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NAT 6/08 - THL

NAT 6/08 - THL

Screening and brief

Screening and brief intervention for alcohol problems in Norway A policy document by the Norwegian College of GPs clearly states that “the extent of preventive work must be balanced with other core duties, as the GP’s primary task is to offer health care for the sick”. In other words, many preventive interventions compete for the GP’s time and attention. KEywORDS Screening, brief intervention, BI, alcohol problems, general practitioners, Norway 516 NORDIC STUDIES ON ALCOHOL AND DRUGS VOL. 25. 2008 . 6 wegian Society for Alcohol Treatment” (Norsk alkoholistterapuetisk forening, later Norsk forening for medisinsk rusmiddelproblematikk, and since 2007 Norsk forening for rus og avhengighet), established in 1964. The main effort of this association presently is to work towards an official medical specialty of addiction medicine in Norway. WHO’s collaborative projects on identification and treatment of persons with harmful alcohol consumption Norway has played an active role in the WHO collaborative projects on the identification and treatment of persons with harmful levels of alcohol consumption (Saunders & Aasland 1987; Aasland et al. 2008). Local history in Norway therefore follows this line to a large extent. In the 1980s, Norway, like many other western countries, experienced a conceptual shift with regard to alcoholism treatment, from the traditional long-term institutional treatment towards detoxification units and more short-term and out-patient treatment. Increasing interest was given to the role of primary health care and general practitioners in dealing with alcohol hazards. In 1981 the first author of this paper, then a relatively young doctor of 37, was appointed medical director of the Directorate for the prevention of alcohol problems (Statens edruskapsdirektorat) with an agenda of reform and change. One new and typical initiative was a project where 179 general practitioners and 3,497 of their patients on a specified day answered questionnaires about possible alcohol-related conditions. The patients’ questionnaires could be matched with the doctors’ anonymously. Doctors considered 11% of their patients belonged to a “possible alcohol problems group”, and an even higher proportion of the patients themselves felt this to be the case (Bruusgaard & Rutle & Aasland 1984a; 1984b; Aasland & Bruusgaard & Rutle 1987a). This study was followed up in 1985 by a survey of the Norwegian doctors’ drinking habits (Aasland et al. 1987). The intention was to show that most doctors are moderate drinkers, and therefore in a good position to give advice to their patients about safe alcohol use.

Screening and brief intervention At this point in time a Norwegian group of researchers were heavily involved with the development of a screening instrument, AUDIT, as part of the above-mentioned WHO-project. Norwegian patient data were collected, as were patient data from Australia (Sidney), Bulgaria (Sofia), Kenya (Nairobi), Mexico (Mexico City) and the USA (Hartford Ct.). All data were sent to Norway and organized into a common data file. Data analysis was performed both in Norway and in Australia. In Norway, data was collected from ten general practices and six general hospitals. One of the general practitioners recruited for this effort was Arne Johannesen, second author of this article, and for him this became the start of an interesting and fruitful career with a special interest in alcohol and addiction. The Norwegian participation in Phase II of the WHO project (Babor & Grant 1992), the brief intervention phase, was co-ordinated by psychologist Arvid Skutle in Bergen. High-risk patients were recruited for brief intervention from four health centres and general practices in the Bergen area. The recruitment of candidates turned out to be a difficult and time consuming process, mainly due to the fact that so few GP patients met the inclusion criteria. We actually had to recruit extra subjects through postal questionnaires at a large work site in Bergen, and even then the total number of actual candidates was low, 37 men and 15 women out of a total of 3,454 screened subjects. Thus the alcohol risk level in Norwegian general practices seemed much lower than in the other participating centres (Australia, Bulgaria, Costa Rica, Ken- Screening and brief intervention for alcohol problems in Norway ya, Mexico, USSR, the UK, the USA and Zimbabwe). As in other participating countries, pamphlets advising on how to reduce alcohol consumption were produced, so by now the screening and brief intervention technology was readily available in Norway. However, implementation remained a problem, not many general practitioners were interested in using this new approach. At first we regarded this primarily as a communication problem – when GPs became aware of the new possibilities they would readily embrace it. During the spring of 1990 the Journal of the Norwegian Medical Association published a series of articles on alcohol, including some dealings with case finding and early intervention. This series was also made available as a book, of which 1000 copies were made available for free by The National Directorate for the Prevention of Alcohol and Drug Problems (Nylenna et al. 1990). The directorate was also the main funding resource for this book project. Occupational health initiatives At the same time there was also an inter- est by some occupational health specialists to implement screening and brief intervention at various work sites. Dr. Sverre Fauske introduced AUDIT through his occupational Centre for Alcohol Prevention Strategies (CAPS). The work place is still an important arena for secondary prevention, and AKAN, the Workplace Advisory Centre for issues relating to alcohol, drugs and addictive gambling, has developed internet-based screening tools along with self-screening pamphlets and other materials. NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 25. 2008 . 6 517

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