New Evidence for Alcohol Brief Interventions (ABI) in General Hospital McQueen J, Howe TE, Allan L, Mains D, Hardy V (2011) Interventions for heavy alcohol users admitted to general hospital Cochrane Database of Systematic Reviews

New evidence for ABI in General Hospital Alcohol in Scotland Alcohol in Scotland Alcohol Brief Interventions Alcohol Brief Interventions Cochrane Systematic Review Cochrane Systematic Review Results Results Implications for Practice Implications for Practice Implications for Further Research Implications for Further Research

Alcohol Global alcohol consumption is continuing to increase linked to 2.5 million deaths per annum (WHO 2008) Global alcohol consumption is continuing to increase linked to 2.5 million deaths per annum (WHO 2008) Almost 1 million people in Scotland currently drink at hazardous/harmful levels (SHAPP 2011) Almost 1 million people in Scotland currently drink at hazardous/harmful levels (SHAPP 2011) 1 in 20 of all admissions to hospital in Scotland were either wholly or partly attributed to alcohol (ISD Scotland 2009) 1 in 20 of all admissions to hospital in Scotland were either wholly or partly attributed to alcohol (ISD Scotland 2009)

Alcohol Brief Interventions ABI’s are important for non-dependent heavy alcohol users in primary care shown to reduce total alcohol consumption and binge drinking for up to 1 year (SIGN 2003, Kaner et al 2007) ABI’s are important for non-dependent heavy alcohol users in primary care shown to reduce total alcohol consumption and binge drinking for up to 1 year (SIGN 2003, Kaner et al 2007) Admission to hospital represents an opportunity whereby heavy drinkers are accessible, have time for an intervention and maybe made aware of links between admission and alcohol (Saitz 2007) Admission to hospital represents an opportunity whereby heavy drinkers are accessible, have time for an intervention and maybe made aware of links between admission and alcohol (Saitz 2007) The acute post traumatic period may act as a catalyst for change a teachable moment (Soderstrom 2007, Sommers 2006) The acute post traumatic period may act as a catalyst for change a teachable moment (Soderstrom 2007, Sommers 2006)

Objective To determine whether brief interventions reduce alcohol consumption and improve outcomes for heavy alcohol users admitted to general hospital To determine whether brief interventions reduce alcohol consumption and improve outcomes for heavy alcohol users admitted to general hospital McQueen J, Howe TE, Allan L, Mains D, Hardy V (2011) Brief interventions for heavy alcohol users admitted to general hospital Cochrane Database of Systematic Reviews

Primary Outcomes Alcohol consumption levels, self report data measured by number of drinks per day, drinking diary, grams of alcohol per week Alcohol consumption levels, self report data measured by number of drinks per day, drinking diary, grams of alcohol per week Alcohol consumption tests FAST, AUDIT, CAGE Alcohol consumption tests FAST, AUDIT, CAGE Laboratory markers eg GGT blood or saliva Laboratory markers eg GGT blood or saliva

Secondary Outcomes Hospital re-admission rates Hospital re-admission rates Mortality Mortality Alcohol related injuries Alcohol related injuries Quality of life Quality of life Sickness absence from work Sickness absence from work Adverse legal events i.e violence driving offences Adverse legal events i.e violence driving offences Need for institutional care Need for institutional care

Inclusion Criteria Trials with adults 18 years or over Trials with adults 18 years or over Hospital inpatient units not identified as Hospital inpatient units not identified as psychiatric or addiction services Brief intervention a single session up to four Brief intervention a single session up to four sessions involving an individual patient or health care practitioner Should be compared to a control condition or Should be compared to a control condition or routine practice

Included Studies 14 studies 4041 participants 14 studies 4041 participants 5 from the UK (Chick 1985, Holloway 2007, McManus 2003,McQueen 2006, Watson 1999) 5 from the UK (Chick 1985, Holloway 2007, McManus 2003,McQueen 2006, Watson 1999) 4 from the US (Gentillelo 1999, Saitz 2007, Schermer 2006,Soderstrom 2007) 4 from the US (Gentillelo 1999, Saitz 2007, Schermer 2006,Soderstrom 2007) 2 from Tiawan (Lui 2011, Tsai 2009) 2 from Tiawan (Lui 2011, Tsai 2009) 1 from Australia (Heather 1996) 1 from Australia (Heather 1996) 1 from Finland (Antti-Poika 1988) 1 from Finland (Antti-Poika 1988) 1 from Germany (Freyer-Adam 2008) 1 from Germany (Freyer-Adam 2008)

