Explore relevant journal articles

Research and evidence

This page brings together curated peer-reviewed research on alcohol screening and brief interventions (SBI), including systematic reviews, randomised controlled trials and implementation studies conducted across different settings.

The evidence base underpins the effectiveness, feasibility and cost-effectiveness of SBI, and provides insights relevant to policy development, programme design, implementation and scale-up in health care, social care and workplace settings.

A tidy office desk with a computer monitor, keyboard, mouse and headphones. On the desk are printed materials about alcohol policies, including a document titled “Alcohol Policies” with icons and checkmarks, a book on public health, a yellow folder, and two pens. The setting suggests a professional workspace focused on health policy or research.

See all peer-reviewed articles

Large-scale implementation of alcohol brief interventions in new settings in Scotland: A qualitative interview study of a national programme

Abstract Background: This study aimed to explore experiences of implementation of alcohol brief interventions (ABIs) insettings outside of primary healthcare in the Scottish national programme. The focus of the study was on strategiesand learning to support ABI implementation in settings outside of primary healthcare in general, rather on issuesspecific to any single setting.Methods: 14 semi-structured telephone interviews were conducted with senior implementation leaders inantenatal, accident and emergency and wider settings and audio-recorded. Interviews were analysed inductively.Results: The process of achieving large-scale, routine implementation of ABI proved challenging for all involvedacross the settings. Interviewees reported their experiences and identified five main strategies as helpful for strategicimplementation efforts in any setting: (1) Having a high-profile target for the number of ABIs delivered in a specifictime period with clarity about whose responsibility it was to implement the target; (2) Gaining support from seniorstaff from the start; (3) Adapting the intervention, using a pragmatic, collaborative approach, to fit with currentpractice; (4) Establishing practical and robust recording, monitoring and reporting systems for intervention delivery,prior to widespread implementation; and (5) Establishing close working relationships with frontline staff includingflexible approaches to training and readily available support.Conclusions: This qualitative study suggests that even with significant national support, funding and a specificdelivery target, ABI implementation in new settings is not straightforward. Those responsible for planning similar initiatives should critically consider the relevance and value of the five implementation strategies identified.Keywords: Alcohol, Brief intervention, Implementation, Brief advice, Target

Brief interventions implementation on alcohol from the European health systems perspective

Alcohol-related health problems are important public health issues and alcohol remains one of the leading risk factors of chronic health conditions. In addition, only a small proportion of those who need treatment access it, with figures ranging from 1 in 25 to 1 in 7. In this context, screening and brief interventions (SBI) have proven to be effective in reducing alcohol consumption and alcohol-related problems in primary health care (PHC) and are very cost effective, or even cost-saving, in PHC. Even if the widespread implementation of SBI has been prioritized and encouraged by the World Health Organization, in the global alcohol strategy, the evidence on long term and population-level effects is still weak. This review study will summarize the SBI programs implemented by six European countries with different socio-economic contexts. Similar components at health professional level but differences at organizational level, especially on the measures to support clinical practice, incentives, and monitoring systems developed were adopted. In Italy, cost-effectiveness analyses and Internet trials shed new light on limits and facilitators of renewed, evidence-based approaches to better deal with brief intervention in PHC. The majority of the efforts were aimed at overcoming individual barriers and promoting health professionals’ involvement. The population screened has been in general too low to be able to detect any population-level effect, with a negative impact on the acceptability of the program to all stakeholders. This paper will present a different point of view based on a strategic broadening of the implemented actions to real inter-sectoriality and a wider holistic approach. Effective alcohol policies should strive for quality provision of health services and the empowerment of the individuals in a health system approach.

A systematic review of the efficacy, effectiveness and cost-effectiveness of workplace-based interventions for the prevention and treatment of problematic substance use

Employee alcohol and other drug use can negatively impact the workplace, resulting in absenteeism, reduced productivity, high turnover, and worksite safety issues. As the workplace can influence employee substance use through environmental and cultural factors, it also presents a key opportunity to deliver interventions, particularly to employees who may not otherwise seek help. This is a systematic review of workplace-based interventions for the prevention and treatment of problematic substance use. Five databases were searched for efficacy, effectiveness and/or cost-effectiveness studies and reviews published since 2010 that measured use of psychoactive substances (i.e., alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, and stimulants) as a primary or secondary outcome, in employees aged over 18. Thirty-nine articles were identified, 28 describing primary research and 11 reviews, most of which focused solely on alcohol use. Heterogeneity between studies with respect to intervention and evaluation design limited the degree to which findings could be synthesized, however, there is some promising evidence for workplace-based universal health promotion interventions, targeted brief interventions, and universal substance use screening. The few studies that examined implementation in the workplace revealed specific barriers including lack of engagement with e-health interventions, heavy use and reluctance to seek help amongst male employees, and confidentiality concerns. Tailoring interventions to each workplace, and ease of implementation and employee engagement emerged as facilitators. Further high-quality research is needed to examine the effectiveness of workplace substance use testing, Employee Assistance Programs, and strategies targeting the use of substances other than alcohol in the workplace.

Efficacy of a theory‐driven program to implement alcohol screening and brief interventions in primary health care: A cluster randomized controlled trial

Background and Aims Screening and brief interventions (SBI) in primary health care practices (PHCPs) are effective in reducing reported alcohol consumption, but have not been routinely implemented. Most programs seeking to improve implementation rates have lacked a theoretical rationale. This study aimed to test whether a theory-based intervention for PHCPs could significantly increase alcohol SBI delivery. Design Two-arm, cluster-randomized controlled, parallel, 12-month follow-up, trial. Setting PHCPs in Portugal. Participants Staff from 12 PHCPs (N=222, 81.1% women): nurses (35.6%), general practitioners (28.8%), receptionists (26.1%) and family medicine residents (9.5%); patients screened for alcohol use: intervention N=8,062; controls N=58. Intervention and Comparator PHCPs were randomized to receive a training and support program (N=6; 110 participants) tailored to the barriers and facilitators for implementing alcohol SBI following the principles of the Behaviour Change Wheel/Theoretical Domains Framework approach, or to a waiting-list control (N=6; 112 participants). Training was delivered over the first 12 weeks of the trial. Measurements The primary outcome was the proportion of eligible patients screened (unit of analysis: patient list). Secondary outcomes included the brief intervention (BI) rate per screen-positive patient and the population-based BI rate (unit of analysis: patient list), and changes in health providers’ perceptions of barriers to implementation and alcohol-related knowledge (unit of analysis: health provider). Findings The implementation program had a significant effect on the screening activity in the intervention practices compared with control practices at the 12-month follow-up (21.7% vs. 0.16%, intention-to-treat analysis, P=0.003). Although no significant difference was found on the BI rate per screen-positive patient (intervention 85.7% vs. control 63.6%, P=0.55, Bayes Factor = 0.28), the intervention was effective in increasing the population-based BI rate (intervention 0.69% vs. control 0.02%, P=0.006). Health providers in the intervention arm reported fewer barriers to SBI implementation and higher levels of alcohol-related knowledge at 12-month follow-up than those in control practices. Conclusion A theory-based implementation program, which included training and support activities, significantly increased alcohol screening and population-based brief intervention rates in primary care.