Last year, I did a study Evaluating EBI in alcohol settings – May 2011 as part of a Certificate in Drug and Alcohol Studies at University of Stirling which I thought might be useful for other people looking to offer EBI/Brief Treatment in alcohol settings delivered by alcohol specialists. It is very small scale and, of course, biased by my position in relation to the research participants, and was my first foray into the Social Sciences but hoping it will be of some use.
Abstract
While Increasing Risk drinkers can access Brief Advice (short, structured advice) through generalists, and High Risk/dependent drinkers can access specialist alcohol treatment, the needs of those drinkers who fall between these two groups—known as Higher Risk drinkers—are often overlooked by both generalist services and specialist alcohol settings. Extended Brief Interventions (EBI)—short motivational sessions with follow-ups—have been recommended in national guidance as a means of filling this gap in provision. The present study sought to explore and evaluate the effectiveness of alcohol specialists delivering EBI as a form of Brief Treatment (BT).
A literature review was conducted, focusing first on the evidence regarding the comparative efficacy of Brief Advice (BA) and EBI, and then on comparative studies of EBI with more intensive treatment. In reviewing the literature, it was concluded that, whilst there is a broad consensus that BA is as effective as EBI and that BT can be as effective as intensive treatment, it does not follow that either EBI or more intensive treatment is ineffective or unnecessary. In spite of some patent flaws in the evidence base, EBI and BT are legitimate modalities for Higher or High Risk individuals who require more than BA and less than treatment proper.
In January 2011, a local alcohol service in North London, HAGA—the author’s employer—introduced EBI as a new treatment option. Under this new treatment pathway, all clients were to be screened at entry and exit using the Alcohol Use Disorders Identification Test (AUDIT) in addition to the Treatment Outcomes Profile (TOPS). All appropriate Higher Risk drinkers (AUDIT score 16-19) were to be offered one to four EBI sessions instead of longer-term treatment.
The researcher undertook analysis of data relating to HAGA’s EBI client cohort (January-March 2011), conducted semi-structured interviews with members of this cohort, and sought commissioner perspectives on EBI through an online questionnaire
During the period under analysis, twelve individuals were allocated as EBI clients; of which 75% (n=9) received EBI. All twelve clients were approached to take part in semi-structured interviews and 41.67% (n=5) took part; of which 80% had received EBI. The interviews explored client’s experiences of EBI, and the advantages and disadvantages of alcohol services providing EBI.
At follow-up, all EBI clients had improved AUDIT and TOPS scores, which while subject to biasing effects, were not negligible. There was a 53.6% reduction in the mean TOPS drinking days over the last month from entry to follow-up. This is a substantial short-term change in cohort drinking levels. 100% of EBI clients reported either sustained abstinence or controlled drinking.
Commissioning leads were not so much interested in debates around terminology but rather driven by a perceived need to fill an identified gap in provision for Higher Risk and motivated High Risk drinkers with EBI (or other BT modalities).
The provision of EBI as a form of BT in a specialist service appears to have met the needs of the majority (80% n=4)) of the follow-up cohort assessed here. The findings of this study further support the idea that local alcohol services should integrate EBI (and/or other BT modalities) into their service provision. In order to reach those individuals put off by the stigma of attending an alcohol service and less motivated to seek treatment, commissioners should seriously consider specialist-led EBI satellites in primary care and other settings.
A large-scale longitudinal study of the short- and long-term outcomes for treatment-seeking Higher Risk and suitable High Risk drinkers allocated to three different study groups who would either receive EBI as BT in an alcohol setting, receive EBI from a specialist in a primary care setting, or remain in primary care and receive no support (or only BA) would test these recommendations.
Why an IBA blog?
9 AprI have thought long and hard about whether to do this blog. My main reservation was that it may be duplicating existing web resources, but overall I think there is room for a blog that highlights new ideas and relevant updates. I hope this blog will attract a range of contributions and prove of value as a simple space largely aimed to support those delivering IBA.
Another decision I wrestled with was whether to use ‘Identification and Brief Advice’ (IBA) or Screening and Brief Interventions (SBI) terminology. Actually, I lean towards SBI for a number of reasons, namely its used by NICE and has a longer history. However in my experience, it seems IBA now has a wider recognition outside the research field. The Department of Health coined IBA, along with the ‘risk’ terminology and so I wanted to keep the language as consistent as possible for the target audience of this blog.
In defence of IBA, I would also back this as applying to the simpler form or simple ‘brief advice’, not lasting much more than 5 minutes at the most. ‘Brief intervention’ however covers a wider range of approaches including longer lifestyle counselling or ‘brief motivational interviewing’ approaches. Following the release of the recent SIPS trial findings, we know that overall shorter approaches are in most cases as effective as longer interventions. For this reason, emphasising IBA as a short but effective brief intervention approach seems pragmatic to me.
See here for a paper on ‘Clarifying brief interventions’ or here for further links.
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Tags: alcohol, IBA