Primary prevention
Your Organisational Guidance
ebpracticenet urges you to prioritise the following organisational guidance:
Alcoholmisbruik bij jongerenPublished by: Federaal Wetenschapsbeleid (Belspo)Last published: 2015Alcoholmisbruik bij jongerenPublished by: Federaal Wetenschapsbeleid (Belspo)Last published: 2015Routine screening in primary care settings leading to early intervention has demonstrated efficacy in reducing alcohol use and related consequences.[28] One study analysed data from a large healthcare system where screening, brief intervention, and referral for treatment (SBIRT) was systematically implemented in primary care (2014-2017).[29] Over 300,000 patients screened positive, and subsequent brief intervention was associated with significant reductions in the number of drinking days and drinks consumed. The intervention was most effective in younger adults and those with at-risk drinking but without alcohol use disorder. Electronic screening and brief intervention (e.g., smartphone, internet) has also been demonstrated to reduce alcohol use up to 12 months post-intervention.[30]
An increasing body of evidence has investigated the effect of digital interventions on alcohol use among young people, in particular. Numerous studies indicate that brief, computer and internet-based interventions may reduce alcohol intake or influence behaviour change in college students.[31][32][33] However, findings are mixed as to whether they are as effective as in-person, brief interventions in these populations.[31][34] In one randomised controlled trial of university students with self-reported unhealthy alcohol use, smartphone applications were effective in reducing alcohol intake, including heavy drinking, throughout 12-month follow-up.[35]
In adolescents, family interventions have a small but consistent and lasting effect in reducing alcohol initiation and frequency of alcohol use.[36]
The International Alcohol Control (IAC) policy index was developed to provide a benchmarking tool by which to assess countries on their alcohol policies. It includes four domains determined to have the greatest effect on per capita alcohol consumption and alcohol-related harms: alcohol pricing (e.g., excise taxes), availability (e.g., hours of sale, outlet density), marketing (e.g., advertising, promotions) and drink-driving legislation.[37] Study of 10 diverse, high- and middle-income countries showed that volume and frequency of alcohol consumption decreased with higher IAC index score, particularly among young adults (aged 18-24 years) and people of lower educational status.[38] These policies can, therefore, influence sociodemographic groups that experience a high burden of alcohol-related harms. However, the World Health Organization (WHO) reports that they are underutilised. While all countries in the WHO European Region (which has the highest alcohol-attributable mortality) implement alcohol excise taxes, only 11 have minimum unit pricing (MUP) policies in place.[39] Reducing alcohol affordability has demonstrated benefits: MUP introduction in Scotland in 2018 was associated with reduced alcohol-related mortality and hospitalisations over the following 2.5 years (by 13% and 4%, respectively), mainly attributed to effects on chronic outcomes like alcoholic liver disease.[40]
Other global challenges include unregulated alcohol marketing on internet and social media, the availability of remote-ordering, and underutilisation of health warnings on alcohol products.[7]
Secondary prevention
Advise the patient to avoid any identifiable triggers to alcohol use (e.g., drinking friends, drinking locations, activities associated with alcohol use). Encourage involvement with support groups.[42] Alcoholics Anonymous Opens in new window
Ensure that treatment programmes have policies in place that support engagement and retention of patients, such as:[3]
minimised administrative, clinical assessment or test requirements, where possible
flexible appointment and communication systems, use of telehealth and outreach services (e.g., to streets, hospitals, jails)
support systems that address the social and cultural factors influencing alcohol use
non-judgemental response to non-abstinence or return to use.
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