INEBRIA 2012: research into practice?

8 Oct

INEBRIA is the International Network for Brief Interventions for Alcohol and Other Drugs. The 2012 conference was held in Barcelona on 27th and 28th September 2012.

This year I attended my first INEBRIA conference which was an overwhelmingly positive experience. The breadth of presentations, posters, and leading international experts available to talk to was inspiring. Of course much of it was focused on the latest research – to a non-academic this often leaves one constantly asking the question “How does this influence what happens in real world?”.

My primary interest is the delivery of brief intervention across England, so the 2012 conference title ‘From clinical practice to public health’ was fitting. Of course research is crucial in both understanding what brief intervention in practice should look like, and how or in which settings it should be delivered. Here I reflect broadly on some of the challenges in achieving this as I see them within the international brief intervention agenda.

Terminology

The most apparent issue is – as would expected – variations in language. The number of Three Letter Acronyms (TLAs) for brief interventions can’t be a good thing, let alone addressing the terminology around alcohol misuse categories.

The most common TLA seems to be SBI – Screening and Brief Intervention. Yet in England this has largely been superseded by IBA (Identification and Brief Advice) outside of academic circles. This is of not without contention!

In Scotland, ABI (Alcohol Brief Intervention) dominates. In the US, SBI often becomes SBIRT to acknowledge the ‘Referral to Treatment’ option. The expert Richard Saitz however argued convincingly that Referral to Treatment is inherently part of SBI, so should not be an extended part of the acronym – it may incorrectly suggest referral as the main or only goal of SBI.

I won’t go on to name all the other combinations describing brief interventions and variations, but one must consider that these variations probably aren’t helping efforts to make a coherent argument about the need for implementation.

The complexity of research outside of academia

Randomized Controlled Trials, P-values, statistical significance? Not being a researcher, I’ve certainly struggled to come to terms with some of the fundamentals of research programmes. It’s fascinating stuff, though undoubtedly a complex area in which most policy makers and implementers don’t have the time or background to delve to deeply into. Of course there are some excellent organisations and resources to try to distil and disseminate key research findings – but sometimes I’m left feeling these are not nearly well enough equipped to do justice to the amount of research and the need to distil and disseminate it.

Brief interventions: under- or over-researched?

One comment was made that many policy leads in England believe there has been ‘too much research into brief interventions’. Over-simplified, there is a belief amongst some that ‘we know IBA/SBI works, so why do we need more research’?  Whilst this may be true to a degree in terms of Primary Care (though even this is contested), this overlooks two key issues:

  1. Does the largely Primary Care based brief intervention research mean that we should pursue implementation across a far wider range of settings?
  2. Do we have enough understanding of many of the more complex aspects of brief intervention, including why it works and therefore what the most effective delivery approaches are?

With regard to the first issue, it seems logical to assume that the same processes of behaviour change work for at-risk drinkers in general, therefore brief intervention should be effective in any setting where it is feasibly delivered. And there is of course a growing evidence base for many of these other settings. Further to this, the ‘precautionary principle’ seems to me a strong rationale for extending implementation to other settings – that is where there is good reason to expect potential benefit, activity may be justified on the basis that it would be unethical to deprive people of the chance to benefit.

Implementation: the universal challenge?

One thing I picked up on this year is that England is absolutely not alone in its challenge to implement routine brief intervention effectively. “Effectively” is crucial here as, although we may have an increasing level of alcohol screening/identification activity in England, this seems to fall a long way short of reaching even the simplest ‘brief intervention’ mark in many cases. But we are not alone, nor is this a new challenge as longer standing INEBRIA members assure me!

New technologies?

Some excellent discussions and presentations focussed on the unavoidable question of new technologies in the delivery of brief intervention. A growing evidence base seems to suggest that in certain contexts, electronic screening or even brief advice/information can be effective. Yet the pace of technological advancement and increasing abundance of apps, online portals and other new technologies poses lots of questions. Certainly the brief intervention agenda will not be able to afford to ignore the big technology opportunities – and challenges.

Brief Interventions: not just for alcohol?

Another challenging but also exciting issue is the one of alcohol specific Vs other approaches to brief intervention, including other lifestyle areas and drug use. Clearly these are universal behaviour change problems, with behaviours of smoking, drug use, diet and exercise often inter-linked with alcohol use. As with new technologies, there are clear gains and opportunities through embracing such approaches, but so too are there many cases where good old face-to-face alcohol specific brief intervention is required.

So what about the answers?

Soon the wealth of INEBRIA 2012 presentations will be available which we will highlight here. Many of these cover research or forthcoming projects which aim to directly address these issues. Please leave any comments or suggestions you may have, and perhaps see you in Rome for INEBRIA 2013!

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