Brief interventions: an oportunity for reducing excessive drinking among young people
DOI:
https://doi.org/10.20882/adicciones.557Keywords:
Excessive drinking, Alcohol-related harm, Brief interventions, Medical settings, Young people, Binge drinkingAbstract
Brief interventions against excessive alcohol consumption delivered in health care settings have been shown by research to be effective in reducing consumption among excessive drinkers. The widespread and routine implementation of brief interventions in these settings would lead to substantial gains for public health. This paper reviews evidence for the effectiveness of brief interventions in a range of medical settings. Special mention is made of the WHO series of studies on “The Detection and Management of Alcohol-related Problems in Primary Health Care”, including the current Phase IV of this project concerned with developing strategies for implementing early identification and brief intervention for excessive drinking in the primary health care systems of participating countries. Attention then turns to the potential of brief interventions for reducing alcohol problems specifically among young people. The relevance to this aim of a range of health care settings -general medical practice, general hospital wards, accident and emergency departments- is reviewed. Particular issues that arise when considering brief alcohol interventions for young people are discussed. The paper ends with a series of conclusions regarding research and policy for brief interventions in general and brief interventions adapted for the needs of young people.References
Bien, T.H., Miller, W.R., & Tonigan, J. (1993). Brief interventions for alcohol problems: A review. Addiction, 88, 315-336.
Fremantle, N., Gill, P., Godfrey, C., Long, A., Richards, C., Sheldon, T., Song, F., & Webb, J. (1993). Brief interventions and alcohol use. Effective Health Care Bulletin #7. Nuffield Institute for Health: Leeds, UK.
Heather, N. (1995). Brief intervention strategies. In R.K. Hester & W.R. Miller (Eds.), Handbook of Alcoholism Treatment Approaches: Effective Alternatives. (2nd edition). Needham Heights MS: Allyn & Bacon.
Kahan, M., Wilson, L. & Becker, L. (1995). Effectiveness of physician-based interventions with problem drinkers: a review. Canadian Medical Association Journal, 152, 851-859.
Wilk, A.I., Jensen, N.M. & Havighurst, T.C. (1997). Metaanalysis of randomised control trials addressing brief interventions in heavy alcohol drinkers. Archives of Internal Medicine, 12, 274-283.
Wallace, P., Cutler, S., & Haines, A. (1988). Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. British Medical Journal, 297, 663-668.
Heather, N. (1996). The public health and brief interventions for excessive alcohol consumption: the British experience. Addictive Behaviors, 21, 857-868.
Heather, N. (in press). Brief interventions. In N. Heather, T. Peters & T. Stockwell (Eds.), International Handbook of Alcohol Dependence and Problems. Chichester, UK: John Wiley.
Romelsjö, A., Andersson, L. Barrner, H. et al. (1989). A randomised study of secondary prevention of early stage problem drinkers in primary health care. British Journal of Addiction, 84, 1319-1327.
Anderson, P. & Scott, E. (1992). The effect of general practitioners’ advice to heavy drinking men. British Journal of Addiction, 87, 891-900.
Richmond, R., Heather, N., Wodak, A., Kehoe, L. & Webster, I. (1995). Controlled evaluation of a general practice-based brief intervention for excessive drinking. Addiction, 90, 119-132.
Fleming, M.F., Barry, K.L., Manwell, L.B., Johnson, K. & London, R. (1997). Brief physician advice for problem alcohol drinkers: A randomised controlled trial in community-based primary care practices. Journal of
the American Medical Association, 277, 1039-1045.
Senft, R.A., Polen, M.R., Freeborn, D.K. & Hollis, J.F. (1997). Brief intervention in a primary care setting for hazardous drinkers. American Journal of Preventive Medicine, 13, 464-70.
Córdoba, R., Delgado, M.T., Pico, V. et al. (1998). Effectiveness of brief intervention on non-dependent alcohol drinkers (EBIAL): a Spanish multi-centre study. Family Practice, 15, 562-567.
Babor, T.F. & Grant, M. (Eds.) (1992). Project on Identification and Management of Alcohol-related Problems. Report on Phase II: A Randomised Clinical Trial of Brief Interventions in Primary Health Care.
