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 B1 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 aims 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 score in at-risk zones 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 typically studied screening and brief intervention activities.

This cell is however not about the content of the intervention (for which see cell A1), but about whether its impact depends on the interpersonal style and other features of the person doing the advising – much less commonly researched. In fully-fledged psychotherapy it is well established (see cell B4) that the approach of the person doing the therapy and their ability to forge therapeutic relationships are important influences on outcomes – but is the same true in what are often the fleeting, one-off encounters of brief interventions?

There are reasons to believe this might be the case. Compared to treatment which people often patently need and have sought or at least accepted, in brief interventions there is an added dimension. For a population-level impact, a high proportion of risky-drinkers must be reached. Since by definition the impetus to engage in screening and intervention does not come from the risky drinker, it must come from the practitioner, who needs to have the opportunity, rationale and motivation to prioritise screening and to carve out the time to advise risky drinkers – even if this is not their main role or their or the drinker’s priority. A briefing based on a conference held in England in 2015 needed no convincing: “ultimately quality [alcohol identification and brief advice] comes down to the beliefs, motivations and skills of the practitioner”. They were not alone: in 2016 south London’s Health Innovation Network asserted that, “Central to quality assurance and improvement of the [alcohol identification and brief advice] pathway are the frontline staff delivering the service,” and in particular “the relationship between the individual and the staff member delivering [identification and brief advice]”.