1. Alcohol is a big problem 23% adults hazardous or harmful drinkers (7.1M) Consumption doubled in adolescents in past 10 yrs 3.6% alcohol dependent (1.1M) (Drummond et al., 2005) Only 1 in 18 access treatment (Drummond et al., 2005) 25,000 premature deaths annually Cost of alcohol misuse £25bn per annum 3 rd leading cause of disability in Europe 40% A&E attendances (Drummond et al., 2003) Prevalence high in CJS (SIPS project, 2010) : –78% prison; 65% probation; 58% police custody Mental health services- 49%; PHC – 30% (Coulton et al., 2006) Alcohol Dependence: 25 years of potential life lost Professor Colin Drummond Alcohol Research Group, Addictions CAG

2. SIPS research programme Funded by Department of Health: Led by IOP 3 cluster randomised clinical trials of alcohol screening and brief intervention (PHC, AED, CJS) Research questions: –What are the barriers/facilitators to implementation? –What is the most effective screening method? –What is the most cost effective intervention approach? Screened 10,521; 40% AUD +ive; 2,485 recruited 17% reduction in AUD at 12 months across trials No difference between interventions of different intensity Whats next: –SIPS Junior NIHR programme grant –ASBI for 10-17 year olds in AED –Cohort study (NIHR BRC): impact of alcohol on development

3. 3 Assertive Community Treatment in Alcohol Dependence (ACTAD) Typically high level of drop out and poor outcome Initial pilot work on ACT methods (Passetti et al., 2008) MRC pilot trial of ACT in chronic relapsing AD Research questions: –Is ACT feasible/acceptable to implement in alcohol treatment? –Does ACT lead to improved treatment engagement? –Does ACT lead to improved clinical outcomes? 90 patients in 3 South London specialist CDATs Random allocation to –Assertive community Treatment, or –Treatment as usual Results so far –ACT high level of acceptability with patients and staff –High level of engagement (100% at 12 months) Whats next? –Clinical outcomes 6 & 12 months –ACTAD II –full RCT (NIHR HTA) –CHAOS – ACT targeting frequent flyers (NIHR programme grant)