Armed forces deploy brief interventions: will it work?

25 Aug

This post originally appeared on Alcohol Policy UK. Ministry of Defence (MoD) have released figures on an initiative to deliver alcohol brief interventions across the armed forces via dental check ups, identifying 61% of military personnel drinking at a risky or harmful levels.

The MoD has previously come under fire over a lack of action to address high levels of alcohol misuse amongst the armed forces. In 2015 Professor Neil Greenberg, lead on military health at the Royal College of Psychiatrists and a former Navy Commander, said an approach based education alone was not effective. Subsequently an MoD alcohol working group was instigated to “review policy and data to identify what more we can do to tackle alcohol misuse in the armed forces”.

Alcohol brief interventions (ABI), often referred to as Identification and Brief Advice (IBA) in England, have been increasingly sought as a strategy to promote behaviour change amongst at-risk drinkers, as advised by NICE and national health bodies. Much debate has been had though over how and where they should be delivered, with question marks over to what extent various national and local efforts may have been successful.

The MoD report highlights Armed Forces personnel are expected to attend a dental inspection between every 6 to 24 months, therefore presenting an opportunity to deliver ABI to the whole workforce. The initiative used AUDIT-C, a 3 item assessment tool utilising the first three questions of the full AUDIT. Scores of 5 or above on the AUDIT-C indicate a level of risk and/or harm, though it is considered less effective at distinguishing different levels of risk or probable dependence in comparison with the full AUDIT.

The MoD sought to offer all personnel with a score of 1+ (any level of drinking) an alcohol advice leaflet, reporting 80% (n = 80,662) as receiving one. Of the 61% personnel who scored 5-12 on the AUDIT-C, 63% (n = 42,074) were given an ‘Alcohol Brief Intervention’ (ABI), though the report states it is ‘not currently possible to measure how many of these ABIs have been delivered’. Indeed a key question for all ABI initiatives has been to what extent the reported interventions have been delivered, particularly in view of time time limitations and other issues such as a lack of training.

For those scoring 10-12 on the AUDIT-C, a total of 2% (n = 2,502), the MOD states personnel should have also been ‘advised on the importance of seeking further advice from their GP or a local alcohol support service’ in addition to the ABI. Overall, higher alcohol risk levels were associated with being young and single, being of more junior rank and being of white ethnicity, with navy personnel indicating the highest AUDIT-C scores. MoD ABI fig

Will dental ABIs reduce alcohol misuse in the military?

The report states the MoD is undertaking other initiatives to reduce alcohol misuse, including ABI beyond its dental settings. Measuring the specific impacts of such schemes is notably difficult, though having such data on the levels of alcohol misuse may prove useful data for any future evaluation. However as with wider debates over approaches to reduce alcohol misuse, researchers tend to highlight the need for ‘multi-component’ programmes and supply side controls rather than relying on single initiatives to have a sustained impact.

The MoD’s alcohol working group is likely to face many specific challenges in shifting what MPs have described as a heavy drinking culture within the armed forces. The availability of subsidised alcohol, attitudes and expectations of personnel towards alcohol and the many other complex factors influencing health and wellbeing are all likely to play important roles in seeking such changes. Observers may see a committent to ABIs as welcome, but will hope that they are not relied upon as the sole strategy for addressing alcohol misuse in the military services.

See the MoD report here, or a 2013 letter in The BMJ’s Journal of the Royal Army Medical Corps and a 2011 report on ‘Alcohol use and misuse within the military: A review’ [pdf].

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