Numerous studies have reported that brief interventions delivered in primary care are effective in reducing excessive drinking. However, much of this work has been criticised for being clinically unrepresentative. This review aimed to assess the effectiveness of brief interventions in primary care and determine if outcomes differ between efficacy and effectiveness trials.A pre-specified search strategy was used to search all relevant electronic databases up to 2006. We also hand-searched the reference lists of key articles and reviews. We included randomised controlled trials (RCT) involving patients in primary care who were not seeking alcohol treatment and who received brief intervention. Two authors independently abstracted data and assessed trial quality. Random effects meta-analyses, subgroup and sensitivity analyses and meta-regression were conducted.The primary meta-analysis included 22 RCT and evaluated outcomes in over 5800 patients. At 1 year follow up, patients receiving brief intervention had a significant reduction in alcohol consumption compared with controls [mean difference: -38 g week(-1), 95%CI (confidence interval): -54 to -23], although there was substantial heterogeneity between trials (I(2) = 57%). Subgroup analysis confirmed the benefit of brief intervention in men but not in women. Extended intervention was associated with a non-significantly increased reduction in alcohol consumption compared with brief intervention. There was no significant difference in effect sizes for efficacy and effectiveness trials.Brief interventions can reduce alcohol consumption in men, with benefit at a year after intervention, but they are unproven in women for whom there is insufficient research data. Longer counselling has little additional effect over brief intervention. The lack of differences in outcomes between efficacy and effectiveness trials suggests that the current literature is relevant to routine primary care.
Abstract The study aimed to assess the psychometric properties of the Indigenous Risk Impact Screen (IRIS) as a screening instrument for determining (i) the presence of alcohol and drug and mental health risk in Indigenous adult Australians and (ii) the cut‐off scores that discriminate most effectively between the presence and absence of risk. A cross‐sectional survey was used in clinical and non‐clinical Indigenous and non‐Indigenous services across Queensland Australia. A total of 175 Aboriginal and Torres Strait Islander people from urban, rural, regional and remote locations in Queensland took part in the study. Measures included the Indigenous Risk Impact Screen (IRIS), the Severity of Dependence Scale (SDS), the Alcohol Use Disorders Identification Test (AUDIT) and the Leeds Dependence Questionnaire (LDQ). Additional Mental Health measures included the Depression Anxiety and Stress Scale (DASS‐21) and the Self‐Report Questionnaire (SRQ). Principle axis factoring analysis of the IRIS revealed two factors corresponding with (i) alcohol and drug and (ii) mental health. The IRIS alcohol and drug and mental health subscales demonstrated good convergent validity with other well‐established screening instruments and both subscales showed high internal consistency. A receiver operating characteristics (ROC) curve analysis was used to generate cut‐offs for the two subscales and t‐tests validated the utility of these cut‐offs for determining risky levels of drinking. The study validated statistically the utility of the IRIS as a screen for alcohol and drug and mental health risk. The instrument is therefore recommended as a brief screening instrument for Aboriginal and Torres Strait Islander people.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the effects of brief interventions in reducing excessive alcohol consumption in routine primary health care and characterise the types of drinkers to whom these effects relate. The following comparisons will be made: 1) Brief intervention vs a control condition (assessment only, standard treatment or non‐intervention) 2) Brief intervention vs a extended psychological intervention. Subgroup analysis will be undertaken to assess the impact of brief interventions in efficacy (ideal world) and effectiveness (real world) trials using a coding scale developed from the work of Shadish and colleagues (Shadish 2000) and to account for variability in treatment exposure relating to the frequency, duration and theoretical basis of the brief intervention. Intervention outcomes will also be classified according to the time at which they were followed‐up to ascertain the short, medium and long‐term effects. Finally, the applicability of brief intervention to different sub‐groups of drinkers will be described in narrative form.
Research highlights that lesbian, gay, bisexual and transgender (LGBT) people use alcohol and drugs (AOD) more than heterosexual people; however, the incidence of AOD use by LGBT youth is less understood. The purpose of the current study was to ascertain AOD prevalence rates for LGBT youth compared with the Australian youth population; perceptions of AOD use within the LGBT community; and the impact of homophobia on AOD use.The study surveyed a cross-sectional sample of LGBT youth (13-24 years) (n = 161) who attended a LGBT festival in Brisbane, Australia, in 2012. The Alcohol Use Disorders Identification Test-Consumption, Fagerström Test for Nicotine Dependence and Drug Check Assessment Tool were utilised to examine patterns of AOD use, with items developed to explore perceptions of AOD use and homophobia.AOD use was common among the LGBT sample, with higher prevalence rates compared with the general Australian youth population (2010 National Drug Strategy Household Survey). AOD use by under 18-year-olds, and gender diverse youth was markedly higher. The majority misperceived AOD use to be the same in the LGBT and heterosexual communities. Those who believed homophobia impacted on AOD use were significantly more likely to use AOD.The higher prevalence of AOD use strongly suggests the need for AOD agencies to better respond to LGBT youth by not only screening sexuality and gender identity but also exploring young people's perceptions of AOD use in the LGBT community and their experiences of homophobia in order to provide effective AOD clinical treatment.
RODGER BROUGH: Next we have a joint presentation Coralie Ober who currently works as a research fellow, Queensland Alcohol and Drug Research and Education Centre at the University of Queensland School of Population Health. She has a very broad experience in clinical nursing through to teaching, advocacy and advisory roles. Her work with Indigenous communities is widely recognised inside and outside this country and her role with the WHO is testimony to that.
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