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The Evidence of Effectiveness & Standards for IBA: Hospital & Criminal Justice settings

16 Jul

Further guidance for IBA delivery has been released, outlining the evidence for IBA and minimum standards for delivery in Hospital and Criminal Justice settings.

Download: IBA hospital settings

Guidance for community health settings was also released earlier this year – full report here [pdf].

Although the documents share many of the same sections in terms of explaining IBA and the evidence base, setting specific implications and invest to save rationale are included.

  • Alcohol misuse costs the NHS £3.5 billion per annum; much of this burden is from hospital care.
  • In 2010/2011 there were 1.2 million alcohol-related hospital admissions. This equated to 7% of all hospital admissions and offers a substantial opportunity to intervene.
  • Over 14 million people are treated in ED in England each year. The Department of Health estimates that 35% of ED attendances in the UK are attributable to alcohol, increasing to 70% between midnight and 5am.
  • Almost one third of London fire deaths are alcohol related.
  • 11% of male high blood pressure is alcohol related.
  • Over 4,000 people die each year as a result of alcoholic liver disease.51
  • A National Statistics study found that 27% of people with severe and enduring mental health problems had an AUDIT score of 8 or more in the year before interview, including 14% who were classified as alcohol dependent.IBA Criminal Justice

For Criminal Justice Settings, the rationale for IBA is also convincing:

  • The prevalence of individuals with an alcohol use disorder in the criminal justice setting
    is three times greater than in the general population.
  • As many as 75% of arrestees may be risky drinkers and therefore appropriate for brief advice.
  • In 2010/2011 1.4 million people were arrested in England and Wales highlighting police custody as an effective setting to reach around 3% of the adult population annually.
  • Self-reported associations between drinking alcohol and the offence were identified in two fifths of respondents and for 50% of violent crimes.
  • 47 % of violent crime is believed to be alcohol related.
  • 45% of victims of domestic violence say their attacker had been drinking.
  • The national cost of domestic violence to criminal justice, health, social, housing and legal services as well as the economy amounts to more than £5.7 billion a year.
  • A study of arrestees and offenders who had been given brief advice and treatment in police custody or referred elsewhere identified that 40% of respondents found the advice useful.
  • 74% of probation clients in a study in South London were AUDIT-C positive

The guidance was commissioned by the Safe Sociable London Partnership, a regional body aiming to supports alcohol improvement work in London.

SIPS: largest ever UK study into alcohol brief interventions

15 May

Orginally posted on Alcohol Policy UK:

SipsFindings from the SIPS trial, the largest UK alcohol screening and brief intervention study, have been released.

The study took place across key settings of Primary Care, Emergency Departments and Probation and tested the effectiveness of a range of brief intervention approaches and screening tools. A conference event took place on the 5th of March 2012 to launch the findings, with presentations available to download.

SIPS covered 9 Emergency Departments, 29 GP surgeries and 20 Probation Offices across London, the South East and the North East of England. During the 13-month data collection period 10,530 patients were screened with 2,481 recruited into the study. The trial tested three key ‘brief intervention’ approaches of:

  1. Feedback [of screening result] + Patient Information Leaflet (PIL)
  2. Feedback + five minutes of structured advice using the SIPS brief advice tool + PIL
  3. Feedback + 20 minutes of ‘Brief Lifestyle Counselling’ (BLC) + PIL

For Emergency Departments, the Modified Single Alcohol Screening Question (M-SASQ) was found to be the most efficient and effective screening tool. However successful implementation in EDs required champions and dedicated staff. In terms of results, all three approaches showed positive outcomes on drinking behaviours, with greater effects at 12 than 6 months. However when compared to simple feedback and leaflet, brief structured advice or longer 20 minute lifestyle counselling did not offer any significant advantage in terms of drinking behaviour or alcohol use disorder outcomes. However lifestyle counselling was considered to have a greater cost impact due to greater QALY gains and a greater reduction in societal costs.

In Primary Care settings, the FAST alcohol screening tool was the most efficient and effective screening tool. Successful implementation though required financial incentives, training and ongoing specialist support, though longer lifestyle/extended interventions were harder to implement. All brief intervention approaches resulted in reductions in alcohol use, but when compared to simple feedback and leaflet, brief structured advice or longer 20 minute lifestyle counselling did not offer any significant advantage in terms of drinking behaviour or alcohol use disorder outcomes. Feedback and leaflet was found to be the most cost-effective approach.

In Probation (Criminal Justice) settings, the FAST was also found to be the most effective screening tool. Successful implementation was challenging, requiring managerial support and ongoing specialist input to maintain activity. For ‘increasing risk’ [hazardous drinkers] who scored between 8-15 on the AUDIT, simple feedback and leaflet was as effective as longer interventions or lifestyle counselling. However for ‘higher risk’ [harmful] drinkers scoring 16 or more on the AUDIT, more intensive interventions were beneficial.

See the SIPS website for forthcoming further analysis and details of the SIPS ‘junior’ trial which will explore the impact of brief intervention approaches on young people.