Effects Of A National Program To Encourage Alcohol Screening And Brief Intervention

Screening and brief intervention (SBI) for unhealthy alcohol use is recommended in primary care, but implementation has been limited. From 2004 to 2010, Sweden executed a national program of capacity-building and workshops to encourage primary care and occupational health services to perform alcohol SBI. Using data from a public health survey conducted every 4 years since 2000 in Uppsala County among 18-84 year-olds, researchers evaluated to what extent people in contact with a health care provider (GP or hospital) reported having received alcohol SBI.

• Between 2004 and 2012, the prevalence of being asked about alcohol use doubled (from 13% to 32%) for patients visiting a GP or hospital. The prevalence of being advised on alcohol consumption increased from 3% to 4%.
• Receiving screening was associated with male gender, younger age, being overweight (BMI >30), and smoking, but not with AUDIT-C score, indicating that screening was independent of drinking levels.
• Receiving advice was associated with AUDIT-C score: those reporting more use were more likely to receive advice. Receiving advice was also associated with male gender, smoking, and report of psychological distress.
• Being advised increased the likelihood of wanting to cut down on alcohol consumption.
• There were no population-level effects on consumption.

Comments: Despite recommendations, screening was far from universal, so the absence of population-level effects is not surprising. Some groups (women, older individuals) were less likely to be screened, suggesting that clinicians targeted specific population groups. Nevertheless, programs like this may play an important role in decreasing unhealthy alcohol use.

Nicolas Bertholet, MD, MSc

Reference: Lundin A, Danielsson AK, Hallgren M, Torgén M. Effect of screening and advising on alcohol habits in Sweden: a repeated population survey following nationwide implementation of screening and brief intervention. Alcohol Alcohol. 2017;52(2):190–196.