Efficacy Of Alcohol Brief Interventions Research Articles

The Effect of Question Order on Outcomes in the Core Outcome Set for Brief Alcohol Interventions Among Online Help-Seekers: Protocol for a Factorial Randomized Trial.

BackgroundA core outcome set (COS) for trials and evaluations of the effectiveness and efficacy of alcohol brief interventions (ABIs) has recently been established through international consensus to address the variability of outcomes evaluated.ObjectiveThis is a protocol for studies to assess if there are order effects among the questions included in the COS.MethodsThe 10 items of the COS are organized into 4 clusters. A factorial design will be used with 24 arms, where each arm represents 1 order of the 4 clusters. Individuals searching online for help will be asked to complete a questionnaire, and consenting participants will be randomized to 1 of the 24 arms (double-blind with equal allocation). Participants will be included if they are 18 years or older. The primary analyses will (1) estimate how the order of the clusters of outcomes affects how participants respond and (2) investigate patterns of abandonment of the questionnaire.ResultsData collection is expected to commence in November 2020. A Bayesian group sequential design will be used with interim analyses planned for every 50 participants completing the questionnaire. Data collection will end no more than 24 months after commencement, and the results are expected to be published no later than December 2023.ConclusionsHomogenizing the outcomes evaluated in studies of ABIs is important to support synthesis, and the COS is an important step toward this goal. Determining whether there may be issues with the COS question order may improve confidence in using it and speed up its dissemination in the research community. We encourage others to adopt the protocol as a study within their trial as they adopt the ORBITAL (Outcome Reporting in Brief Intervention Trials: Alcohol) COS to build a worldwide repository and provide materials to support such analysis.Trial RegistrationISRCTN Registry ISRCTN17954645; http://www.isrctn.com/ISRCTN17954645International Registered Report Identifier (IRRID)PRR1-10.2196/24175

Assessing the delivery of alcohol screening and brief intervention in sexual health clinics in the north east of England

BackgroundRisky drinking is associated with risky sexual experiences, however the relationship between alcohol and sex is complex. The aim of the study was to assess the feasibility of delivering alcohol screening and brief interventions in genitourinary medicine (GUM) clinics. The objectives were to; understand the levels of alcohol use amongst patients; report on the number of alcohol interventions delivered; and to analyse the relationship between alcohol use with demographic data as well as diagnosed sexually transmitted infections (STIs) to see if there were any associations.MethodsAll new patients attending GUM between April 2012 and March 2013 self-completed the Alcohol Use Disorder Identification Test (AUDIT) prior to their clinical consultation. Where appropriate (scoring 8+ on AUDIT) the clinician would deliver up to 2–3 min of alcohol brief intervention. Descriptive statistics, t-tests, ANOVA and logistic regression were carried out as appropriate.ResultsAUDIT scores were available for 90% of all new patients (3058/3390) with an average mean score of 7.75. Of those who drank alcohol, 44% were categorised as being AUDIT positive, including 2% who had a score indicative of probable alcohol dependence (20+). 55 % (n = 638) of patients who screened positive on the AUDIT received a brief intervention whilst 24% (n = 674) of drinkers were diagnosed with a STI. Logistic regression modelling revealed that males, younger age groups and those of ‘white’ ethnicity were more likely to score positive on AUDIT. Patients classified as non-students, living in deprivation quintiles one to four and categorised as probable alcohol dependence on the AUDIT were more likely to be diagnosed with an STI.ConclusionIt is possible to embed alcohol screening into routine practice within sexual health services however further work is required to embed brief interventions particularly amongst increasing risk drinkers. If resources are limited, services may consider more targeted rather than universal alcohol screening to specific population groups. The study was undertaken in one GUM service in the North East of England and therefore findings may not be generalizable. The study did not assess efficacy of alcohol brief intervention in this setting.

Understanding Mechanisms of Change for Brief Alcohol Interventions Among Youth: Examination of Within-Session Interactions.

