Early Intervention for Harmful Alcohol Consumption: the WHO Collaborative Study

Abstract

There is growing evidence that treatment for persons with a drinking problem is more effective when it is provided at an early stage than if delayed until dependence has become established and disability severe. There are two essential components in any early intervention programme — a simple, but valid, procedure to detect persons drinking harmfully and a brief, systematic form of therapy that can be delivered by non‐specialist health professionals in a variety of health care settings. The WHO Collaborative Study was established to develop a suitable screening procedure and to evaluate various forms of brief therapy. A ten item “core” questionnaire has been developed by selecting the most representative questions contained within a comprehensive assessment schedule which was administered to non‐alcoholic drinkers recruited in six centres in both the developed and developing worlds. The questions selected relate to the quantity and frequency of drinking, alcohol dependence and alcohol‐related problems including psychological reactions to drinking. Questions on past medical history and current symptoms and findings on physical examination were excluded from the instrument because of their low correlation with alcohol intake. The instrument has high sensitivity and specificity and is easy to administer and to score. A second “clinical screening procedure” has been devised which includes non‐alcohol specific questions, clinical examination findings and a blood test. Three different types of brief therapy are currently being evaluated in 11 centres in a controlled clinical trial. In our own centre 1,000 subjects attending a variety of health care facilities and whose drinking places them at risk of harm are randomised to receive brief advice, counselling in problem solving strategies, counselling together with diary monitoring and feedback of laboratory results, or no therapy. Subjects are assessed up to 12 months by independent interviewers.

Screening Patients for Alcohol Problems in Primary Health Care Settings

“…To help their patients avoid alcohol‐related medical consequences, it is important that primary care providers be able to identify drinking problems. Because more people in the population drink who are not at the alcohol‐dependent stage than do those who are physically dependent, they suffer the most alcohol‐related harm (Saunders et al, 1988). Simple screening questionnaires or tests that can be administered during a routine office visit are helpful in determining if and to what degree patients have alcohol problems (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 1993).…”

Prodigious alcohol consumption by Australian rugby league footballers

“…Footballers are a discreet group with clubs organized into a framework which would appear to provide the opportunity for early intervention techniques [3] aimed at reducing alcohol consumption. Footballers are a discreet group with clubs organized into a framework which would appear to provide the opportunity for early intervention techniques [3] aimed at reducing alcohol consumption.…”

“…The level of alcohol consumption in Australian rugby league football clubs appears to reflect frequent episodes of harmful drinking according to National Health and Medical Research Council [i] criteria. Footballers are a discreet group with clubs organized into a framework which would appear to provide the opportunity for early intervention techniques [3] aimed at reducing alcohol consumption. Accordingly, a pilot intervention scheme has been initiated despite the powerful traditions and culture associated with alcohol and football.…”