Pilot study of the effectiveness and cost-effectiveness of stepped care intervention for alcohol use disorders in primary care

First published: 10 May 2019 | Last updated: 20 May 2019

Simon Coulton, Colin Drummond, Darren James, Christine Godfrey, Steve Parrott, John Baxter, David Ford, Bruce Lervy, Stephen Rollnick, Ian Russell & Timothy Peters.

Aim: To evaluate the feasibility, effectiveness and cost-effectiveness of opportunistic screening and stepped care intervention in primary care.

Design: Pragmatic prospective randomised controlled trial.

Setting: Six primary care practices in South Wales.

Participants: 1794 male primary care attendees were screened using the Alcohol Use Identification Test (AUDIT). 112 who scored 8 or more on the AUDIT and who consented to enter the study were randomised.

Interventions: Control group: 5 min. minimal intervention delivered by a practice nurse. Intervention group: stepped care intervention consisting of three successive steps: 1. a single session of Behaviour Change Counselling delivered by a practice nurse, 2. 4 sessions x 50 min Motivational Enhancement Therapy delivered by a trained alcohol counsellor, and 3. referral to a community alcohol treatment agency.

Measurements: Percent days abstinent using TLFB180, Motivation using the Readiness to Change Questionnaire, Severity of Alcohol Dependence Questionnaire, Alcohol Problems Questionnaire, Self-efficacy using the Situational Confidence Questionnaire, Quality of Life using SF12, Health utility using EQ5D and service utilisation.

Findings and conclusions: Stepped care was feasible to implement in this setting. Both groups reduced alcohol consumption six months after randomisation with a greater, although not significant, improvement for the stepped care intervention. Motivation to change was greater following stepped care intervention. Stepped care intervention resulted in greater cost savings compared to minimal intervention.

ISRCTN registration Number: ISRCTN55274820

The authors have no conflict of interest to declare.


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Simon Coulton