Alcohol brief interventions (BIs) for youth are efficacious, but effect sizes found have been modest. This article presents secondary data analyses from a randomized controlled trial of motivational interviewing-based (MI) alcohol BIs among youth in an emergency department, examining within-session predictors of alcohol outcomes at 3 months among those receiving BIs. Risky drinkers (ages 14-20) received either a computer BI (n = 277) or therapist BI (n = 278). Within-session measures were obtained via computer metrics (therapist and computer BIs) and coding of audiotapes (therapist BI only). Parallel structural equation models examined direct and indirect effects of BI components on 3-month alcohol consumption and consequences, with posttest precursors of behavior change (e.g., importance, readiness, and intentions) as potential mediators. Components examined included reasons to avoid or reduce drinking, strengths, strategies for change, benefits of change, and leisure activities (computer BI only), and MI global ratings and MI-adherent behaviors (therapist BI only). For both BIs, greater number of strategies directly predicted greater posttest scores, with posttest scores mediating the relationship between strategies and alcohol consumption at 3 months. Greater number of strengths directly predicted fewer alcohol-related consequences at 3 months for both BIs; however, strengths also indirectly predicted greater consumption, mediated by posttest scores. Greater number of reasons to avoid or reduce drinking directly predicted greater alcohol consumption for the therapist BI only. These findings suggest ways to optimize the content and efficacy of alcohol BIs. Reviews of strategies such as refusal skills, protective behavioral strategies, and coping with negative affect may be particularly salient for reducing alcohol misuse.

Efficacy of Brief Interventions in Reducing Hazardous or Harmful Alcohol Use in Middle-Income Countries: Systematic Review of Randomized Controlled Trials.

The aim of this paper is to systematically review the efficacy of alcohol brief intervention in middle-income countries. Randomized controlled trials (RCTs) of face-to-face brief motivational intervention aimed at reducing heavy alcohol use conducted in middle-income countries were identified through electronic databases: Medline, EMBASE and Cochrane Library published up to and including 2015. Methodological quality assessment of the RCTs was made by using two validated tools. Nine RCTs of alcohol brief intervention in middle-income countries met the review's inclusion criteria. The results of five trials suggest a benefit for brief intervention in reducing self-reported hazardous or harmful alcohol use. Methodological quality was found to be adequate using a standard tool, without any serious methodological issues or biases in more than half of the selected trials. The content of brief intervention was based on the principles of motivational interviewing and was delivered by trained nurses in almost all the trials. This systematic review of RCTs on alcohol brief intervention conducted in middle-income countries suggests that brief intervention can help reduce self-reported hazardous or harmful alcohol use in primary-care population.

Exploration of delivering brief interventions in a prison setting: A qualitative study in one English region

Aims: There is evidence that alcohol is strongly correlated with offending. This qualitative study explored the views of staff on the efficacy of alcohol brief interventions within a prison setting. The perceptions of prisoners in relation to non-dependent drinking were also examined. Methods: Nine prisons in one English region took part in this research. Five focus groups with 25 prisoners were undertaken with prisoners alongside focus group discussions with 30 professionals. Discussions were recorded using shorthand notation and the main themes were thematically mapped using visual mapping techniques. Findings: The use of the Alcohol Use Disorder Identification Test (AUDIT) was perceived as problematic. Prisoner drinking norms differed widely from community consumption patterns. There were also operational issues that reduced the salience of a brief intervention for prisoners. Conclusions: The delivery of screening and brief interventions within a prison setting is highly nuanced and fraught with inconsistencies. Despite these challenges, there are opportunities to develop coherent and tailored brief interventions for a custodial environment that should focus on developing three key areas around: (a) interventions for the point of release; (b) enhanced content around family impact and offending; and (c) forward-looking goal-setting as motivational tools to facilitate change.

A scoping study of practitioner training in alcohol brief interventions as described and delivered in randomised controlled trials

Background Good evidence for the efficacy of alcohol brief interventions (ABIs) delivered in primary care [1] has been insufficient to drive routine implementation [2] and may not translate to normal clinical settings, possibly due to a loss of fidelity [3]. Implementation efforts, and research trials, rely on practitioners being adequately prepared to deliver ABIs consistently with evidence or protocols (amongst other factors). Relatively little research attention has been paid to establishing optimal duration, content, methods, style, deliverer or format of training and the importance of heterogeneity in training provision in affecting trial outcomes is currently unknown. This study aimed to ascertain how published trials of ABIs describe the training and related support provided to practitioners, what additional relevant information can be obtained from trial authors and how current frameworks or taxonomies can inform how best to analyse and describe training content and design.

