Toolkit for general practice
Brief interventions
Primary care workers are in a unique position to offer brief interventions to people with alcohol related problems and for a significant percentage of people experiencing problems with alcohol these are surprisingly effective.
Each year 70% of the population visit their GP. The primary care setting offers many opportunities to ask about alcohol use such as new patient registrations, well person clinics and diabetic and hypertension clinics as well as individual consultations. Research suggests that approximately 20% of patients presenting to primary care are likely to be hazardous drinkers and problem drinkers are known to consult their GP twice as often as the average patient, commonly with gastrointestinal or psychiatric complaints or following accidents.
GPs sometimes fail to identify excessive drinkers because of an over-reliance on physical symptoms to detect alcohol misuse. Screening questionnaires have been demonstrated to be the most effective method to identify alcohol misuse, and screening in itself can encourage some people to reduce consumption.
Brief interventions themselves are targeted at people drinking excessively, but not yet experiencing major problems. They are not designed for dependent drinkers. They are often opportunistic – the person has not complained about a problem with alcohol use and is seeking help for something other than an alcohol problem.
However, a UK survey of GPs† identified three main disincentives to involvement in alcohol work. These were:
- Too busy dealing with presenting problems of patients
- Lack of training in counselling for reducing alcohol consumption
- Lack of Government policies supportive of preventative medicine.
It was found that incentives that might persuade GPs to engage more in alcohol intervention work included more readily available support services to which to refer people, early interventions (including brief interventions) being proved to be effective and patients actually requesting advice about alcohol.
More information on the contents of brief interventions and evidence of their efficacy can be found at http://www.alcoholconcern.org.uk/doc/178
Any help with problem drinking for the parent or advice to affected others will obviously be of benefit to any children in the family.
† Kaner, E.F.S., Heather, N., McAvoy, B.R., Lock, C.A. and Gilvarry, E. (1999) Intervention for excessive alcohol consumption in primary health care: attitudes and practices of English general practitioners, Alcohol & Alcoholism, no. 34(4), pp559-566.
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