Geneva: World Health Organization.
Israel, Y., Hollander, O., Sanchez-Craig, M. et al. (1996). Screening for problem drinking and counseling by the primary care physician-nurse team. Alcoholism: Clinical & Experimental Research, 20, 1443-1450.
Ockene, J.K., Adams, A., Hurley, T.G., Wheeler, E.V., & Herbert, J.R. (1999). Brief physician- and nurse practitioner-delivered counseling for high-risk drinkers: does it work? Archives of Internal Medicine, 159, 2198-
Scott, E. & Anderson, P. (1991). Randomised controlled trial of general practitioner intervention in women with excessive alcohol consumption. Drug & Alcohol Review, 10, 313-321.
Fleming, M.F., Mundt, M.P., French, M.T., Manwell, L.B., Stauffacher, E.A. & Barry, K.L. (2000). Brief physician advice for problem drinkers: long-term efficacy and benefit-cost analysis. Unpublished ms., Department of Family Medicine, University of Wisconsin-Madison, WI 53715, USA.
Fleming, M.F., Mundt, M.P., French, M.T., Manwell, L.B., Stauffacher, E.A. & Barry, K.L. (2000). Benefit-cost analysis of brief physician advice with problem drinkers in primary care settings. Medical Care, 38, 7-18.
Monteiro, M.G. & Gomel, M. (1998). World Health Organization project on brief interventions for alcoholrelated problems in primary health care settings. Journal of Substance Abuse, 3, 5-9.
Babor, T.F., de la Fuente, J.R., Saunders, J.B. & Grant, M (1989). AUDIT - The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Health Care. Geneva: World Health Organization.
Saunders, J.B. & Aasland, O.G. (1987). WHO Collaborative Project on the Identification and Treatment of Persons with Harmful Alcohol
Consumption. Report on Phase I: Development of a Screening Instrument. Geneva: World Health Organization.
Babor, T.F., Grant, M. et al. (1994). A randomised clinical trial of brief interventions in primary health care: summary of a WHO project. Addiction, 89, 657-678.
Saunders, J. & Wutzke, S. (Eds.) (1998). WHO Phase III Collaborative Study on Implementing and Supporting Intervention Strategies in Primary Health Care. Report on Strand 1: General Practitioners’ Current Practices
and Perceptions of Preventive Medicine and Intervention for Hazardous Alcohol Use. Copenhagen, Denmark: WHO Regional Office for Europe, Alcohol, Drugs & Tobacco Programme.
Kaner E., Heather N. & McAvoy B. et al. (1999). Intervention for excessive alcohol consumption in primary health care: attitudes and practices of English general practitioners. Alcohol & Alcoholism, 34, 559-
McAvoy, B.R., Donovan, R.J., Jalleh, G. et al. (in press). General practitioners, prevention and alcohol - a powerful cocktail? Facilitators and inhibitors of practising preventive medicine in general and early intervention for alcohol in particular: a twelve nation key informant and general practitioner study. Drugs: Education, Prevention & Policy.
Gomel, M.K., Wutzke, S.E., Hardcastle, D.M., Lapsley, H. & Reznik, R. (1998). Cost-effectiveness of strategies to market and train primary health care physicians in brief intervention techniques. Social Science & Medicine, 47, 203-211.
Hansen, L.J., de Fine Olivarius, N., Beich, A. & Barfod, S. (1999). Encouraging GPs to undertake screening and a brief intervention in order to reduce problem drinking: a randomised controlled trial. Family Practice, 16, 551-557.
McCormick, R., Adams, P., Powell, A., Bunbury, D., Paton-Simpson, G. & McAvoy, B. (1999). Encouraging general practitioners to take up screening and early intervention for problem use of alcohol: a marketing
trial. Drug & Alcohol Review, 18, 171-177.
