Screening and Brief Interventions for Harmful Alcohol Use — Where To Now?
Dr. Chris Holmwood, Director of Clinical Partnerships at Drug and Alcohol Services South Australia discusses in this perspective article, how Australian’s view alcohol and the need for more support for people with alcohol problems.
Dr. Holmwood stated that most Australians do not see the need for changes in alcohol use and therefore, support for policies to control alcohol use is declining.
Australia’s National Alcohol Strategy advocates for the adoption of alcohol screening, brief intervention and referral for treatment (SBIRT) in primary care. However, there is a lack of evidence that it this supports population level alcohol consumption. Further evidence suggests it does not result in increased engagement in specialist treatment even in well resourced health systems.
According to the author, the Alcohol Use Disorder Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) developed by the World Health Organization (WHO) both explore relevant key areas such as frequency of use, harms and dependence, which are important for the clinician and the patient to understand and address. He suggests these tools should be promoted when a patient is identified as having an alcohol problem. However, expectation that they will reduce population level alcohol use is not evidence backed.
Dr. Holmwood said there should be a renewed emphasis on alcohol as a significant driver of morbidity and mortality at three levels:
- On the clinical level, renewed emphasis on education and training for medical practitioners to enable clinicians to better respond to people with alcohol problems;
- On the health care structural level, changing remuneration arrangements to better support primary care treatment for people with alcohol-related problems should be advocated for; and
- In parallel with these changes, increased advocacy for changes to policies that reduce [alcohol use] and related harms on a population level, with particular emphasis on high risk populations.