EFFECTIVENESS BANK BULLETIN 23 February 2009: reviews and meta-analyses
EFFECTIVENESS BANK BULLETIN 23 February 2009: reviews and meta-analysesThe entries below are our accounts of documents selected by Drug and Alcohol Findings as particularly relevant to improving outcomes from drug or alcohol interventions in the UK. Entries were drafted after consulting related research, study authors and other experts and are © Drug and Alcohol Findings. Permission is given to distribute these entries or incorporate passages in other documents as long as the source is acknowledged including the web address http://findings.org.uk. However, the original documents were not published by Findings; click on the Titles to obtain copies. Free reprints may also be available from the authors; if displayed, click Request reprint to send or adapt the pre-prepared e-mail message. The Summary is intended to convey the findings and views expressed in the study. Below are comments from Drug and Alcohol Findings. Links to source documents are in blue. Hover mouse over orange text for explanatory notes.
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Rare review of the evidence on whether drug law enforcement works ...
Britain's doctors tell government what they should do about problem drinking ...
Is all it takes to tell people how their drinking compares to the norm? ...
Drug law enforcement: a review of the evaluation literature.Mazerolle L., Soole D., Rombouts S.
Police Quarterly: 2007, 10, p. 115–153.
Request reprint using your default e-mail program or write to Dr Mazerolle at l.mazerolle@griffith.edu.au
Rare review of enforcement tactics concludes that proactive interventions involving partnerships between the police and third parties and/or community entities have the greatest research backing, but also that the evidence base is poor and sparse.
Summary This article describes the results of a systematic review of evaluations of the impact of drug law enforcement on drug problems including drug use, dealing, supply, demand, and associated problems in drug dealing areas. The review divides the interventions in to five main categories.
1 International and national interventions such as eradicating crops being grown for drug production and interdicting and seizing drug shipments, neither of which have been shown to be effective.
2 Reactive/directed interventions such as crackdowns, raids, buy-busts, and saturation patrolling. These traditional tactics which respond to problems coming to the attention of the police generally have mixed evidence of effectiveness, in the case of raids, also short-term, and in the case of crackdowns, dependent on the circumstances. Intelligence-led search and seizure targeting domestic manufacturing has been found effective in two US studies.
3 Proactive/partnership interventions initiated on the basis of an analysis of the underlying problem, forming part of a more strategic response involving partnerships with community bodies and local people intended to have a lasting impact. Among these are third-party policing, problem-oriented policing, community policing, changing the physical environment, and drug nuisance abatement. Apart from 'drug-free' zones which exclude drug offenders and cross-jurisdiction task forces, these have some evidence of effectiveness.
4 Interventions targeting identified individuals such as arrest referral of suspects and diverting offenders from prosecution through the use of cautions, both of which have some evidence of effectiveness.
5 Interventions deploying a combination of reactive/directed and proactive/partnership strategies, for which there is some evidence of effectiveness.
The authors concluded that proactive interventions involving partnerships between the police and third parties and/or community entities appear to be more effective at reducing both drug and non-drug problems in areas with drug problems than reactive/directed approaches. However, they cautioned that the general quality of research in drug law enforcement is poor and only a limited range of interventions have been evaluated.
Last revised 21 February 2009
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Refocusing drug-related law enforcement to address harms REVIEW 2009
Community solidarity and civil law important tools in reducing drug-related nuisance and crime STUDY 2000
Police crackdowns: environmental and community changes sustain impact STUDY 2002
Drug Strategy 2010. Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life DOCUMENT 2010
Effect of drug law enforcement on drug-related violence: a systematic review REVIEW 2011
Effect of drug law enforcement on drug-related violence: evidence from a scientific review REVIEW 2010
Internationally proven community alcohol crime and harm reduction programmes feasible in Britain STUDY 2008
The Drug Treatment Outcomes Research Study (DTORS): final outcomes report STUDY 2009
Criminalising drug possession in the Czech Republic did not reduce drug problems OFFCUT 2003
Drugs, crime and public health: the political economy of drug policy REVIEW 2010
Alcohol misuse: tackling the UK epidemic.British Medical Association Board of Science.
