Screening and Early Intervention Strategies for Harmful Drinkers: Initial Lessons from the Amethyst Project

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Abstract
This paper reviews recent advances in the secondary prevention of alcohol‐related problems. Demonstration projects, clinical trials and early identification programs are discussed. Special emphasis is given to theoretical assumptions, intervention strategies and barriers to implementation in the primary care setting. Common features of these programs include their low cost, minimal demands on health professionals' time and resources, emphasis on self‐help and behavioural self‐management strategies, and their apparent effectiveness in reducing hazardous drinking. The final part of this paper illustrates this new approach to secondary prevention by describing the design and initial implementation of the ‘Amethyst’ Project, a multinational field trial of early intervention strategies sponsored by the World Health Organization. It is concluded that while secondary prevention of alcohol‐related problems is still in its early stages, the promising initial findings warrant a more systematic effort to evaluate the cross‐national generalizability of early intervention strategies in primary care settings.