Lock, C.A., Kaner, E.F.S., Heather, N., McAvoy, B.R. & Gilvarry, E. (1999). A randomised trial of three marketing strategies to disseminate a screening and brief alcohol intervention programme to General Practitioners. British Journal of General Practice, 49, 695-698
Kaner, E.F.S., Haighton, C.A., McAvoy, B.R., Heather, N. & Gilvarry, E. (1999). A RCT of three training and support strategies to encourage implementation of screening and brief alcohol intervention by general
practitioners. British Journal of General Practice, 49, 699-703.
Kristenson, H., Ohlin, H., Hulten-Nosslin, M., Trell, E. & Hood, B. (1983). Identification and intervention of heavy drinking in middle-aged men: results and followup of 24:60 months of long-term study with
randomised controls. Alcoholism: Clinical & Experimental Research, 20, 203-209.
Trell, E., Kristenson, H. & Fex, G. (1984). Alcohol-related problems in middle-aged men with elevated serum gamma-glutamyltransferase: a preventive medical investigation. Journal of Studies on Alcohol, 45, 302-
Nilssen, O. (1991). The Tromsø study: identification of and a controlled intervention on a population of earlystage risk drinkers. Preventive Medicine, 20, 518-528.
Suokas, A. (1992). Brief Intervention of Heavy Drinking in Primary Health Care: Hämeenlinna Study. Academic Dissertation, Research & Treatment Unit for Alcohol Diseases, University of Helsinki: University Printing House.
McIntosh, I.D. (1982). Alcohol-related disabilities in general hospital patients: a critical review of the evidence. International Journal of the Addictions, 17, 609-639.
Chick, J., Lloyd, G., & Crombie, E. (1985). Counselling problem drinkers in medical wards: a controlled study. British Medical Journal, 83, 159-170.
Elvy, G.A., Wells, J.E., & Baird, K.A. (1988). Attempted referral as intervention for problem drinking in the general hospital. British Journal of Addiction, 83, 83-89.
Heather, N., Rollnick, S., Bell, A., & Richmond, R. (1996). Effects of brief counselling among male heavy drinkers identified on general hospital wards. Drug & Alcohol Review, 15, 29-38.
Prochaska, J.O. & DiClemente, C.C. (1992). Stages of change in the modification of problem behaviors. In M. Hersen, R.M., Eisler & P.M. Miller (Eds.), Progress in Behavior Modification. Newbury Park, CA: Sage.
Marshall, J., Canning, U.P., Kennell-Webb, S.A., Gunstone, C.M., Wessely, S.C. & Peters, T.J. (2000). The effects of brief intervention amongst “at risk” drinkers on general medical wards: a randomised
controlled trial. Paper presented at Annual Symposium of Society for the Study of Addiction to Alcohol and Other Drugs, Leeds, UK, November 3rd.
Holt, S., Stewart, I.C., Dixon, J.M.J., Elton, R.A., Taylor, T.V., & Little, K. (1980). Alcohol and the emergency service patient. British Medical Journal, 281, 638-640.
Lockhart, S.P., Carter, Y.H., Straffen, A.M., Pang, K.K., McLoughlin, J., & Baron, J.H. (1986). Detecting alcohol consumption as a cause of emergency general medical admissions. Journal of the Royal Society of Medicine, 79, 132-136.
Weisner, C. & Schmidt, L. (1993). Alcohol and drug problems among diverse health and social service populations. American Journal of Public Health, 83, 824-829.
Green, M., Setchell, J., Hames, P., Stiff, G., Touquet, R. & Priest, R. (1993). Management of alcohol abusing patients in accident and emergency departments. Journal of the Royal Society of Medicine, 86, 393-395.
Gentilello, L.M., Donovan, D.M., Dunn, C.W. & Rivara, F.R. (1995). Alcohol interventions in trauma centers: current practice and future directions. Journal of the American Medical Association, 274, 1043-1048.
Smith, S.G.T., Touquet, R., Wright, S. & Das Gupta, N. (1996). Detection of alcohol misusing patients in accident and emergency departments: the Paddington Alcohol Test (PAT). Journal of Accident & Emergency Medicine, 13, 308-312.
