Effectiveness and cost-effectiveness of a stepped care intervention for alcohol use disorders in primary care: pilot study.
BACKGROUND
Screening for alcohol use disorders identifies a wide range of needs, varying from hazardous and harmful drinking to alcohol dependence. Stepped care offers a potentially resource-efficient way of meeting these needs, but requires evaluation in a randomised controlled trial.


OBJECTIVE
To evaluate the feasibility, effectiveness and cost-effectiveness of opportunistic screening and a stepped care intervention in primary care.


METHODS
A total of 1794 male primary care attendees at six practices in South Wales were screened using the Alcohol Use Disorders Identification Test (AUDIT). Of these, 112 participants who scored 8 or more on the AUDIT and who consented to enter the study were randomised to receive either 5 minutes of minimal intervention delivered by a practice nurse (control group) or stepped care intervention consisting of three successive steps (intervention group): a single session of behaviour change counselling delivered by a practice nurse; four 50-minute sessions of motivational enhancement therapy delivered by a trained alcohol counsellor; and referral to a community alcohol treatment agency.


RESULTS
Both groups reduced alcohol consumption 6 months after randomisation with a greater, although not significant, improvement for the stepped care intervention. Motivation to change was greater following the stepped care intervention. The stepped care intervention resulted in greater cost savings compared with the minimal intervention.


CONCLUSIONS
Stepped care was feasible to implement in the primary care setting and resulted in greater cost savings compared with minimal intervention.
Drummond
Colin
C
National Addiction Centre, PO48, Institute of Psychiatry, King's College London, 4 Windsor Walk, London SE5 8BB, UK. Colin.drummond@iop.kcl.ac.uk
Coulton
Simon
S
James
Darren
D
Godfrey
Christine
C
Parrott
Steve
S
Baxter
John
J
Ford
David
D
Lervy
Bruce
B
Rollnick
Stephen
S
Russell
Ian
I
Peters
Timothy
T
D000328:Adult; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D003156:Community Mental Health Services / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D004812:Epidemiologic Methods; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000191:economics / Q000379:methods*; D011788:Quality of Life; D016896:Treatment Outcome; D014852:Wales