Alcohol Policy UK

Latest Findings alcohol research: Web-based interventions can work & what works best for young drinkers

Recent research from the drug and alcohol Bank:

REVIEW CONFIRMS THAT COMPUTER-BASED ALCOHOL INTERVENTIONS CUT DRINKING
Computer-based and in particular internet-based therapies open doors to treatment for drinkers who cannot get or do not want face-to-face-help. This review finds they do curb drinking, but its sub-finding that they are as effective as alternative therapies should not be taken to mean computers can replace therapists.

MODERATE DRINKING OVER THE WEB: THERAPY PROGRAMME BOLSTERS MUTUAL AID
Does it help to add a structured internet-based therapeutic programme to web access to a mutual aid network also geared to moderate drinking? Sustained extra moderation in the form of fewer days drinking was the clearest positive effect; less clear was whether it led to greater reductions in drink-related problems.

REVIEW OF STUDIES ON WHAT WORKS BEST WITH YOUNG DRINKERS
Though some studies may have been persuasive, this review of recent attempts to find which therapeutic approaches work best for young risky drinkers was unable to reach firm conclusions due to variability in the studies and methodological inadequacies. Still, the tentative verdict favouring cognitive-behavioural therapy, family therapy and community reinforcement accord with UK guidance.

Other recent Findings bulletins include:

• Emergency department nurses can screen for risky drinking
• Opioid antagonists useful supplement in alcohol treatment
• Spanish GPs target binge-drinking patients
• New Zealand commission calls for alcohol price rises and licensing reform

Hot topic searches can also be run on key issues including:

• Matching alcohol treatments to the patient
• Alcohol licensing, price and taxation

Behavioural interventions most effective for higher risk drinkers, NWPHO report shows

A report from the North West Public Health Observatory (NWPHO) demonstrates brief interventions for alcohol are the most cost effective, followed by interventions for smoking, sexual health and physical activity. 

Changing Health Choices - A review of the cost-effectiveness of individual level behaviour change interventions

Key findings include:

• The cost-effectiveness of brief interventions is strongest for interventions among high risk drinkers.
• The average costs of an intervention differ depending on the duration of the intervention, which health professional delivers it and the topic covered. For example, an intervention delivered by a GP is around double the cost of that delivered by a nurse, in terms of salary costs
• Training for nurses and other health professionals to undertake more brief interventions could therefore potentially lead to real cost savings or increased efficiencies. This is providing it can be shown that they are equally as effective as GPs in delivering these interventions, and that other costs (such as administration) are not increased

For resources and guidance on alcohol brief interventions (also known as Identification and Brief Advice) see here on the Alcohol Learning Centre. Findings from the SIPS trial are expected later this year which will provide insight into the most effective approaches for alcohol brief interventions.

The North West Public Health Observatory (NWPHO) hosts the Local Alcohol Profiles for England which provide alcohol related harm data and indicators for areas across the country.

The NWPHO  is based at the Centre for Public Health (www.cph.org.uk), Liverpool John Moores University. 

Inebria bulletin 6: Brief interventions terminology explored, pharmacy settings and Boston conference

The Inebria Bulletin nº6 has been released by the International Network on Brief Interventions for Alcohol Problems (INEBRIA). 

It includes information on the next Conference in Boston, which will take place on the 22-23^rd of September 2011, conclusions from a debate about appropriate EIBI terminology, a digest from 2010 conference on evidence and experience of delivering brief interventions in the pharmacy setting and further announcements. Past bulletins are also available on the Inebria website.

Resources for brief interventions, also known as 'Identification & Brief Advice' (IBA) in England, are available from the Alcohol Learning Centre.

Scotland news and updates: AFS release new Manifesto; SNP still seek minimum price; national brief interventions target met

Alcohol Focus Scotland (AFS) have launched a new Manifesto which calls for the new Scottish Parliament to take decisive steps to reduce the harm caused by alcohol by:

• Increasing the price and reducing the availability of alcohol
• Specifically targeting supermarkets for increased regulation
• Banning alcohol sports sponsorship
• Reducing drink driving limits to 50mg
• Awareness raising campaign on the harm alcohol causes to others
• Improved treatment and support services for people in need

See here for the full 8 calls to action. The Scottish National Party (SNP) recently announced they would revive their plans for a minimum price if they win the Scottish national elections on May 5th. A senior police officer has also backed the measure.

NHS Scotland have also recently met the national 3 year target to deliver nearly 150,000 brief interventions by March 2011. See this Alcohol Information Scotland page for previous reports.

Latest Findings & other alcohol research: UK Criminal Justice needs; depressed drinkers and intervention insights

Recent research from the drug and alcohol Bank:

Alcohol Interventions in the British Criminal Justice System

• Unmet need for alcohol services in English prisons
  Prison inspections and surveys of prisoners and staff in England reveal what HM Inspectorate of Prisons called a depressing picture of very limited services for problem drinking inmates, leaving them with poor prospects on release.
• Scottish prisons leave many problem drinkers without help 
  What does the Scottish Prison Service need to do to adequately address alcohol problems among inmates? Key finding was that many prisoners who could benefit from interventions were being missed.
• Not enough money for problem drinking offenders in the community   Complements the prison report above with an investigation of what is being done in Scotland to meet the needs of problem drinking offenders by  services outside prison, and assesses whether local arrangements measure up. Under-funding emerges as a key issue.

