Can screening and brief intervention in our GP surgeries reduce problem drinking?

Looking back on the hot health topics of 2012, I think the one that struck me most was the rise of liver disease and the scale of problem alcohol use in the UK, compared to our European neighbours. In England, about 1 in 4 adults between 16 and 65 drinks harmful quantities of alcohol and the problem is growing. So this week we’re focusing on some new research on how this might best be tackled.

Brief interventions are an attractive option in health promotion, not least because they need fewer resources than more intensive efforts. Last year I wrote here about a Cochrane review which suggested possible benefits of delivering a brief intervention to heavy alcohol users admitted to general hospital wards. Now the results of a trial have been published, which explored the effectiveness of screening and brief alcohol intervention in primary care practices in the north east and south east of England and in London. Practices were randomised to one of three interventions, each building on the previous one:

  • an alcohol information leaflet (control group)
  • 5 minutes of structured brief advice
  • 20 minutes of lifestyle counselling

The leaflet and brief advice were given straight after screening and the longer counselling session as a separate appointment. Of almost 3000 people eligible to enter the trial, 900 (30%) screened positive for harmful or hazardous drinking and 756 (84%) agreed to take part. Follow-up took place at six and twelve months and the main outcome was the proportion of people scoring less than 8 on the alcohol use disorders identification test (AUDIT), which indicates non-hazardous or non-harmful drinking. Here’s what they found:

  • The proportion of people scoring less than 8 increased in all groups
  • No difference between groups in AUDIT scores
  • No difference between groups in alcohol-related problems or health-related quality of life
  • People receiving the most intensive intervention reported being slightly more satisfied with treatment and slightly more ready to change

It’s good that there was some improvement in all groups, but why no difference between them? An accompanying editorial in the BMJ considers this. One explanation is that something ‘active’ was done in all groups. Everyone was screened and given their results; everyone got a leaflet, and everyone completed the AUDIT questionnaire – this alone has been shown elsewhere to reduce people’s drinking. Another possibility is that that health professionals might have given some advice when they handed out the leaflet. Or it might be that none of the strategies worked and the changes were simply a result of regression to the mean – so people reporting drinking lots of alcohol around the time of screening might later report drinking less, just by random fluctuation. If you’re not familiar with the concept of regression to the mean, and even if you are, I highly recommend you read (or listen to) this fun poem explaining it.

The researchers think that the first explanation, that all groups received something, is the most likely, and suggest that

Screening followed by simple feedback and written information may be the most appropriate strategy to reduce hazardous and harmful drinking in primary care.

If this is so, it’s good news for those funding services, reserving specialist referral and more intensive support for those who are most in need of it. If you’re wondering about your alcohol intake, you can check out some useful stuff on the NHS Change for Life choose less booze pages, which include a drinks checker and a drink tracker app. There’s also the British Liver Trust’s Love Your Liver campaign, which recommends three steps to a healthier liver: keep off alcohol for two to three days in a row, exercise more and cut down on sugar and fat in your diet. Sounds good to me.

Links:

Kaner E, Bland M, Cassidy P, Coulton S, Dale V, Deluca P, Gilvarry E,Godfrey C, Heather N, Myles J, Newbury-Birch D, Oyefeso A, Parrott S, Perryman K, Phillips T, Shepherd J, Drummond C. Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial. BMJ2013;346:e8501

Editorial: Screening and brief intervention for alcohol use disorders in primary care. BMJ2013;346:e8706

Lifestyle Elf blog, February 10 2012. Hospital admission may be good news for heavy drinkers.  

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Sarah Chapman

My name is Sarah Chapman. I have worked on systematic reviews and other types of research in many areas of health for the past 17 years, for the Cochrane Collaboration and for several UK higher education institutions including the University of Oxford and the Royal College of Nursing Institute. I also have a background in nursing and in the study of the History of Medicine.

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