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.