The future of specialised alcohol treatment services: a matter of policy?

Rao, Harish; Luty, Jason

doi:10.1192/apt.bp.107.004531

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…In England, people who continue to drink heavily despite IBA can also be referred to Community Drug and Alcohol Services (CDAS). CDAS provide open access treatment conducted by specialist alcohol counsellors, ideally with a comprehensive substance misuse assessment, alcohol-specific information, advice and support, and brief interventions based on motivational interviewing [ 14 ]. Treatment typically takes place weekly for 6 to 8 weeks based at CDAS, although there may be shared care with general practitioners.…”

Section: Introductionmentioning

confidence: 99%

DIAMOND (DIgital Alcohol Management ON Demand): a mixed methods feasibility RCT and embedded process evaluation of a digital health intervention to reduce hazardous and harmful alcohol use

Hamilton

Hornby

Sheringham³

et al. 2017

Pilot Feasibility Stud

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BackgroundAlcohol is a major risk factor for preventable illness, with huge cost to healthcare economies. There is a role for alcohol-specific digital health interventions (DHI), but there have been few randomised controlled trials (RCT) comparing DHI with face-to-face treatment. Such trials are complex and face obstacles in recruitment and retention.MethodsMixed-methods feasibility RCT of an alcohol DHI, testing recruitment, online data-collection and randomisation processes, with an embedded process evaluation. Recruitment ran from October 2014 for 9 months. Participants were adults drinking at hazardous and harmful levels, attending four community drug and alcohol services (CDAS) in London. Participants completed baseline demographic, alcohol-related and other psychological questionnaires online and were randomised to HeLP-Alcohol, a six-module DHI with weekly reminder prompts (phone, email or text message), which mirrors face-to-face treatment, or to face-to-face treatment at CDAS. Alcohol counsellors took part in qualitative interviews at the end of the study.ResultsAlcohol counsellors screened 1253 patients. One thousand one hundred eighty-nine did not meet inclusion criteria so were excluded: 579 were dependent drinkers, 548 had health conditions that made them ineligible to take part and 62 were ineligible for other reasons including homelessness. Of the 64 patients who were eligible to take part, 54 declined to participate, with 36 stating a preference for face-to-face treatment, 13 gave no reason, and 5 gave other reasons including not wanting to use a computer. Ten consented but then 3 changed their minds, so we were able to randomise 7 participants to the study (11% of eligible).Five alcohol counsellors agreed to be interviewed for the process evaluation and provided the following feedback: Although most of their colleagues were enthusiastic about the trial, some were not at equipoise in recruiting; potential participants also declared strong preference to intervention arm from the outset. These factors affected recruitment. Counsellors also lacked time to undertake the data inputting and follow-up of participants in addition to their everyday work.ConclusionsThis feasibility study aimed to test recruitment, randomisation, retention and data collection methods but recruited only 7 participants so these aims were not fully achieved. This illustrates to all researchers of complex interventions the importance of conducting feasibility studies and is generalisable to areas other than alcohol research.CDAS were seeing larger numbers of non-dependent drinkers with complex additional problems than alcohol commissioners expected. CDAS clients and some counsellors were not at equipoise for recruitment. Alternative settings for recruitment need to be explored in future trials.Trial registrationInternational Standard Randomized Controlled Trial Number: ISRCTN31789096, DOI 10.1186/ISRCTN31789096

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Section: Introductionmentioning

confidence: 99%

DIAMOND (DIgital Alcohol Management ON Demand): a mixed methods feasibility RCT and embedded process evaluation of a digital health intervention to reduce hazardous and harmful alcohol use

Hamilton

Hornby

Sheringham³

et al. 2017

Pilot Feasibility Stud

View full text Add to dashboard Cite

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“…British authors were 10 times more likely to appear as authors in the two general psychiatry journals that are UK based (44% of 1674 authors) as opposed to the three USA based journals (7% of 4788 authors) odds ratio=10.37, 95% confidence interval=8.95-12.02, two sided p-value < 0.0001. (Rao & Luty, 2009). Xenophobia within medical journals will effectively suppress any research to measure and counter these potentially overwhelming public health problems.…”

