Can screening and brief intervention lead to population-level reductions in alcohol-related harm?

The term “brief intervention” has been applied both to shorter forms of treatment delivered in specialist alcohol or addiction services and to interventions offered by generalist professionals to individuals who are not seeking help for an alcohol problem but whose alcohol consumption is of concern. It has been argued that these two uses of the term should be clearly distinguished [1,2], and it is the second that is the focus of this article. In this sense, it is better to use the term “opportunistic brief intervention,” with the implication that the opportunity is taken of the drinker’s presence in a setting not directly connected with help for alcohol problems to offer advice and assistance to cut down consumption or abstain. For convenience, however, this form of activity will be called simply brief intervention (BI) here.Brief intervention is directed at two separate targets: hazardous drinkers, whose level or pattern of drinking increases the risk of alcohol-related harm, and harmful drinkers, who have already incurred some degree of harm but who show no or only low levels of alcohol dependence [3]. Since, by definition, these individuals are not seeking help to resolve an alcohol problem, it is necessary to screen for level of consumption and/or the presence of alcohol-related problems or employ some other form of identification before BI can be offered. The more specific aims of screening and brief intervention (SBI) will be discussed below.There is no single form of BI; rather, the term applies to a family of interventions that differ in length, content, and in a number of other ways [4]. Recently, however, two distinct forms of BI have emerged: brief structured advice and brief motivational interviewing. Brief structured advice is typically employed in time-limited situations, such as general medical practice, with immediate intervention following screening. The intervention typically lasts between five and 10 minutes and usually consists of a standard pack