No impact on crime by alcohol arrest referral schemes

Disappointing results have been obtained from pilot alcohol arrest referral schemes in the UK. The projects provided brief counselling to arrested individuals who the police believed were under the influence of alcohol. It was hoped that these interventions would lead to a reduction in offending behaviour. If successful, such schemes could form an important tool in tackling the public disorder associated with the night time economy.

The schemes delivered nearly 7,000 interventions, mainly to young white men. Nearly half of the individuals were drinking at hazardous/harmful levels, while more than a third were dependent drinkers. Just over a third of those arrested were suspected of violent offences and a sixth of being drunk and disorderly.

Disappointingly, there was no clear evidence that the interventions led to a reduction in offending behaviour. In fact, in some schemes individuals in a control group showed a greater decrease in offending behaviour than in the group receiving counselling.

The authors believe that one cause for this disappointing result lay in the fact that many of the participants were not prolific offenders. For these individuals there was not much offending to reduce, a situation very different from drug referral schemes. Schemes that might be appropriate in the context of illegal drugs cannot simply be transposed over to problematic alcohol use.

The schemes did identify many dependent drinkers and may be an effective way to signpost those individuals into alcohol treatment. However, it is questionable that interventions aimed at offenders are the best way to tackle the disorder associated with the night time economy.

Findings has a report on this research here.

The effectiveness of brief interventions in A&E

A recent study suggests that brief alcohol interventions in A&E may not be as effective as other studies have indicated. However, within this overall disappointing result, variations in counsellor skills may have a positive effect upon outcomes.

The Swiss research, reported in Findings, used a sample of 987 heavy drinkers to explore the effectiveness of brief motivational interventions in A&E. The disappointing headline result was that in this study, at least, receiving a brief intervention did not seem to lead to any greater level of improved outcomes in drinking one year later. About two-thirds of the participants were still drinking heavily after one year, regardless of whether or not they had received a brief intervention. This does contradict other studies, which have shown some positive effects from this form of intervention. For example, another study mentioned in Findings found that brief motivational interventions did seem to lead to a reduction in harmful drinking for dependent drinkers who were admitted to A&E with an injury.

However, the Swiss researchers also looked in more detail at these brief interventions and at the performance of individual counsellors. They found that although the overall results were disappointing, some patient and counsellor characteristics did predict a more positive outcome. The analysis was based upon a sample of only five counsellors and so should be treated with great caution. What it did find was that counsellors tended to produce more positive results to the degree that they delivered the interventions in a motivational style. The article describes this style in terms of demonstrating acceptance of the patient, having a collaborative approach and emphasising the individual’s control over their behaviour.

People who are approached with a brief alcohol intervention in A&E are generally there for some other reason and are not expecting an intervention regarding their alcohol use. The background notes to the article in Findings suggest that in this case, especially, a collaborative and non-confrontational approach is more likely to be successful.

Concrete plans in brief interventions for heavy drinkers

A recent study showed that very brief interventions with heavy drinkers were far more effective when the participants were asked to choose or to make concrete plans for alcohol reduction.

The British study was carried out in public places, such as shopping centres, where 471 people were asked to take part in a survey about alcohol. Around half agreed and were then given a questionnaire to fill in that contained information about safe drinking levels. The participants were randomly given one of four versions of the questionnaire, three of which had a different instruction at the end. The three instructions to participants were either:

  1. A request to write down a plan for reduced consumption.
  2. A choice between one of three pre-set reduction plans based upon an if-then model.
  3. An instruction to formulate their own if-then plan.

(An if-then plan makes an intention for future behaviour change more concrete by putting it into the format of ‘if this happens, then I will do/not do this‘.)

Around a third of the respondents were exceeding recommended safe drinking levels.

Follow up surveys a month later showed no changes to the drinking levels of the two-thirds of respondents who were not exceeding safe drinking levels. However, amongst the heavier drinkers there was a marked difference between those given the questionnaire with no instructions, who reported almost no change, and those given questionnaires with one of the three instructions listed above. Those given instructions tended to reduce their alcohol consumption, with the more concrete if-then plans prompting a significantly greater change.

The period before follow-up was fairly short and the effects of these interventions may not be long lasting. However, the study suggests that even a very brief, self-administered intervention can have an impact upon heavy drinking, particularly if the intervention includes support in making a simple, concrete plan for behaviour change. Asking participants to choose or to make an if-then plan may help to fix an intention and to rehearse its implementation.

A report and discussion on the study can be found here.

Is abstinence from alcohol the only reasonable treatment goal?

Further analysis of data from the UK Alcohol Treatment Trial (UKATT) throws more light on the debate about abstinence or non-abstinence as a treatment goal for people seeking help with an alcohol problem. [1] (Initial preference for drinking goal in the treatment of alcohol problems: II. Treatment outcomes. Alcohol and Alcoholism 2010 45(2):136-142.) The analysis compared treatment outcomes for individuals who at intake were aiming at abstinence with those who were not. Outcomes were compared after three months and at a twelve-month follow-up. Read more Is abstinence from alcohol the only reasonable treatment goal?