London: BMA, 2008.
Report from Britain's trade union and professional association for doctors reviewing the extent and consequences of problem drinking in the UK and making recommendations for government action and evidence-based policies.
Summary After reviewing the extent and consequences of problem drinking in the UK, Britain's professional body for doctors made recommendations to government including:
• Taxation on all alcoholic beverages should be increased at higher than inflation rates proportionate to alcohol content.
• Licensing hours should be cut.
• Town planning and licensing authorities should be legally required to consider the local density of on-licensed premises and the surrounding infrastructure when evaluating any planning or licensing application.
• Licensing legislation should be strictly and rigorously enforced including penalties for breach of licence, suspension or removal of licences, test purchases to monitor underage sales, and restrictions on individuals with a history of alcohol-related crime or disorder.
• Enforcement agencies should be adequately funded and resourced. Consideration should be given to a dedicated alcohol licensing and inspection service.
• Legislation should prohibit irresponsible promotions and set minimum price levels.
• A statutory rigorously enforced new code of marketing practice should ban: alcohol advertising at times likely to be viewed by young people; alcohol industry sponsorship of sporting, music and other entertainment events aimed mainly at young people; marketing alcoholic soft drinks to young people.
• The legal blood alcohol limit for driving should be cut to 50mg/100ml.
• New laws should permit random roadside testing without the need for prior suspicion of intoxication, accompanied by adequate resourcing and public awareness campaigns.
• There should be further qualitative research examining attitudes to alcohol misuse in the UK.
• Public and school-based alcohol education should only be used as part of a wider harm reduction strategy to support policies shown to be effective, to raise awareness of the adverse effects of alcohol misuse, and to promote public support for comprehensive alcohol control measures.
• Laws should require: alcoholic products to be labelled with their alcohol content in units, recommended daily UK consumption guidelines, and a warning about exceeding these guidelines; all adverts and retail points of sale to display the guidelines and warning message.
• Detection and management of alcohol misuse should be an adequately funded and resourced component of primary and secondary medical care and include: formal screening for alcohol misuse; referral for brief interventions and treatment as appropriate; follow-up care and assessment.
• Comprehensive training and guidance should be provided to all relevant healthcare professionals on the identification and management of alcohol misuse.
• Funding for alcohol treatment services should be significantly increased and ring-fenced to so everyone identified as having severe alcohol problems or dependent is offered referral to these services at the earliest possible stage.
• The need for and provision of alcohol treatment services should be continually reassessed.
• There should be strong support for European Union, World Health Organisation and World Health Assembly initiatives and policies aimed at reducing alcohol-related harm.
• The UK should lobby for and support the World Health Organisation in developing and implementing a legally binding international treaty on alcohol control.
Last revised 20 February 2009
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Alcohol-use disorders: Preventing the development of hazardous and harmful drinking REVIEW 2010
Independent review of the effects of alcohol pricing and promotion STUDY 2008
Reducing alcohol harm: health services in England for alcohol misuse STUDY 2008
Alcohol in our lives: curbing the harm DOCUMENT 2010
The effectiveness of tax policy interventions for reducing excessive alcohol consumption and related harms REVIEW 2010
Economic impacts of alcohol pricing policy options in the UK STUDY 2011
Curbing problem drinking with personalized-feedback interventions: a meta-analysis.Riper H., van Straten A., Keuken M. et al.
American Journal of Preventive Medicine: 2009, 36(3), p 247–255.
Request reprint using your default e-mail program or write to Dr Riper at hriper@trimbos.nl
Synthesis of randomised trials finds worthwhile reductions in drinking after college students and others are simply very briefly informed how their drinking compares to population norms.
