INTRODUCTION TO THE CONFERENCE: BREAKING NEW GROUND IN THE STUDY AND PRACTICE OF ALCOHOL BRIEF INTERVENTIONS Nick Heather PhD, Northumbria University Presentation at INEBRIA2009, Newcastle/Gateshead, UK 8/10/09

CURRENT SITUATION: The upside Good evidence for the effectiveness of alcohol SBI, especially in primary health care Increasing acceptance of the major contribution SBI can make to reducing alcohol-related harm Growing interest by governments around the world in the potential of SBI as an effective and cost-effective policy against alcohol-related harm Also, possibly in A&E and in higher educational settings. In scientific community. We’ve won scientific debate. Particularly true in UK.

CURRENT SITUATION: The downside A necessary focus on testing the effectiveness of SBI has led to neglect of other important questions Too much emphasis on meta-analysis? Risk of complacency? Self-evident. Meta-analysis stops us thinking. Also, hasn’t resolved important issues, eg gender differences in response to BI. Eg, still considerable problems in implementing – persuading generalists to routinise SBI.

SPECIAL TOPICS (1) the theory of brief interventions; development and applications of SBI in the criminal justice setting: brief interventions and the Internet; development, evaluation and implementation of SBI among young people; application of SBI to black and minority ethnic groups; Will return to this. Illustrated at this conference by Keynote address and by parallel session. Special symposium at the conference. Parallel session Part of a parallel session on this and will probably be mentioned at times in the conference.

SPECIAL TOPICS (2) optimal forms of screening in various medical and nonmedical settings; innovative ways of encouraging health professionals to incorporate SBI in their routine work; effective strategies for achieving integration of SBI in government policies; applications of SBI in parts of the world where it has yet to make much impact. 6) Parallel session 7) 2 parallel sessions on this. 8) PA will over this in his plenary talk. 9) This covered by international representation at the conference, though still much room for expansion.

HOW MANY FORMS OF BI ARE THERE? Brief advice (+FRAMES) vs. motivational interviewing But do they have different effects? If so, does motivational interviewing add to the effects of brief advice? If so, with whom and under what circumstances? These 2 forms come out of 2 traditions. MI has now replaced condensed CBT as more theoretically-derived form. Simply, is it worth making this distinction? Conflicting findings in literature over whether “counselling” adds anything to brief advice. 4) ie, what kinds of client, what kinds of setting, degree of training needed, etc.

WHAT ARE THE LIMITS OF BI Dichotomy of “dependent” vs. “non-dependent” unhelpful At what point along the continuum of dependence and/or problem severity does BI become practically ineffective? Is the dependence the only, or even the main factor determining the limit of BI effectiveness? Those who know me will have heard this many times. For one thing, nearly all those in the “non-dependent” category would score positively on a dependence measurement instrument. Maybe SIPS results will throw light on this, as well as study being conducted in Liverpool in general hospital wards. Dependence may not be that important, compared eg with “social capital” and motivation. It would be foolish to expect thatBI would be effective across the entire range of alcohol problems but equally foolish to prematurely restrict its application to just those with minor problems.

HOW FAR CAN EVIDENCE OF BI EFFECTIVENESS BE GENERALISED? Good evidence for effectiveness in primary health care (brief advice) and in higher educational settings (motivational interviewing) But can this evidence be used to justify implementation on other settings? NB. The extended precautionary principle At least in those settings. An issue that has cropped up in relation to NICE guidance on SBI. Are haz & harmful drinkers roughly the same wherever found? Explain.

HOW DO BRIEF INTERVENTIONS WORK? By increasing the number who try to cut down (without necessarily increasing the effectiveness of change attempts)? Or by increasing the success rate among those who do try? Theoretical bases: Stages of change (Prochaska & DiClemente); Outcome and/or efficacy expectancies (Bandura); Cognitive dissonance (Festinger); Self-affirmation (Harris). More research needed!!! 1) I mentioned all this in the 1st INEBRIA meeting in Barcelona in 2004 but no progress as far as I can see. And not much interest either.