “absence of evidence.” By contrast, under a Bayesian approach, such a distinction is possible and it is explained how this approach could classify ABIs in particular settings or among particular populations as either truly ineffective or as of unknown effectiveness, thus accelerating progress in the field of ABI research.

Effectiveness of alcohol brief interventions in general practice.

Harmful levels of alcohol consumption are a longstanding but continually growing health concern affecting individuals, and consequently populations. Through personalised advice, alcohol brief interventions (ABIs) target drinking habits, which are deemed damaging to health. They are not targeted at dependent drinkers for whom a more intensive and specialist service would be better suited. In response to recent shifts in public-health strategy away from ABIs, and the publication of new trials into their effectiveness, this article evaluates the value of ABIs through the review of elevenrelevant studies. Findings suggest that hazardous drinkers did reduce their drinking patterns following ABI, but not more so than control participants who were given standard treatment. The evolution of standard treatment to include thorough screening, non-personalised advice and sometimes literature on alcohol intake delivers an intervention, that is effective in reducing drinking. Therefore, future research and practice should focus on screening methods and quality of standard care rather than on brief interventions.

Toward an Understanding of the Effective Mechanisms of Alcohol Brief Interventions

Research on effective mechanisms of alcohol brief interventions has been neglected, but Bertholet and colleagues provide an example of such research in a re-analysis of combined data from 3 trials of brief motivational interviewing (BMI). However, it is disappointing that, in a well-designed and well-conducted analysis, little support was found for highly plausible hypotheses relating treatment processes to outcome of intervention. It is argued here that, because BMI must be assumed to work by increasing client motivation to cut down drinking, some measure of overall motivation before and after intervention is necessary to elucidate the pathway by which treatment processes are translated into positive outcomes. In pioneering research on physician advice on smoking cessation by Russell and colleagues, it was possible to distinguish between whether intervention worked by motivating more people to try to stop smoking, by increasing the success rate among those who did try, or by reducing the relapse rate among those who quit. It is recommended that similar measures be employed in research on how alcohol brief interventions work. A further consideration bearing on the relationship between treatment processes and outcome is whether or not individuals are dependent on alcohol and this is reminiscent of a dispute in the literature concerning the relative priority that should be given to motivational or dependence variables in the prediction of smoking cessation. In order to improve the effectiveness of alcohol brief interventions, future research should focus more on effective mechanisms of behavior change.

Effectiveness of alcohol brief intervention delivered by community pharmacists: two-arm randomised controlled trial

The UK Department of Health’s aim is to involve community pharmacists in the delivery of alcohol brief intervention (BI). This possibility extends the settings in which BIs have been delivered and has attracted international attention. The objective of this study was to assess the effectiveness of BI delivered by community pharmacists in a randomised controlled trial (RCT) in London. A two-arm RCT was conducted to determine the effectiveness of BI delivered by community pharmacists. Pharmacists and their support staff were trained in the trial procedures. Pharmacy support staff (N = 23) approached and informed customers about the study, to support formal recruitment by the community pharmacist (N = 17). Eligible and consenting pharmacy customers (aged≥18 years) at the 16 community pharmacies were randomised in equal numbers to either BI delivered by a community pharmacist or a non-intervention control condition, conducted in the pharmacy consultation room. The intervention was a brief motivational discussion of approximately 10 minutes duration. Participants randomised to the control arm were given an alcohol information leaflet with no opportunity for discussion. At 3-month follow up, alcohol consumption and related problems were assessed with the Alcohol Use Disorders Identification Test (AUDIT) administered by telephone. Of the 1440 customers approached, 541 (38%) consented to participate. Of those who consented, 409 were identified as hazardous/harmful drinkers (AUDIT 8-19), 94 as low risk drinkers (AUDIT≤7), and 38 as possibly dependent drinkers (AUDIT≥20), with the latter two groups excluded from the trial. The 409 trial participants were followed up at three months (follow-up rate ≥80%). Data analysis is under way and the preliminary main trial results are presented here. This is the first presentation of trial outcomes from this internationally significant study.

Effectiveness of alcohol brief intervention delivered by community pharmacists: study protocol of a two-arm randomised controlled trial

BackgroundThere is strong evidence to support the effectiveness of Brief Intervention (BI) in reducing alcohol consumption in primary healthcare.Methods and designThis study is a two-arm randomised controlled trial to determine the effectiveness of BI delivered by community pharmacists in their pharmacies. Eligible and consenting participants (aged 18 years or older) will be randomised in equal numbers to either a BI delivered by 17 community pharmacists or a non-intervention control condition. The intervention will be a brief motivational discussion to support a reduction in alcohol consumption and will take approximately 10 minutes to deliver. Participants randomised to the control arm will be given an alcohol information leaflet with no opportunity for discussion. Study pharmacists will be volunteers who respond to an invitation to participate, sent to all community pharmacists in the London borough of Hammersmith and Fulham. Participating pharmacists will receive 7 hours training on trial procedures and the delivery of BI. Pharmacy support staff will also receive training (4 hours) on how to approach and inform pharmacy customers about the study, with formal trial recruitment undertaken by the pharmacist in a consultation room. At three month follow up, alcohol consumption and related problems will be assessed with the Alcohol Use Disorders Identification Test (AUDIT) administered by telephone.DiscussionThe UK Department of Health’s stated aim is to involve community pharmacists in the delivery of BI to reduce alcohol harms. This will be the first RCT study to assess the effectiveness of BI delivered by community pharmacists. Given this policy context, it is pragmatic in design.Trial registrationCurrent Controlled Trials ISRCTN95216873