The advent of brief interventions represented a radical realignment away from aiming for abstinence among a (relatively) few ‘alcoholics’, to reducing harm and preventing more serious problems among the bulk of non-dependent heavy drinkers (1 2). Instead of narrow and intensive, the strategy was (and remains) to spread thin and wide, deploying easily-learnt interventions delivered in a few minutes by non-specialist staff.

The targets were no longer to be drinkers forced to or who chose to seek help, but the far greater number whose sub-critical consumption generated no impetus for intervention. They were to be identified by biochemical tests, a few screening questions, or clinical signs, while coming into contact with services for other reasons. The resulting package is variously known as ‘screening and brief intervention’ or ‘identification and brief advice’, a package which could be replicated so widely that even if only a minority responded to a small degree, the result would be a worthwhile improvement in health across a population of drinkers. Individuals would benefit by being diverted from yet more risky drinking, but unlike treatment, the population was the main target, not the individual.......