Study reinforces that brief intervention for alcohol use ‘works’

Jolyon Attwooll

19/07/2021 4:47:40 PM

GP referrals help prevent moderate and high-risk alcohol users from returning to hospital, a recent Australian-run trial has found.

Man saying no to a shot of alcohol.
Issuing a GP referral can be an important factor in improving long-term outcomes for hospital patients whose alcohol use puts them at risk.

The paper, published in Sage Journals last month, reaffirmed the positive effect general practice can have on improving long-term outcomes following alcohol screening and brief interventions (ASBI) in hospital.
Conducted in Western Australia, the study looked at a cohort of 453 emergency department presentees identified as either moderate- or high-risk on the three-item Alcohol Use Disorders Identification Test-Consumption (AUDIT-C).
The research team compared the outcomes of those with a GP, including those issued a GP referral letter and some who continued treatment as usual, to those without a GP.
Follow-up interviews were conducted with 247 individuals (55% of the total).
The authors reported that alcohol consumption was significantly reduced at one month – but diverged in subsequent checks.
‘[Reduced alcohol consumption] was sustained at three months in the … group who also had a referral letter sent to their GP at discharge,’ the authors state.
‘However, the ASBI group who did not have the specific referral letter sent did not exhibit significantly reduced alcohol consumption compared with baseline after three months.
‘The participants who had “no GP” continued with similar levels to baseline of alcohol consumption over the three-month period following ASBI and discharge from hospital.’
The authors also concluded that the ‘no GP’ group had a ‘significantly greater’ risk of alcohol-related events requiring a return to hospital compared with the group that had a GP referral.
‘Thus, failure to engage with a GP following discharge with an alcohol-related event is predictive of a high likelihood of representation,’ the study concludes.
The findings are no surprise to Dr Hester Wilson, Chair of RACGP Specific Interests Addiction Medicine.
‘It flags for us as GPs the importance of our role,’ she told newsGP.  ‘Ideally, we want to be opportunistic asking all our patients about their drinking and their drug use.’
The frequency of hospital staff brief interventions was explored in the survey, with the finding that only 42% of them ‘often’ or ‘always’ asked individuals about their alcohol use.
Dr Wilson believes that a consistent approach can make a crucial difference.
‘Asking the question is important. Doing it in an ongoing fashion, it helps people to begin to make those changes,’ she said.
‘If we can have healthcare workers giving the same messaging at all the touch-points people come into contact with, then that adds up to a substantial intervention and supports people to begin to make change and to maintain change.’
Sydney GP Dr Chris Davis, who set up a GP-led home detox and alcohol management service, also said the study’s findings are not unexpected.
‘That echoes many other research projects they have done before that [found] brief intervention works,’ he told newsGP.
‘It’s a proven intervention, very cheap, very quick – patients don’t mind being asked. It just reiterated what we already knew about the efficaciousness of that.
‘We don’t need any special training or magic wand or particular experience or skillset to help our problem drinkers. What we really need to do is ask the question – that’s a brilliant starting point.
‘It’s quite an easy way in. There’s a perception that patients who drink don’t want help with it – and that’s not always the case.’
The study authors wrote that allowing patients to reflect on personal alcohol consumption ‘is a potentially powerful opportunity for those who are willing to change’.
They also note that while ASBIs were effective in primary care, the impact in hospital acute stays is equivocal according to previous studies.
Dr Davis said the issue is even more pertinent now with lockdowns having a widespread effect across Australia. He says drinking rates have increased by 20% since the pandemic began.
Previous, pre-pandemic studies suggest alcohol-related events are behind almost one in 10 emergency department presentations, and that one in every six Australians consumes alcohol at a rate that increases their risk of alcohol-related disease or injury.
The Australian Institute of Health and Welfare annual report for 2019–20 on ‘Alcohol and other drug treatment services in Australia’ shows around 139,300 people aged 10 and over received treatment for alcohol or other drug use during that 12 month period.
Released this month, the report shows alcohol is the most common principal drug of concern, making up more than one-third (34%) of all treatment episodes.
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