Alcohol
BRIEF
ENCOUNTER
Alcohol brief interventions
promised a way of improving the
nation’s public health – so what
happened to this ambitious
initiative? Mike Ashton looks back
at a 27-year journey
he advent of brief interventions represented a radical realignment
away from aiming for abstinence among relatively few ‘alcoholics’
to reducing risk among risky drinkers of all levels. Instead of narrow
and intensive, the strategy was to spread thin and wide, deploying
easily learnt interventions that could be delivered in a few minutes
by non-specialist staff.
Drinkers whose consumption generated no impetus to seek advice were
nevertheless to be offered it, after being identified by screening questions or
clinical signs while coming into contact with services for other reasons. Some
might not benefit and others only modestly, but – unlike treatment – the
population was the target. Screening and brief intervention was primarily a
public health strategy to reduce alcohol-related harm at the level of a whole
population, to a degree otherwise unattainable without imposing politically
unpalatable restrictions on the availability of alcohol.
This is the story of the partial retreat from those ambitions, traced through
three British studies in which the same researcher was involved – Professor
Nick Heather, the first to evaluate an alcohol brief intervention in primary care,
a venue chosen for its near-universal reach. The most influential thinker and
T
22 | drinkanddrugsnews | March 2018
researcher on brief interventions in Britain, his work forms the spine of the
research-driven realisation that hopes and potential were one thing, realising
them another.
Conducted in Dundee in 1985, the results of his first trial can in retrospect
be seen as a harbinger of what was to come. Whether screening had been
followed by no advice on drinking at all, a very brief warning from the doctor, or
the more elaborate ‘DRAMS’ brief intervention, drinking reductions did not
significantly differ. The researchers commented: ‘The results... provide little
support for the hypothesis that the DRAMS scheme is superior to simple advice
and to no intervention.’
Fifteen years later recruitment started for another study co-authored by
Professor Heather, seen as the UK trial closest to routine practice, an essential
step in showing ‘potential’ could be turned into public health gains. After
suffering from low recruitment to the trial and low rates of screening and
intervention, it found no statistically significant evidence that a five- to ten-
minute brief intervention by primary care nurses in England was more effective
than usual unstructured advice, despite costing nearly £29 more per patient.
Though appreciating the difficulties, in 2006, the year these results were
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