The SIPS alcohol screening and brief intervention (ASBI) research programme was funded by the UK Department of Health in 2006 as part of the national Alcohol Harm Reduction Strategy for England. The programme comprised three cluster randomised controlled trials of different methods of screening and brief intervention across three settings: Primary Health Care, Emergency Departments, and Probation Services. The three trials had a similar design to allow comparisons across settings. The main aims of the programme were to evaluate the effectiveness and cost effectiveness of different methods of screening and brief interventions for alcohol misuse and to assess the feasibility of, and factors promoting or inhibiting, implementation in the typical practice setting.
The whole programme of research has taken just over three years to complete (including a 13-month data collection period and follow-ups at 6 and 12 months post recruitment). It has taken place across 9 Emergency Departments, 29 GP surgeries and 20 Probation Offices across three regions (London, South East and North East of England). We have involved and trained 670 members of staff across all these settings. During the 13-month data collection period we screened 10,530 patients and recruited 2,481 into the study, making it the largest alcohol screening and brief intervention study so far conducted in the UK.
The programme has addressed key gaps in the current evidence base on screening and brief intervention and our findings will guide further developments in the field and local, national and international implementation of alcohol screening and brief intervention.
Primary Health Care (PHC) study
The Primary Health Care (PHC) study uses a pragmatic nested factorial design including a cluster randomised element to evaluate the implementation, effectiveness and cost effectiveness of different models of alcohol screening and brief intervention piloted in 24 typical primary health care practices in three English regions. The study will test three models of implementation: a control group receiving a patient information leaflet (PIL), brief advice (BA) provided by PHC staff plus PIL, and brief lifestyle counselling (BLC) provided by PHC staff plus BA and PIL. Two screening approaches (targeted vs universal) and two screening tools of different complexity will be compared (FAST and M-SASQ). 744 hazardous or harmful drinking patients will be recruited for the study (31 per PHC). PHC study outcomes will include measures of implementation, attitudinal and organisational predictors of implementation, and patient outcomes, which will include drinking behaviour, alcohol related problems, quality of life and health economic outcomes. The PHC study is designed to answer key policy questions concerning the implementation of screening and brief intervention in PHC. (ISRCTN06145674).
Accident and Emergency Department (AED) study
The Accident and Emergency Department (AED) study also employs a cluster randomised and nested factorial design to test the impact and cost effectiveness of implementing three models of screening and brief intervention piloted in nine AEDs in the same three regions as the PHC study. The study will compare three conditions: a control group receiving a patient information leaflet (PIL); AED staff trained to provide brief advice with hazardous and harmful drinkers attending AED plus PIL; and AED staff trained to screen and refer to an alcohol health worker who will carry out brief lifestyle counselling plus BA and PIL. The AED study will also compare targeted and universal screening approaches. However, due to the limited number of AEDs in the North East and the anticipated difficulties in finding 18 sites needed to have the same design as in the PHC study, a slightly different study design has been planned. Six AEDs across the three regions will be randomly allocated to universally screen, collect information about whether a patient would be part of a linked (targeted) presentation group and subsequently use statistical simulations to analyse the interactions and devise the optimal targeted screening strategy using these tools. Three further AEDs will be randomly allocated to carry out targeted screening using the Paddington Alcohol Test (PAT) which is the purpose and method the PAT was designed for. Thus we will be able to compare the efficacy of targeted and universal screening. 1179 subjects will be recruited (131 per AED). Study outcome measures will be the same as in the PHC study yielding important information on the effectiveness and cost effectiveness of different implementation approaches to guide implementation in AEDs nationally. (ISRCTN93681536).
Criminal Justice Study (CJS)
The Criminal Justice Study (CJS) will compare the relative effectiveness of two screening tools and three forms of intervention of different intensity and duration.
Overall 96 Offender Managers from nine probation offices across three English regions (London and the South East Regions (n=5), North East Region (n=4)) will be recruited.
In London and the South East Regions it is likely that the five offices will be situated in the London boroughs of Brent, Enfield, Lambeth and Southwark and in Winchester. Within each office approximately 10-11 Offender Managers will each need to recruit five offenders to the study during a nine month period.
In the North East it is likely that the four offices will be situated in Darlington/Durham, Newcastle, Northumberland and South of the Tyne. Within each office approximately 10-11 Offender Managers will each need to recruit five offenders to the study during a nine month period.
Offender Managers will be fully trained during a 2-3 hour training session by the research team and the experienced alcohol health workers and will also receive ongoing support during the time of the project.
The 96 Offender Managers will be randomly allocated to screen for alcohol use disorders on their caseload using a short screening questionnaire (either the Fast Alcohol Screening Test (FAST) or the Modified Single Alcohol Screening Question (M-SASQ) and to deliver one of three intervention conditions:
- 1. A client information leaflet control condition (n=32 Offender Managers)
- 2. 5 minute simple structured advice (n=32)
- 3. 20 minute brief lifestyle counselling delivered by an Alcohol Health Worker (n=32).
When a client screens positive, the OM will invite them to participate in the research and ask them to complete a short questionnaire before they receive the intervention. They will receive a £10 voucher for taking part in the research. All offenders will then be contacted via telephone by research staff in six months time, who will administer the same questionnaire. They will receive another £10 for doing this.
Overall, the six-month follow up will provide important information on the effectiveness and cost effectiveness of screening and brief intervention for alcohol use disorders in probation. We will also look at OMs and clients views about the appropriateness and acceptability screening and intervention, and examine the staff and organisational factors associated with successful implementation. (ISRCTN19160244).
- Modified-Single Alcohol Screening Question (M-SASQ)
- Fast Alcohol Screening Test (FAST)
- SIPS Paddington Alcohol Test (SIPS-PAT)
Frequently Asked Questions (FAQs)
Professor Colin Drummond, King's College London