Summary The effectiveness of personalised feedback interventions to reduce problem drinking has been evaluated in several randomised trials and systematic reviews. A meta-analysis was performed to examine the overall effectiveness of brief, single-session personalised feedback comparing the individual's drinking or drink-related risks to population norms, delivered without any further therapeutic guidance. Selection and analyses of studies were conducted in 2008. Fourteen randomised trials of single-session personalised feedback interventions without therapeutic guidance were identified. Their combined effectiveness on the reduction of problematic alcohol consumption was evaluated in a meta-analysis. Alcohol consumption was the primary outcome measure.
The results In technical terms, the pooled standardized-effect size (14 studies, 15 comparisons) for reduced alcohol consumption at post-intervention was d = 0.22 (95% CI=0.16, 0.29; the number needed to treat=8.06; areas under the curve=0.562). No heterogeneity existed among the studies (Q=10.962; p=0.69; I2=0). indicated that such interventions led on average to a statistically significant small to medium size reduction in alcohol consumption such that about eight people had to receive the intervention to generate one good clinical outcome. The authors concluded that single-session personalised feedback interventions without therapeutic guidance appear to be a viable and probably cost-effective option for reducing problem drinking in student and general populations. The Internet offers ample opportunities to deliver personalised feedback interventions on a broad scale, and problem drinkers are known to be amenable to Internet-based interventions. More research is needed on the long-term effectiveness of personalised feedback interventions for problem drinking, on their potential as a first step in a stepped-care approach, and on their effectiveness with other groups (such as youth obliged to use judicial service programmes because of violations of minimum-age drinking laws) and in other settings (such as primary care).
Last revised 25 February 2009
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Dismantling motivational interviewing and feedback for college drinkers: a randomized clinical trial STUDY 2009
Computer-delivered interventions for alcohol and tobacco use: a meta-analysis REVIEW 2010
Web-based alcohol prevention for incoming college students: a randomized controlled trial STUDY 2010
Computerised feedback challenges belief that most drink more than me STUDY 2001
Students respond to brief alcohol intervention STUDY 1999
Alcohol-use disorders: Preventing the development of hazardous and harmful drinking REVIEW 2010
Fidelity to motivational interviewing and subsequent cannabis cessation among adolescents STUDY 2011
Diagnosis and management of alcohol use disorders.Parker A.J.R., Marshall E.J., Ball D.M.
British Medical Journal: 2008, 336, p. 496–501.
Request reprint using your default e-mail program or write to Dr Parker at andrew.parker@iop.kcl.ac.uk
Clinical guidance for UK health care professionals on managing alcohol problems based on a review of British and international official guidance and major systematic reviews and research syntheses.
Summary Clinical guidance for UK health care professionals on managing alcohol problems based on a review of British and international official guidance and major systematic reviews and research syntheses. The authors from the Maudsley Hospital and King's College in London assess ways to routinely identify and diagnose drinking problems including brief questionnaires and biological tests, and recommend areas further assessment should cover. Guidance is given on brief interventions and on managing withdrawal using medications, including the avoidance of neuropsychiatric complications. Also covered are ways to help prevent relapse and stabilise recovery including medications, professional psychosocial support, and/or the encouragement of self-help group attendance. A short list of additional education and support resources for professionals and patients is also provided.
Last revised 20 February 2009
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Alcohol-use disorders: Diagnosis, assessment and management of harmful drinking and alcohol dependence REVIEW 2011
Alcohol-use disorders: Preventing the development of hazardous and harmful drinking REVIEW 2010
Reducing alcohol harm: health services in England for alcohol misuse STUDY 2008
Investing in alcohol treatment SERIES OF ARTICLES 2002
Naltrexone helps GPs and practice nurses manage alcohol dependence STUDY 2004
Reducing the impact of alcohol-related harm to Londoners – how well are we doing? STUDY 2011
Efficacy of physician-delivered brief counseling intervention for binge drinkers STUDY 2010
