Early Intervention for Harmful Alcohol Consumption: the WHO Collaborative Study

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Abstract
There is growing evidence that treatment for persons with a drinking problem is more effective when it is provided at an early stage than if delayed until dependence has become established and disability severe. There are two essential components in any early intervention programme — a simple, but valid, procedure to detect persons drinking harmfully and a brief, systematic form of therapy that can be delivered by non‐specialist health professionals in a variety of health care settings. The WHO Collaborative Study was established to develop a suitable screening procedure and to evaluate various forms of brief therapy. A ten item “core” questionnaire has been developed by selecting the most representative questions contained within a comprehensive assessment schedule which was administered to non‐alcoholic drinkers recruited in six centres in both the developed and developing worlds. The questions selected relate to the quantity and frequency of drinking, alcohol dependence and alcohol‐related problems including psychological reactions to drinking. Questions on past medical history and current symptoms and findings on physical examination were excluded from the instrument because of their low correlation with alcohol intake. The instrument has high sensitivity and specificity and is easy to administer and to score. A second “clinical screening procedure” has been devised which includes non‐alcohol specific questions, clinical examination findings and a blood test. Three different types of brief therapy are currently being evaluated in 11 centres in a controlled clinical trial. In our own centre 1,000 subjects attending a variety of health care facilities and whose drinking places them at risk of harm are randomised to receive brief advice, counselling in problem solving strategies, counselling together with diary monitoring and feedback of laboratory results, or no therapy. Subjects are assessed up to 12 months by independent interviewers.