BackgroundThe evidence suggests that brief alcohol-focused interventions, directed at hazardous and harmful drinkers in non-specialist settings such as primary care are effective in reducing alcohol consumption. However, there is a need for further research in the hospital setting. This is a randomised controlled trial to investigate the effectiveness of a 10-minute brief intervention amongst 'at risk’ drinkers admitted to general hospital wards. Unlike some previous trials, this trial is randomised, used blinded assessors, includes an intention-to-treat analysis, included female subjects and excluded people with alcohol dependence.MethodsA total of 250 'at risk’ drinkers admitted to King’s College Hospital were identified using the Alcohol Use Disorders Identification Test (AUDIT). Some 154 subjects entered the study and were randomly allocated to the control and intervention groups. Subjects in the control group received no advice about their drinking whilst subjects in the intervention group received 10 minutes of simple advice on reducing alcohol consumption. Recruitment took place between 1995 and 1997. The primary outcome was the AUDIT questionnaire at 12 months. Secondary outcomes were a previous week’s Drinks Diary, questionnaires (General Health Questionnaire, Alcohol Problems Questionnaire and the Severity of Alcohol Dependence Questionnaire) and laboratory blood tests (gamma glutamyl transferase, mean cell volume and haemoglobin).ResultsAt 3-month and 12-month follow-up, all participants were included in the intention-to-treat analysis. At both time points there was no evidence of an intervention effect that could be attributed to the brief intervention. Both the intervention and control groups had an improved AUDIT score and reduced levels of alcohol consumption as measured by a subjective Drinks Diary at 3 months which was maintained at 12 months.ConclusionsThis study has added further evidence on brief interventions in the hospital setting. In contrast to the recent Cochrane review by McQueen et al., the results of this study do not support the effectiveness of a brief alcohol intervention in general hospital wards. However our study was underpowered and there were flaws in the statistical analyses, and these limitations temper the strength of our conclusions.
We conducted a prevalence study of current substance misuse amongst acute general medical admissions, and compared the sociodemographic profile of this group of patients with total admissions and the local catchment population. Patients were included in the study if they were resident in the Lambeth, Southwark and Lewisham (LSL) Health Commission catchment area and were aged between 18 and 85 years. The prevalence of non-dependent misuse was of particular interest. Of 2988 acute admissions, 609 (20%) were identified as misusing alcohol and/or drugs, 277 (9%) being identified by the admitting doctor and 332 (11%) being identified by means of a Health and Lifestyle Questionnaire (HLQ) which included the Alcohol Use Disorders Identification Test (AUDIT). The majority 437 (72%) of the identified patients had an alcohol problem. A smaller proportion, 116 (19%) were currently using illegal drugs and 56 (9%) were polydrug users. Compared with patients who misused either drugs or alcohol, alcohol misusers were more likely to be older and Irish, whereas users of illegal drugs were more likely to be younger and Black. Significantly more 'at risk' drinkers were identified by the AUDIT questionnaire than by the admitting doctor. This study supports the policy of routine screening for health-damaging behaviours and the implementation of health promotion strategies in general hospitals.
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