Section: Resultsmentioning

confidence: 99%

Xenophobia in general psychiatry journals

Sarkhel

Butterworth²,

Varughese³

et al. 2009

Ethnicity and Inequalities in Health and Social Care

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“…If people continue to drink heavily despite IBA, they may be referred for specialist alcohol treatment. Local authorities are responsible for commissioning alcohol treatment services from NHS and voluntary sector Community Drug and Alcohol Services (CDAS) [ 15 ]. There is not only high demand for these services, but also a large unmet need for treatment for people who do not seek help, mainly due to stigma but also due to difficulties in attending appointments due to work or other commitments, a shortage of services, or confusing care pathways [ 16 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

DIAMOND (DIgital Alcohol Management ON Demand): a feasibility RCT and embedded process evaluation of a digital health intervention to reduce hazardous and harmful alcohol use recruiting in hospital emergency departments and online

Hamilton

Hornby

Sheringham³

et al. 2018

Pilot Feasibility Stud

View full text Add to dashboard Cite

BackgroundThe harmful use of alcohol is a causal factor in more than 200 disease and injury conditions and leads to over 3 million deaths every year worldwide. Relatively few problem alcohol users access treatment due to stigma and lack of services. Alcohol-specific digital health interventions (DHI) may help them, but trial data comparing DHI with face-to-face treatment are lacking.MethodsWe conducted a feasibility RCT of an alcohol DHI, testing recruitment, online data-collection and randomisation processes, with an embedded process evaluation. Recruitment ran from October 2015 for 12 months. Participants were adults, drinking at hazardous and harmful levels, recruited from hospital emergency departments (ED) in London or recruited online. Participants were randomised to HeLP-Alcohol, a six module DHI with weekly reminder prompts (phone, email or text message), or to face-to-face treatment as usual (TAU). Participants were invited to take part in qualitative interviews after the trial.ResultsThe trial website was accessed 1074 times: 420 people completed online eligibility questionnaires; 350 did not meet eligibility criteria, 51 declined to participate, and 19 were recruited and randomised. Follow-up data were collected from three participants (retention 3/19), and four agreed to be interviewed for the process evaluation. The main themes of the interviews were:Participants were not at equipoise. They wanted to try the website and were disappointed to be randomised to face-to-face, so they were less engaged and dropped out.Other reasons for drop out included not accepting that they had a drink problem; problem drinking interfering with their ability to take part in a trial or forgetting appointments; having a busy life and being randomised to TAU made it difficult to attend appointments.ConclusionsThis feasibility RCT aimed to test recruitment, randomisation, retention, and data collection methods, but recruited only 19 participants. This illustrates the importance of undertaking feasibility studies prior to fully powered RCTs. From the qualitative interviews we found that potential recruits were not at equipoise for recruitment. An alternative methodology, for example a preference RCT recruiting from multiple locations, needs to be explored in future trials.Trial registrationInternational Standard Randomized Controlled Trial Number: ISRCTN31789096Electronic supplementary materialThe online version of this article (10.1186/s40814-018-0303-7) contains supplementary material, which is available to authorized users.

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The future of specialised alcohol treatment services: a matter of policy?

Cited by 5 publications

References 28 publications

DIAMOND (DIgital Alcohol Management ON Demand): a mixed methods feasibility RCT and embedded process evaluation of a digital health intervention to reduce hazardous and harmful alcohol use

DIAMOND (DIgital Alcohol Management ON Demand): a mixed methods feasibility RCT and embedded process evaluation of a digital health intervention to reduce hazardous and harmful alcohol use

Xenophobia in general psychiatry journals

DIAMOND (DIgital Alcohol Management ON Demand): a feasibility RCT and embedded process evaluation of a digital health intervention to reduce hazardous and harmful alcohol use recruiting in hospital emergency departments and online

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