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A rare ‘real world’ trial of whether a routine and feasible brief alcohol intervention can have population-wide public health benefits found that among university students in Sweden, web-based screening had very minor impacts which were not enhanced by feeding back the results.
Computerisation promises to spread the consumption-moderating benefits of alcohol screening and brief advice or treatment across the population, overcoming resource and access limitations to in-person interventions, but small and transient effects may not be enough to mitigate the health and social consequences of drinking.
Treatment services do not have to adopt, or ask patients to adopt, the belief system on which 12-step groups are founded in order to effectively encourage patients to tap in to the social support offered by these groups and improve their chances of sustained abstinence.
Around the world, programmes which take a spiritual or overtly religious route to overcoming substance use problems are extremely common and in some countries dominant – but do they work any better than the alternatives? This review systematically sifted the evidence from the past 30 years.
Amalgamated findings from studies of risky drinkers identified and counselled in primary care settings indicate that compared to screening and assessment only, brief counselling lead to greater reductions in drinking, gains reflected less strongly in some indicators of health. However, it is unclear whether the generally small impacts would be sustained in routine practice.
Is it feasible (and desirable) to give regular doses of alcohol to hospital inpatients when supervised withdrawal or short-term abstinence from drinking is not a realistic goal?
Does it help to add a structured internet-based therapeutic programme to web access to a mutual aid network also geared to moderate drinking? Sustained extra moderation in the form of fewer days drinking was the clearest positive effect; less clear was whether it led to greater reductions in drink-related problems.
For US problem drinkers and drug users not at the severest end of the spectrum, four sessions of group were as effective as four of individual therapy but took much fewer therapist hours per patient. The little research we have suggests this a common finding, commending group approaches on cost-effectiveness grounds.
Motivational interviewing’s originator has stressed how unexpected findings can force fruitful rethinking. This study may prove an example; designed to forefront the approach’s distinct active ingredients, other than fleetingly and non-significantly, these did not seem active at all among the stable, moderately dependent drinkers recruited to the trial.
In the Netherlands an intensive cognitive-behavioural treatment programme for problem drinkers based on messages sent via a web site between therapist and patient achieved substantial remission in drinking and improvements in health – promising results undermined somewhat by how few patients were followed up.
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