Dunn., C.W., Donovan, D.M. & Gentilello, L.M. (in press). Practical guidelines for performing alcohol interventions in trauma centers. Journal of Trauma: Injury, Infection & Critical Care.
Antti-Poika, I, Karaharju, E, Roine, R. & Salaspuro, M. (1988) Intervention of heavy drinking: a prospective and controlled study of 438 consecutive injured male patients. Alcohol & Alcoholism, 23, 115-21.
Persson, J. & Magnusson, P. (1989) Early intervention in patients with excessive consumption of alcohol: a controlled study. Alcohol, 6, 403-408.
Mahaswaren, R, Beevers, M. & Beevers, DG. (1992) Effectiveness of advice to reduce alcohol consumption in hypertensive patients. Hypertension, 19, 79-84.
Chang, G, Wilkins-Haug, L, Berman, S. & Goetz, MA. (1999) Brief intervention for alcohol use in pregnancy: a randomised trial. Addiction, 94, 1499-1508.
Marmot, M. (1997). Inequality, deprivation and alcohol use. Addiction, 92, S13-20.
Makela, P., Valkonen, T. & Martelin. T. (1997). Contribution of deaths related to alcohol use of socio-economic variation in mortality: register based follow-up study. British Medical Journal, 315, 211-216.
Van Oers. J., Bongers, I., Van der Goor, L. & Garretsen, H. (1999). Alcohol consumption, alcohol-related problems, problem drinking and socio-economic status. Alcohol & Alcoholism, 34, 78-88.
Murgraff, V., Parrott, A. & Bennett, P. (1999). Risky singleoccasion drinking amongst young people: definition, correlates, policy and intervention. Alcohol & Alcoholism, 34, 3-14.
Rehm, J. (1996). On the emerging paradigm of drinking patterns and their social and health consequences. Addiction, 91, 1615-1626.
Smart, R.G. (1996). Behavioural and social consequences related to the consumption of different beverage types. Journal of Studies on Alcohol, 57, 77-84.
Hedges, B. & di Salvo, P. (1996) Alcohol consumption and smoking. Chapter 8 in Health Survey for England. London: The Stationery Office.
Currie, C., Hurrelmann, K., Settertobulte, W., Smith, R. & Todd, J. (2000). Health and Health Behaviour Among Young People. Copenhagen: WHO Regional Office for Europe.
Holmila, M. (1995). Intoxication and hazardous use of alcohol: results from the 1992 Finnish Drinking Habits Study. Addiction, 90, 785-792.
Bailey, S.L., Pollock, N.K., Martin, C.S. & Lynch, K.G. (1999). Risky sexual behaviours among adolescents with alcohol use disorders. Journal of Adolescent Health, 25, 179-81.
Koss, MP. & Gaines, JA. (1993). The prediction of sexual aggression by alcohol use, athletic participation and fraternity affiliation. Journal of Interpersonal Violence, 8, 94-108.
Weschler, H. & Issac, N. (1992). Binge drinking at Massachusetts colleges: prevalence, drinking styles, time trends and associated problems. Journal of the American Medical Association, 267, 2929-2931.
Weschler, H, Moeykens, B, Davenport, A, Castillo, S. & Hansen, J. (1995). The adverse impact of heavy episode drinkers on other college students. Journal of Studies on Alcohol, 56, 628-634.
Johnson, P.B., Boles, S.M., Vaughan, R. & Kleber, H.D. (2000). The co-occurrence of smoking and binge drinking in adolescence. Addictive Behaviours, 25, 779-783.
Kandel, D., Johnson, J., Bird, H. et al. (1999). Psychiatric comorbidity among adolescents with substance use disorders: findings from the MECA study. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 693-699.
Jessor, R. (1987). Problem Behaviour Theory, psychological development and adolescent problem drinking. British Journal of Addiction, 82, 331-342.
DuRant, R.H., Smith, J.A., Kreiter, S.R. & Krowchick, D.P. (1999). The relationship between early onset of initial substance use and engaging in multiple health risk behaviour. Archives of Pediatrics & Adolescent Medicine, 153, 286-291.
