BACKGROUND: Screening for alcohol use disorders identifies a wide range of needs, varying from hazardous and harmful drinking to alcohol dependence. Stepped care offers a potentially resource-efficient way of meeting these needs, but requires evaluation in a randomised controlled trial. AIMS: To evaluate the feasibility, effectiveness and cost-effectiveness of opportunistic screening and a stepped care intervention in primary care. METHOD: A total of 1794 male primary care attendees at six practices in South Wales were screened using the Alcohol Use Disorders Identification Test (AUDIT). Of these, 112 participants who scored 8 or more on the AUDIT and who consented to enter the study were randomised to receive either 5 minutes of minimal intervention delivered by a practice nurse (control group) or stepped care intervention consisting of three successive steps (intervention group): a single session of behaviour change counselling delivered by a practice nurse; four 50-minute sessions of motivational enhancement therapy delivered by a trained alcohol counsellor; and referral to a community alcohol treatment agency. RESULTS: Both groups reduced alcohol consumption 6 months after randomisation with a greater, although not significant, improvement for the stepped care intervention. Motivation to change was greater following the stepped care intervention. The stepped care intervention resulted in greater cost savings compared with the minimal intervention. CONCLUSIONS: Stepped care was feasible to implement in the primary care setting and resulted in greater cost savings compared with minimal intervention.
RCT Entities:
BACKGROUND: Screening for alcohol use disorders identifies a wide range of needs, varying from hazardous and harmful drinking to alcohol dependence. Stepped care offers a potentially resource-efficient way of meeting these needs, but requires evaluation in a randomised controlled trial. AIMS: To evaluate the feasibility, effectiveness and cost-effectiveness of opportunistic screening and a stepped care intervention in primary care. METHOD: A total of 1794 male primary care attendees at six practices in South Wales were screened using the Alcohol Use Disorders Identification Test (AUDIT). Of these, 112 participants who scored 8 or more on the AUDIT and who consented to enter the study were randomised to receive either 5 minutes of minimal intervention delivered by a practice nurse (control group) or stepped care intervention consisting of three successive steps (intervention group): a single session of behaviour change counselling delivered by a practice nurse; four 50-minute sessions of motivational enhancement therapy delivered by a trained alcohol counsellor; and referral to a community alcohol treatment agency. RESULTS: Both groups reduced alcohol consumption 6 months after randomisation with a greater, although not significant, improvement for the stepped care intervention. Motivation to change was greater following the stepped care intervention. The stepped care intervention resulted in greater cost savings compared with the minimal intervention. CONCLUSIONS: Stepped care was feasible to implement in the primary care setting and resulted in greater cost savings compared with minimal intervention.
Authors: Rosely Flam-Zalcman; Robert E Mann; Gina Stoduto; Thomas H Nochajski; Brian R Rush; Anja Koski-Jännes; Christine M Wickens; Rita K Thomas; Jürgen Rehm Journal: Int J Methods Psychiatr Res Date: 2012-11-20 Impact factor: 4.035
Authors: Hedy Kober; Elise E DeVito; Cameron M DeLeone; Kathleen M Carroll; Marc N Potenza Journal: Neuropsychopharmacology Date: 2014-04-07 Impact factor: 7.853
Authors: Derek D Satre; Amy S Leibowitz; Wendy Leyden; Sheryl L Catz; C Bradley Hare; Hannah Jang; Jennifer O Lam; Kendall J Bryant; Constance M Weisner; Stacy A Sterling; Michael Horberg; Paul Volberding; Michael J Silverberg Journal: J Gen Intern Med Date: 2019-06-11 Impact factor: 5.128
Authors: Margarita Antonia Villar Luis; Sara Pinto Barbosa; Jacqueline de Souza; Kelly Graziani Giacchero Vedana; Ana Carolina Guidorizzi Zanetti; João Mazzoncini de Azevedo Marques Journal: Community Ment Health J Date: 2017-12-18
Authors: Eileen Kaner; Martin Bland; Paul Cassidy; Simon Coulton; Paolo Deluca; Colin Drummond; Eilish Gilvarry; Christine Godfrey; Nick Heather; Judy Myles; Dorothy Newbury-Birch; Adenekan Oyefeso; Steve Parrott; Katherine Perryman; Tom Phillips; Don Shenker; Jonathan Shepherd Journal: BMC Public Health Date: 2009-08-10 Impact factor: 3.295
Authors: Paolo Deluca; Simon Coulton; Mohammed Fasihul Alam; Sadie Boniface; David Cohen; Kim Donoghue; Eilish Gilvarry; Eileen Kaner; Ian Maconochie; Paul McArdle; Ruth McGovern; Dorothy Newbury-Birch; Robert Patton; Tracy Pellatt-Higgins; Ceri Phillips; Thomas Phillips; Rhys D Pockett; Ian Russell; John Strang; Colin Drummond Journal: Int J Drug Policy Date: 2021-01-22