Cited by 93Substance Abuse Treatment and OutcomesAlcohol Consumption and Health EffectsBehavioral Health and Interventions

Effectiveness and cost-effectiveness of a stepped care intervention for alcohol use disorders in primary care: pilot study

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Drummond, Colin, Coulton, Simon, James, Darren, Godfrey, Christine, Parrott, Steve, Baxter, John, Ford, David, Lervy, Bruce +3 more·2009·British Journal of Psychiatry

Abstract

Background: Screening for alcohol use disorders identifies a wide range of needs, varying from hazardous and harmful drinking to alcohol dependence. Stepped care offers a potentially resource-efficient way of meeting these needs, but requires evaluation in a randomised controlled trial. Aims: To evaluate the feasibility, effectiveness and cost-effectiveness of opportunistic screening and a stepped care intervention in primary care. Method: A total of 1794 male primary care attendees at six practices in South Wales were screened using the Alcohol Use Disorders Identification Test (AUDIT). Of these, 112 participants who scored 8 or more on the AUDIT and who consented to enter the study were randomised to receive either 5 minutes of minimal intervention delivered by a practice nurse (control group) or stepped care intervention consisting of three successive steps (intervention group): a single session of behaviour change counselling delivered by a practice nurse; four 50-minute sessions of motivational enhancement therapy delivered by a trained alcohol counsellor; and referral to a community alcohol treatment agency. Results: Both groups reduced alcohol consumption 6 months after randomisation with a greater, although not significant, improvement for the stepped care intervention. Motivation to change was greater following the stepped care intervention. The stepped care intervention resulted in greater cost savings compared with the minimal intervention. Conclusions: Stepped care was feasible to implement in the primary care setting and resulted in greater cost savings compared with minimal intervention.

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  • In five studies, there were unexplained differences between losses to follow-up in the intervention and control arms.

    “There were unexplained differences between losses to follow-up in the intervention and control arms in five studies (D'Amico 2008;Drummond 2009;Ettner 2014;Fleming 1997;Moore 2011).”

    From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Drummond 2009

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Research works printed but not linked: 3

  1. [9]9. Bertholet N, Daeppen JB, Wietlisbach V, Fleming M, Burnand B. Brief alcohol intervention in primary care: systematic review and meta-analysis. Arch Intern Med 2005; 165: 986-95.
  2. [22]22. Wallace P, Cutler S, Haines A. Randomized controlled trial of general practitioner intervention with excessive alcohol consumption. BMJ 1988; 297: 663-8.
  3. [43]43. Saitz R. Alcohol screening as good as other recommended screens (eLetter). BMJ 2003; 28 September (http://www.bmj.com/cgi/eletters/327/7414/ 536g37131).

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Authors
Drummond, C., Coulton, S., James, D., Godfrey, C., Parrott, S., Baxter, J., Ford, D., Lervy, B., Rollnick, S., Russell, I., & Peters, T.
Affiliations
  • King's College London (GB)
  • University of Kent (GB)
  • Whitchurch Hospital (GB)
  • University of York (GB)
  • Swansea University (GB)
  • University of Wales (GB)
  • Bangor University (GB)
Corresponding author
Drummond, Colin
Venue
British Journal of Psychiatry
Published
2009-11
Volume
195
Issue
5
Pages
448-456
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
OpenAlex
W2127930525
Cited by
93
References
44
Citations by year
2026: 2 · 2025: 4 · 2024: 1 · 2023: 5 · 2022: 1 · 2021: 4 · 2020: 14 · 2019: 3 · 2018: 6 · 2017: 5 · 2016: 6 · 2015: 3 · 2014: 9 · 2013: 7 · 2012: 10
FWCI
5.15
Type
journal article
Language
en
Open access
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
  • Kent Academic Repository (University of Kent) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion)
Funders
King's College London
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords
stepped care, alcoholism, alcohol screening, auditing, motivational enhancement therapy, behavior change counseling, primary care, cost-effectiveness, alcohol consumption, male patients, feasibility
MeSH terms
Adult, Community Mental Health Services, Cost-Benefit Analysis, Epidemiologic Methods, Humans, Male, Primary Health Care, Quality of Life, Wales, Treatment Outcome, Health Care Costs, Alcohol-Related Disorders

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