Alcohol misuse: tackling the UK epidemic - London

BMA Board of Science
The use of alcohol screening questionnaires in a variety of healthcare settings is an efficient and
cost-effective method for detecting alcohol misuse. 217
Biological markers are less efficient primary
screening measures but can be used as adjuncts to questionnaires for the screening process. It is
important to note, however, that screening for alcohol use disorders is complicated by a number of
factors including:
under or overestimation of alcohol consumption levels in response to screening
questionnaires, either deliberately or as a result of poor recall
embarrassment on the part of healthcare staff who view monitoring as intrusive
inaccurately recorded patient histories of alcohol use
poor use of screening techniques and follow-up procedures by healthcare professionals.
Brief interventions are intended to provide prophylactic treatment before or soon after the onset
and identification of alcohol-related problems. Research has found that brief interventions produce
clinically significant effects on drinking behaviour and related problems in non-alcohol dependent
57, 114, 217-221
individuals who consume alcohol at harmful and hazardous levels. There is however, little
evidence that brief interventions are beneficial for alcohol dependent individuals or those with
114, 222
severe alcohol problems. Brief interventions are cost-effective measures that commonly consist
of a number of stages including assessment, feedback and goal setting. They are delivered using
behavioural modification techniques and reinforced with the provision of written material. Simple
brief interventions involve a specific short interview conducted by a competent practitioner
immediately following a screening assessment. Extended brief interventions incorporate a series of
these structured interviews (between three and 12) delivered by a competent practitioner. They can
be delivered in a variety of settings, including medical settings – such as primary care and accident
and emergency – and in generic non-specialist services. The provision of brief interventions have
been found to be effective at reducing alcohol consumption in non-dependent individuals in both
218, 219
the primary care setting, and in emergency departments. 223
The type of advice that should be
offered during a brief intervention includes:
information about the nature and effects of alcohol and its potential for harm
personalised feedback on risk and harm
emphasis on the individual’s personal responsibility for change
attempts to increase the patient’s confidence in being able to reduce their alcohol
consumption (‘self-efficacy’)
goal-setting (for example, start dates and daily or weekly targets for drinking)
written self-help material for the individual to take away, containing more detailed
information on consequences of excessive drinking and tips for cutting down (this can be in
a variety of media, including electronic, such as the internet)
signposting individuals to having a wider general health check, where indicated
arrangements for follow-up monitoring
information on where to get further help if necessary.
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