Reimagining brief interventions for alcohol: towards a paradigm fit for the twenty first century?
Open Access
- 29 June 2021
- journal article
- editorial
- Published by Springer Science and Business Media LLC in Addiction Science & Clinical Practice
- Vol. 16 (1), 1-10
- https://doi.org/10.1186/s13722-021-00250-w
Abstract
Background: There is no longer support for the idea that brief intervention programmes alone can contribute meaningfully to the improvement of population health relating to alcohol. As a result, calls for major innovations and paradigm shifts grow, notably among research leaders. Main text: This paper briefly examines the history of the development of the evidence-base from the landmark World Health Organisation projects on Screening and Brief Intervention (SBI) in the 1980s onwards. Particular attention is given to weaknesses in the theorisation of social influence and interventions design, and declining effect sizes over time. Although the old SBI paradigm may be exhausted where it has been applied, it has not been replaced by a new paradigm. Alcohol marketing encourages heavy drinking and today may have more powerful effects on thinking about alcohol, and about alcohol problems, than previously. The nature of the societal challenge being faced in an alcogenic environment in which alcohol is widely promoted and weakly regulated underpins consideration of the possibilities for contemporary evidence-informed public health responses. Evidence-informed perspectives in discourses on alcohol problems need to be strengthened in redeveloping rationales for brief interventions. This process needs to move away from sole reliance on a model based on a two-person discussion of alcohol, which is divorced from wider concerns the person may have. Reimagining the nature of brief interventions involves incorporating digital content, emphasising meso-level social processes based on material that people want to share, and seeking synergies with macro-level population and media issues, including alcohol policy measures. Conclusions: Current versions of brief interventions may be simply too weak to contend with the pressures of an alcogenic environment. A new generation of brief interventions could have a key role to play in developing multi-level responses to the problems caused by alcohol.Keywords
Funding Information
- Wellcome Trust (200321/Z/15/Z)
This publication has 52 references indexed in Scilit:
- Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: a cluster randomised trialBMJ, 2013
- Can screening and brief intervention lead to population-level reductions in alcohol-related harm?Addiction Science & Clinical Practice, 2012
- Is alcohol dependence best viewed as a chronic relapsing disorder?Addiction, 2011
- Brief interventions in routine health care: a population‐based study of conversations about alcohol in SwedenAddiction, 2011
- Addiction and personal responsibility as solutions to the contradictions of neoliberal consumerismCritical Public Health, 2011
- Alcohol screening and brief intervention in primary care: Absence of evidence for efficacy in people with dependence or very heavy drinkingDrug and Alcohol Review, 2010
- Toward a theory of motivational interviewing.American Psychologist, 2009
- Stigma, social inequality and alcohol and drug useDrug and Alcohol Review, 2005
- Early Intervention Among Excessive Drinkers: How Early and in What Context?Australian Drug and Alcohol Review, 1987
- Alcohol‐Related Problems in the Primary Health Care Setting: a review of early intervention strategiesBritish Journal of Addiction, 1986