1. Brief intervention in primary care Study of Kristensson et al in Sweden

2. No alcohol problems, approx 8 million Swedes  national alcohol policy  primary prevention Risk behaviour, 700 000  secondary prevention Dependent, 300 000  Tertiary prevention Treatment Target group: people with hazardous consumption

3. Brief intervention example: study of Kristensson et al in Sweden Randomised trial: Results after 5 years

4. Brief intervention  Screening: the AUDIT questionnaire  Motivate patients to change behaviour

5. Brief advice: FRAMES  Feedback  Responsibility  Advice  Menu  Empathy  Self-efficacy

6. Motivational Interviewing Two main components  Understand patient’s readiness to change behaviour  Communications skills

8. How should screening be organised? Who should be screened? All patients All new patients All patients within certain time period Patients with certain diagnoses Individual decision from case to case How? AUDIT distributed by reception staff AUDIT distributed by doctor at consultation Part of general life style assessment Screening questions asked by doctor at consultation Screening questions asked by nurse or other staff What should be done with the repsonses? Advice from doctor or nurse  motivational enhancement Patient offered new appointment for alcohol advice

9. Training program for brief intervention 3 hours training:  Basics about alcohol  effects of alcohol on health  drinking habits in the population  effective treatment  evidence for SBA  Methods for screening and brief advice WHO manual: http://www.who.int/substance_abuse/activities/sbi/en/index.html

10. The Swedish national risky drinking project National center for training and dissemination In Primary Health In the work place

11. National center for training and dissemination Project areas 1.Family medicine 2.Maternal health 3.Primary health nurses with focus on child health care 4.Occupational health 5.Motivational Interviewing

12. The Swedish national risky drinking project The Risky Drinking Project at SNIPH Combining National Center with support for local action in 21 counties