Thom, B., Herring, R. & Judd A. (1999). Identifying alcohol-related harm in young drinkers: the role of Accident and Emergency Departments. Alcohol & Alcoholism, 34, 910-915.
Peters, J., Brooker, C., McCabe, C. & Short, N. (1998). Problems encountered with opportunistic screening for alcohol-related problems in patients attending an accident and emergency department. Addiction, 93,
-594.
Brooker, C., Peters. J., McCabe. C. & Short, N. (1999). The views of nurses to the conduct of a randomised controlled trial of problem drinkers in an accident and emergency department. International Journal of
Nursing Studies, 36, 33-39.
Smith, A.J., Shepard, J.P. & Hodgson, R.J. (1998). Brief interventions for patients with alcohol-related trauma. British Journal of Oral & Maxillofacial Surgery, 36, 408-415.
Wright, S., Moran, L., Meyrick, M., O’Connor R. & Touquet, R. (1998). Intervention by an alcohol health worker in an accident and emergency department. Alcohol & Alcoholism, 33, 651-656.
McCormick, A., Fleming, D. & Charlton, J. (1995). Morbidity Statistics from General Practice: 4th National Study 1991-1992. Series MB5 no.3. London: Office of Population Censuses and Surveys, HMSO.
Kaner, E.F.S., Lock, C.A., Heather, N. & McAvoy, B.R. (2000). Drinking patterns and sociodemographic status in patients screened for excessive drinking by GPs. Unpublished ms, Department of Primary Health Care,
University of Newcastle upon Tyne, UK.
Edwards, A.G.K. & Rollnick, S. (1997). Outcome studies of brief alcohol intervention in general practice: the problem of lost subjects. Addiction, 92, 1699-1704.
Kaner, E.F.S., Heather, N., Brodie, J., Lock, C.A. & McAvoy, B. (2000). Sociodemographic status of patients predicts the offer of brief alcohol intervention by GPs. Unpublished ms, Department of Primary Health Care, University of Newcastle upon Tyne, UK.
Plant, M. & Plant, M. (1992). Risk Takers: Alcohol, Drugs, Sex and Youth. London: Tavistock/Routledge.
Giesbrecht, N. (1999) Reducing risks associated with drinking among young adults: promoting knowledgebased perspectives and harm reduction strategies. Addiction, 94, 353-355.
Mosher, J. (1999). Alcohol policy and the young adult: establishing priorities, building partnerships, overcoming barriers. Addiction, 94, 357-369.
Wilsnack, R.W., Vogeltanz, N.D., Wilsnack, S.C. et al. (2000). Gender differences in alcohol consumption and adverse drinking consequences: cross-cultural patterns. Addiction, 95, 251-265.
Bradizza, C.M., Reifman, A. & Barnes, G.M. (1999). Social and coping reasons for drinking: predicting alcohol misuse in adolescents. Journal of Studies on Alcohol, 60, 491-499.
Engels, R.C.M.E., Knibbe, R.A. & Drop, M.J. (1999). Visiting public drinking places: an explorative study into the functions of pub-going for late adolescents. Substance Use & Misuse, 34, 1261-1280.
Rollnick, S., Butler, C. & Hodgson, R. (1997). Brief alcohol intervention in medical settings: concerns from the consulting room. Addiction Research, 5, 331-342.
Dijkstra, A., De Vries, H. & Roijackers, J. (1999). Targeting smokers with low readiness to change with tailored and non-tailored self-help materials. Preventive Medicine, 28, 203-211.
Borsari, B. & Carey, K.B. (2000) Effects of a brief motivational intervention with college student drinkers. Journal of Consulting and Clinical Psychology, 68, 728-733.
Werch, C.E., Carlson, J.M., Pappas, D.M. & DiClemente, C.C. (1996). Brief nurse consultations for preventing alcohol use among urban school youth. Journal of School Health, 66, 335-338.
Foxcroft, D.R., Lister-Sharp, D. & Lowe, G. (1997) Alcohol misuse prevention for young people: a systematic review reveals methodological concerns and lack of reliable evidence of effectiveness. Addiction, 92, 531-537.
