The advancement of both screening and Brief Interventions (BI) has been in part, a result of the mounting evidence base for the efficacy of such interventions in primary health care settings. There are two main types of BI typically aimed at non-treatment seeking individuals as a way to offer simple structured advice and feedback on an identified health risk behavior. These interventions can be delivered in as little as a few minutes (Brief Advice) or over the course of a few (typically 1-4) time limited motivational sessions (Extended Brief Intervention).
In response to the need to address the worldwide growth in alcohol related problems, the World Health Organisation (WHO) designed and developed the Alcohol Use Disorders Identification Test (AUDIT). An alcohol-screening test designed to see if people are consuming harmful or hazardous amounts of alcohol. Since the development of several validated screening measures, including the AUDIT, a growing number of studies, including several meta analyses (Moyer, 2002; Ballesteros, 2004; Bertholet, 2005; Whitlock, 2004) have reported screening and BI to be an effective intervention which can result in reduced levels of health risks (i.e. alcohol consumption) in primary health care settings. A systematic review of BI in primary healthcare settings reported significant reductions in weekly alcohol consumption in men, compared to controls (Kaner 2007).
Research acknowledges screening and BI effectiveness in public health strategy if it is applied across general health care practice. Despite the well documented strengths of BI there are a number of limitations, the most widely reported being the vast majority of BI trials taking place in Primary Healthcare Settings, which has contributed to an under representation across populations. Where there has been limited clinical implementation of BI practitioners have reported a lack of skills in the management of the more severe cases which can also be identified through screening tools and BI (Nilsen, 2010)
In an attempt to bridge this training gap recent years have seen an expansion of BI training. A good example being The Alcohol Learning Centre which provides an e-learning platform for professionals delivering BI in primary care, community pharmacies and hospital settings. Despite increased access to BI resources and training and the acknowledgement of the range of settings in which the intervention can be delivered, further consideration is needed with regards to the organizational and individual challenges, which may impede implementation.
The SIPS Junior research program is an example of current research, which aims to examine alcohol prevalence among adolescents attending Emergency Departments in addition to the development of screening, and BI (including the use of electronic devices).
The emergence of electronic and web based healthcare provides a new research area of interest which presents itself as a far-reaching, cost effective alternative to face-to-face interventions. A recent systematic review and meta-analysis (Donoghue et al, 2014) found Electronic Screening Brief Interventions (eSBI) to be effective in reducing alcohol consumption at 3 and 6 months but not at longer-term follow-up (12 months).
Screening and BI offers an opportunity for early intervention on a range of health risk behaviours, which may not be immediately apparent to the individual or professional. The growth in research, training, and implementation highlight the potential impact an emphatic, non-judgmental delivery of simple structured advice and feedback on a health risk behavior can have in empowering individuals to consider, address, change and ultimately reduce the level of risk posed.
Hannah Rose, SSA PhD Student
References
Ballesteros, J., Duffy, J, C., Querejeta, I., Arino, J., Gonzalez-Pinto, A (2004). Efficacy of brief interventions for hazardous drinkers in primary care: systematic review and meta-analysis. Alcoholism, 4, 608-18.
Bertholet, N., Daeppen, J, B., Wietlisbach, V., Fleming, M., Burnand, B (2005). Reduction of alcohol consumption by brief alcohol intervention in primary care: systematic review and meta-analysis. Archives of Internal Medicine, 9, 986-995.
Donoghue, K., Patton, R., Phillip, T., Deluca, P., Drummond, C (2014). The effectiveness of electronic screening and brief intervention for reducing levels of alcohol consumption: A systematic review and meta-analysis. Journal of Medical Internet Research, 16 (6) e142. http://doi.org/10.2196/jmir.3193
Kaner, E, F., Beyer, F., Dickinson, H, O., Piener, E., Campbell, F., Schlesinger, C., Heather, N., Saunders, J., Burnand, B., Pienaar, E, D (2007). Effectiveness of brief alcohol interventions in primary care populations. The Cochrane Library, 2, CD004148.
Moyer, A., Finnet, J, W., Swearingen, C, E., Vergun, P (2002). Brief interventions for alcohol problems: A meta-analytic review of controlled investigations in treatment seeking and non-treatment seeking populations. Addiction, 97, 279-292.
Nilsen, P (2010). Brief alcohol intervention – where to from here? Challenges remain for research and practice. Addiction, 6, 954-959.
Whitlock, E, P., Polen, M, R., Green, C, A., Orleans, T., Klein, J (2004) Behavioral Counseling Interventions in Primary Care To Reduce Risky/Harmful Alcohol Use by Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 7, 557-568.
World Health Organisation (2012). Screening and brief interventions for hazardous and harmful alcohol use. [Accessed January 15]
The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.