Support for community pharmacy-based alcohol interventions: a Scottish general public survey

BackgroundCommunity pharmacy teams are recognised by health agencies as vital to increasing capacity in the provision of public health services. Public awareness and support of these services in general, and relating to safe alcohol consumption in particular, have yet to be established. This study aimed to determine the Scottish general public's views regarding the role and involvement of community pharmacists in reducing alcohol consumption amongst customers and alcohol-related harm. MethodsA cross-sectional survey of 6000 adults in Scotland randomly sampled from the electoral register. The piloted questionnaire contained items on: those health professions which could potentially advise on safer alcohol consumption; areas of safer alcohol consumption on which pharmacists could advise; attitudes towards pharmacist involvement; and demographics. ResultsOf the 1573 respondents (a 26.6% response rate), more than half (56.4%, 888) agreed that pharmacists could advise on safer alcohol consumption. Those agreeing expressed high levels of support (≥70% agreement) for all activities, particularly referring people to other individuals or organisations, discussing recommended alcohol consumption limits and how consumption may affect health. There was a high level of agreement of trust that pharmacists would discuss issues confidentially (68.7%, 1080), with a similar proportion (64.3%, 1011) agreeing that they would be concerned over privacy in a community pharmacy. ConclusionPublic support exists for pharmacist involvement in reducing alcohol consumption amongst customers and alcohol-related harm, with some concern over privacy. These findings warrant consideration as models of practice are developed and evaluated. Given the widespread availability of pharmacies and the ease of access to professional advice, there is potential for pharmacists to impact safer alcohol consumption although the efficacy of alcohol brief interventions remains to be demonstrated.

A randomized controlled trial of different methods of alcohol screening and brief intervention in routine accident and emergency department care: 12-month outcomes

There is a wealth of evidence on the detrimental impact of excessive alcohol consumption on physical, psychological, and social health. There also exists a substantial evidence base for the efficacy of alcohol brief intervention (BI) aimed at reducing consumption across a range of settings. Research conducted in emergency departments (EDs) has reinforced the current evidence regarding the potential effectiveness and cost-effectiveness of BI. However, the majority of this research has been conducted in a single center, and there is little evidence of the generalizability of SBI implementation across EDs. This pragmatic cluster randomized controlled trial randomized nine EDs to a combination of screening tools (the Modified Single Alcohol Screening Question [M-SASQ], the Fast Alcohol Screening Test [FAST], or the Screening and Intervention Program for Sensible Drinking modified Paddington Alcohol Test [SIPS-PAT]) and interventions (patient intervention leaflet [PIL], brief advice [BA], or brief lifestyle counseling [BLC]). The primary hypothesis was that BLC delivered by an alcohol health worker would be more effective than BA or PIL delivered by ED staff. Outcomes were assessed at six and 12 months. Overall, 5992 patients were screened for eligibility in 9 EDs; of these, 3737 (62%) were found eligible, and 1491 screened positive for an alcohol use disorder (40%). Of those who screened positive, 1204 (81%) consented to participate in the trial. The mean age of participants was 35 years, and the mean AUDIT score at baseline was 12.4. The majority of the sample was male (65%) and white (88%). At 12 months, 803 (67%) of participants were followed up. No significant differences in follow-up rates were observed between intervention groups. Overall, the proportion of participants positive for an alcohol use disorder reduced significantly by 16.3%. This reflected a significant decrease of 18.8% in the PIL group and 15.1% in both the BLC and BA groups. An adjusted logistic regression model found no significant effects of intervention group, screening approach, or baseline AUDIT score.

Challenges Applying Alcohol Brief Intervention in Diverse Practice Settings: Populations, Outcomes, and Costs

This article summarizes the proceedings of a symposium at the 2005 Research Society on Alcoholism, Santa Barbara, California. The purpose of the symposium was to address challenges that arise in translating evidence for efficacy of alcohol brief intervention (BI) into diverse clinical settings and populations by reviewing the literature and describing 4 research studies. Dr. Saitz reviewed the limitations in evidence for efficacy of BIs and then described results of a randomized clinical trial of brief motivational intervention for medical inpatients drinking risky amounts. Dr. Svikis presented alternative methods for identifying pregnant women in prenatal care at risk for alcohol and drug problems (including nicotine and caffeine) and BIs to reduce or eliminate use. Dr. D'Onofrio discussed results of a randomized trial of the brief negotiated interview in emergency department patients. Dr. Kraemer presented results of a decision analytic and computer-simulation model regarding the cost-effectiveness of alcohol screening and intervention in primary care settings. Finally, Dr. Perl discussed the salient issues and suggested future directions for work in the area of alcohol BI.