Brief Interventions Ten studies delivered a single intervention between15-60 mins Ten studies delivered a single intervention between15-60 mins Four studies delivered two or more brief interventions with one including follow up at outpatient clinic Four studies delivered two or more brief interventions with one including follow up at outpatient clinic Brief interventions delivered by a range of health care professionals (nurses, medics, occupational therapists, psychologists, social workers) Brief interventions delivered by a range of health care professionals (nurses, medics, occupational therapists, psychologists, social workers)

Results1.1 Mean alcohol consumption in grams per week: smaller values indicate better outcome

1.4 Self Reports of Alcohol Consumption

Death

Implications for Practice/Further Research There are benefits to delivering brief interventions within general hospital in terms of reduction of alcohol and death rates There are benefits to delivering brief interventions within general hospital in terms of reduction of alcohol and death rates A range of health professionals including nurses, medics, occupational therapists, social workers and psychologists could deliver brief interventions A range of health professionals including nurses, medics, occupational therapists, social workers and psychologists could deliver brief interventions Further research required to determine the optimum content and treatment exposure in this setting and whether they are likely to be more successful in patients with certain characteristics Further research required to determine the optimum content and treatment exposure in this setting and whether they are likely to be more successful in patients with certain characteristics Further research should use outcomes consistent with the ones in this review to allow results to be pooled in meta-analysis. Further research should use outcomes consistent with the ones in this review to allow results to be pooled in meta-analysis.

References Antti-Poika I, Karaharju E, Roine R, Salaspuro M (1988) A prospective and controlled study of 438 consecutive injured male patients Alcohol and alcoholism 23(2): Chick J, Crombie E (1985) Counselling problem drinkers in medical wards a controlled study British Medical Journal 290: Gentilello L, Rivara FP, Donovan DM, Jurkovich G, Daranciag E at al (1999) Alcohol intervnetions in a trauma centre as a means of reducing the risk of injury recurrence Annals of surgery 230(4) Heather N, Rollnick S, Bell A, Richmond R (1996) Effects of brief counselling among male heavy drinkers identified on general hospital wards Drug and alcohol review Holloway AS, Watson HE, Arthur AJ, Starr G, McFadyn AK, McIntosh J (2007) The effect of brief interventions on alcohol consumption among heavy drinkers in a general hospital setting Addiction 2007 McManus S, Hipkins J, Haddad P, Guthrie E, Creed F (2003) Implementing an effective intervention for problem drinkers on medical wards General Hospital Psychiatry 25: McQueen J, Howe TE, Allan L, Mains D, Hardy V (2011) Brief interventions for heavy alcohol users admitted to general hospital wards Cochrane Database of Systematic Reviews

References McQueen J, Allan L, Mains D (2006) Brief motivational counselling for alcohol abusers admitted to medical wards British Journal of Occupational Therapy National Health Services Scotland (2009) Alcohol attributal mortality and morbidity: alcohol population attributable fractions for Scotland ISD Scotland publications Edinburgh Saitz R, Palfai TP, Cheng DM, Horton NJ, Freedner N, Dukes K, Kraemer KL, Roberts MS, Guerriero RT Samet JH (2007) Brief intervention for medical inpatients with unhealthy alcohol use Annals of internal medicine 146(3( p Schermer CR, Moyers TB, Miller WR, Bloomfield LA, (2006) Trauma centre brief interventions for alcohol disorders decrease subsequent driving under the influence arrests The journal of trauma injury infection and critical care Vol Soderstrom CA, DiClemente CC, Dischinger PC, Hebel R, McDuff DR, Auman KM, Kuferea JA (2007) A controlled trial of brief intervention versus brief advice for at risk drinking trauma centre patients The journal of trauma injury infection and critical care 62(5) WHO (2008) Management of substance abuse report World Health Organisation Geneve