Analysis

Rethinking brief interventions for alcohol in general practice

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j116 (Published 20 January 2017) Cite this as: BMJ 2017;356:j116
  1. Jim McCambridge, professor of addictive behaviours and public health1,
  2. Richard Saitz, professor of community health sciences2
  1. 1Department of Health Sciences, University of York, York, UK
  2. 2Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
  1. Correspondence to: J McCambridge jim.mccambridge{at}york.ac.uk

Jim McCambridge and Richard Saitz question the effectiveness of brief advice and counselling in primary care to prevent harm from heavy alcohol use and call for a more strategic approach

Primary care has been promoted for decades as the key setting for delivering brief individual advice and counselling interventions to reduce heavy alcohol consumption.1 National alcohol programmes have been initiated in many countries in which practitioners are encouraged and supported in various ways (box 1), but uptake is low.

Box 1: Guidance materials on brief interventions for alcohol in general practice

  • WHO. Screening and brief intervention for alcohol problems in primary health care (http://www.who.int/substance_abuse/activities/sbi/en/)

  • Public Health England. Alcohol learning resources (http://www.alcohollearningcentre.org.uk/Topics/Browse/BriefAdvice/)

  • Screening and intervention programme for sensible drinking (SIPS) (http://www.sips.iop.kcl.ac.uk/index.php#)

  • Primary Health Care European Project on Alcohol. Training programme (http://www.gencat.cat/salut/phepa/units/phepa/html/en/dir164/doc7453.html)

  • BISTAIRS: Brief interventions in the treatment of alcohol use disorders in relevant settings (http://www.bistairs.eu/)

  • National Institute on Alcohol and Alcohol Abuse. Helping patients who drink too much (http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/clinicians_guide.htm)

  • CDC. Planning and implementing screening and brief intervention for risky alcohol use (http://www.cdc.gov/ncbddd/fasd/Cdocuments/alcoholsbiimplementationguide.pdf)

  • Substance Abuse and Mental Health Services Administration. Resources for screening, brief intervention, and referral to treatment (http://www.samhsa.gov/sbirt/resources)

  • SAMHSA-HRSA Center for Integrated Health Solutions. SBIRT: screening, brief intervention, and referral to treatment (http://www.integration.samhsa.gov/clinical-practice/SBIRT)

The logic of reducing risky behaviour is compelling because of the burden of preventable diseases and cost pressures on health systems. In such a context, “brief interventions” offer promise of efficiency, and evidence suggests effectiveness for alcohol.2 However, unresolved questions remain about their use in everyday practice3: although most patients don’t mind being asked about their drinking,4 they may not see why intervention is necessary if they do not regard their drinking as problematic,5 and practitioners will be reluctant to screen and intervene if they believe doing so compromises person centred care.6 After …

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