Treatment and prevention bulletins

• Male and female depressed drinkers react best to different therapies Australian study provides the first evidence that integrated treatment may be superior for depressed heavy drinkers, and raises the intriguing possibility that men react best to alcohol-focused therapy, women to a depression focus.
• Problem drinking curbed by EU-funded drug education curriculum The largest European drug education trial ever conducted tested whether US-style social influence programmes would prove effective in Europe. Among the successes were the reductions in problem drinking documented in this report, but substance use as such could not be shown to have been reduced.

Brief interventions and health outcomes research

Free research summaries are available from the US-based Alcohol, Other Drugs, and Health: Current Evidence page. Individual links are listed and a newsletter summarising research findings on Dual Diagnosis, GP barriers to brief interventions, older drinkers and Naltrexone.

Further research can be found in the Findings bank, the AERC library, our research tag and a links page on the Alcohol Learning Centre.

Brief interventions not yet 'routine practice'

A study published in the Drug and Alcohol Review journal explores the limited extent of routine brief interventions in the UK, despite extensive evidence of their effectiveness. However the report suggests the recent publication of the NICE alcohol prevention guidance should act as a significant driver as the first clinical guidelines for practitioners.

The abstract of the study states:

'After 25 years of accumulated evidence in this field, brief alcohol interventions have yet to make a significant impact on routine clinical practice. While it is imperative to have good science to make the case for brief intervention delivery, this work is in vain if practitioners are unwilling or unable to use these interventions with their patients. Evidence from the alcohol field and other clinical areas indicates that national prioritisation of brief alcohol intervention activity, by a body, such as NICE, is likely to be a key driver of implementation by practitioners.'

Brief interventions have been a key plank of the Department of Health's (DoH) alcohol strategy, described as 'Identification and Brief Advice' (IBA). Online training, guidance and resources on IBA can be found here on the Alcohol Learning Centre, including the paper 'Clarifying Brief Interventions'.

Whilst GPs are incentivised to deliver brief interventions through a Direct Enhanced Service (DES) and supporting framework, a study released earlier this year identified a number of issues facing delivery in Primary Care. Scotland has set a national target to support routine delivery. The SIPS research trial will soon be releasing final findings which will inform effective practice for specific settings including Primary Care, A&E and Criminal Justice. Past research can be found here from the Findings bank or the ALC.

Alcohol & Young People: a toolkit for supporting vulnerable young people

Calling Time, the South West Alcohol Improvement Programme (AIP) has published Alcohol and Young People: A Toolkit [pdf]. The toolkit aims to inform and guide professionals and carers concerned with looked after children and young people with special educational needs. It was produced in partnership with Alcohol Concern and builds on relevant policy, research and guidance and is informed by consultation with a number of professionals and young people from across the South West and in particular from Torbay.

A recent report on alcohol harm reduction strategies for all young people was released by Alcohol Concern as part of Alcohol Awareness week 2010.

See here for more alcohol resources for children and young people and more on the South West AIP.

Offender Health & IBA: literature review and case for change

A joint project has been undertaken by the Regional Public Health Group London and London Offender Health to explore and develop the delivery of Identification and Brief Advice (IBA) within Criminal Justice settings.

Reports from the project are now available including:

• 'Case for change – Commissioning Identification and Brief Advice to improve health and justice outcomes in offender populations' Download Case for Change [doc]

• 'Alcohol Identification and Brief Advice (IBA) in Offender Health: A Literature Review'  Download IBA OH lit review [doc]

Further alcohol and Offender Health documents and resources can be found here.

Pharmacy option added to IBA e-learning

The Alcohol IBA e-learning has added a new Pharmacy course pathway so that professionals can now obtain free training on how to deliver simple identification and brief advice (IBA) in a pharmacy healthcare setting.

The course consists of five e-learning sessions and one assessment session. The sessions feature animation, interactive exercises, case studies and video and each takes around 20 minutes to complete. A certificate of completion can be printed out once the assessment session has been undertaken.

The e-learning includes:
-Information and facts about alcohol
-Understanding units
-Using identification tools
-Structuring and conducting brief advice
-Practicing brief advice

It has been designed by the Department of Health's Alcohol Improvement Programme in partnership with e-Learning for Healthcare.

Access the IBA e-learning

Latest Findings alcohol research: importance of 'listen & reflect'; Acramposate helps prevent lapse

Latest alcohol research from the Findings database:

Listen well, reflect back - key ingredients in changing drinking

In this study of Swiss army recruits, reflective listening emerged as possibly the key active ingredient in a brief alcohol intervention based on motivational interviewing.

Acamprosate helps prevent lapse to drinking

The first Cochrane review of the drug acamprosate as a treatment for alcohol dependence finds clear evidence that it offers worthwhile if modest benefits in preventing a return to drinking after detoxification.