The Alcohol Treatment Matrix is concerned with the treatment of alcohol-related problems among adults (another deals with drug-related problems). It maps the treatment universe and for each sub-territory (a cell) lists the most important UK-relevant research and guidance. Across the top, columns move from specific interventions through how their impacts are affected by the widening contexts of practitioners, management, the organisation, and whole local area treatment systems. Down the rows are the major intervention types implemented at these levels. Inside each cell is our pick of the most important documents relevant to the impact of that intervention type at that contextual level.

What is cell A1 about?

In contrast to treatment, screening and brief interventions are usually seen as public health measures. Rather than narrowing in on dependent individuals or just those seeking help, the aim is to reduce alcohol-related harm across a whole population including those unaware of or unconcerned about their risky drinking. Screening programmes aim to spot drinkers at risk of or already experiencing alcohol-related harm while for some other purpose they come in contact with services whose primary remit is not substance use. In studies the typical response to those who seem at risk is from five minutes to half an hour of advice, counselling and/or information aiming to moderate their drinking or its consequences, delivered not by alcohol specialists, but by the worker the drinker came into contact with – the ‘brief intervention’. Click here for more on what screening and brief interventions typically consist of. 

The thinking is that by reaching many millions of low-risk drinkers, small risk reductions achieved by broadly implemented, resource-light interventions could contribute at least as much to improving public health as tackling the greater risks faced by the far fewer drinkers with more extreme and obvious problems. For a population-level impact, a high proportion of risky-drinkers must be reached. In the UK, GPs’ surgeries are the principal venue, but programmes are also mounted in other medical settings such as emergency departments and sexual health clinics, on inpatient wards, at antenatal clinics, as well as in non-medical settings such as criminal justice, social care, community and housing services. 

The effectiveness of structured, research-developed brief interventions has become accepted to the degree that they are now embedded in UK policy and even if imperfectly and patchily, also in practice. This cell redresses the balance by giving you reasons to reconsider that acceptance, whilst acknowledging that there have been positive findings and that studies of the kind available to us can only raise doubts over effectiveness, not definitively prove ineffectiveness. Even if they could, their findings are not an argument for failing to check on patients’ drinking (especially when this is potentially relevant to their health) and responding to risky drinking with usual medical care including individualised advice, information and follow-up, and where this seems warranted, with a more structured and extended response.