Brief intervention content matters

Brief intervention content mattersFor more than 30 years, there have been concerted efforts internationally to develop the evidence base for brief interventions in general practice [1].The choice of this setting reflected strategic judgements about where in health systems heavy drinking and alcohol problems were likely to be most encountered and thus where these interventions may be optimally delivered.This literature is usually interpreted along the lines that efficacy is now well established in general practice and that there is a need to extend study to new settings [2,3].This year has seen the publication of two large general practice cluster randomised effectiveness trials that in different ways draw attention to a crucial limitation of the evidence base in this setting; the lack of welldeveloped study of intervention content.Although both undertaken in the UK, they are likely to be seen internationally as important studies.The three-arm Screening and Intervention Programme for Sensible drinking (SIPS) trial compared a leaflet control condition against the same leaflet plus five minutes advice and the addition subsequently of 20 minutes counselling [4].Preventing disease through opportunistic, rapid engagement by primary care teams using behaviour change counselling (PRE-EMPT) compared training practitioners to address behaviour change for the big four key lifestyle risk factors (diet, exercise, smoking and alcohol) versus delayed training, thus entailing a non-intervention control condition [5].Both trials found no differences in alcohol outcomes for hazardous and harmful drinkers over a 12-month study period following interventions delivery by general practitioners and practice nurses.The authors of these studies identify contrary implications for practice from these null findings.The SIPS authors conclude that the control condition: 'screening followed by simple feedback and written information may be the most appropriate strategy to reduce hazardous and harmful drinking in primary care ' [4].One commentator, however, is concerned that this provides: 'false reassurance that we have taken care of unhealthy alcohol use and will waste time and money' [6] by delivering more time consuming interventions.In contrast, the PRE-EMPT authors, including myself, conclude that: 'enduring behaviour change and improvements on biochemical and biometric measures are unlikely after a single routine consultation with a bs_bs_banner