Dozens of randomized controlled trials suggest that brief interventions (30 minutes or less) delivered in primary health care settings can reduce drinking by 1 to 3 drinks per week, on average, and may also reduce the incidence of risky or problematic drinking.
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Dhital and colleagues tested whether individuals who received a brief intervention delivered by a pharmacist had better drinking outcomes 3 months later compared to those who received an educational brochure on alcohol related harms.
Dhital et al. used a randomized controlled trial to compare a pharmacist-delivered 10-minute alcohol intervention to an educational brochure among 407 adults in London, United Kingdom (205 vs. 202, respectively) who scored between 8 and 19 on the Alcohol Use Disorders Identification Test (AUDIT). Thus, the study focused on “at-risk” drinkers and excluded individuals with low levels of drinking (< 8) and those reporting more severe drinking (20 or greater), possibly reflective of a moderate-severe alcohol use disorder (AUD).
Pharmacists (N = 17, working at 16 pharmacies) received 3.5 hours of training in how to deliver the intervention, which was based on motivational interviewing (MI). Specifically, patients who were interested in learning more about the study or about alcohol in general, as well as those who purchased an over-the-counter product, received a pharmacy service, or had a prescription for a condition that might be related to, or affected by, alcohol use (e.g., cardiovascular disease, depression, smoking cessation, and sleep difficulties) were asked to participate and initially screened for eligibility.
Those who met eligibility criteria and agreed to participate were assigned to either the intervention or comparison group based on pre-determined random assignment – pharmacists were unaware to which group each person was assigned until they opened a sealed envelope to reveal group assignment. For those in the intervention group, the pharmacist brought the participant into a private room behind the pharmacy counter and asked participants to “talk about how drinking fitted in with their lives, explore any ambivalence and [evaluate] their drinking.” For those in the comparison group, the pharmacists only provided an educational leaflet on alcohol.
Study participants were about 40 years old, on average; 54% were male and approximately 75% were White.
Primary outcomes measured 3 months after receiving the intervention or comparison brochure were:
Controlling for any differences in AUDIT scores when they entered the study and for the pharmacist who delivered the intervention (in case certain pharmacists were more effective than others), there were no differences in AUDIT scores at 3-month follow-up.
Lack of differences persisted even after the authors ran a series of rigorous analyses to see if differences in drop-out or demographics between groups might bias the results in favor of the intervention or the comparison condition.
Also, the proportion who no longer reached the AUDIT risky drinking cut-off of 8 was similar across groups at 3-month follow-up (23% intervention vs. 27% control). In their examination of secondary outcomes (AUDIT subscales and general health), outcomes were either similar or actually favored the control group.
Although brief alcohol interventions can feasibly be implemented in pharmacies, as delivered in the current study (10 minute intervention where pharmacists received 3.5 hours of prior training), they may be unlikely to help more than just handing out a brochure.
There is the possibility that simply being asked about their alcohol use – as was the case in the control group – could lead to reductions in drinking and would make it harder for the intervention to produce an effect over and above that effect of simply being assessed, although that explanation does not seem to account for the interventions lack of advantage.
Next steps are to test whether pharmacists with more training in the assessment of alcohol problems and delivery of brief alcohol interventions may be more effective in reducing individuals’ alcohol use than they were in the current trial.
Dhital, R., Norman, I., Whittlesea, C., Murrells, T., & McCambridge, J. (2015). The effectiveness of brief alcohol interventions delivered by community pharmacists: randomized controlled trial. Addiction, 110(10), 1586-1594. doi:10.1111/add.12994
l
Dhital and colleagues tested whether individuals who received a brief intervention delivered by a pharmacist had better drinking outcomes 3 months later compared to those who received an educational brochure on alcohol related harms.
Dhital et al. used a randomized controlled trial to compare a pharmacist-delivered 10-minute alcohol intervention to an educational brochure among 407 adults in London, United Kingdom (205 vs. 202, respectively) who scored between 8 and 19 on the Alcohol Use Disorders Identification Test (AUDIT). Thus, the study focused on “at-risk” drinkers and excluded individuals with low levels of drinking (< 8) and those reporting more severe drinking (20 or greater), possibly reflective of a moderate-severe alcohol use disorder (AUD).
Pharmacists (N = 17, working at 16 pharmacies) received 3.5 hours of training in how to deliver the intervention, which was based on motivational interviewing (MI). Specifically, patients who were interested in learning more about the study or about alcohol in general, as well as those who purchased an over-the-counter product, received a pharmacy service, or had a prescription for a condition that might be related to, or affected by, alcohol use (e.g., cardiovascular disease, depression, smoking cessation, and sleep difficulties) were asked to participate and initially screened for eligibility.
Those who met eligibility criteria and agreed to participate were assigned to either the intervention or comparison group based on pre-determined random assignment – pharmacists were unaware to which group each person was assigned until they opened a sealed envelope to reveal group assignment. For those in the intervention group, the pharmacist brought the participant into a private room behind the pharmacy counter and asked participants to “talk about how drinking fitted in with their lives, explore any ambivalence and [evaluate] their drinking.” For those in the comparison group, the pharmacists only provided an educational leaflet on alcohol.
Study participants were about 40 years old, on average; 54% were male and approximately 75% were White.
Primary outcomes measured 3 months after receiving the intervention or comparison brochure were:
Controlling for any differences in AUDIT scores when they entered the study and for the pharmacist who delivered the intervention (in case certain pharmacists were more effective than others), there were no differences in AUDIT scores at 3-month follow-up.
Lack of differences persisted even after the authors ran a series of rigorous analyses to see if differences in drop-out or demographics between groups might bias the results in favor of the intervention or the comparison condition.
Also, the proportion who no longer reached the AUDIT risky drinking cut-off of 8 was similar across groups at 3-month follow-up (23% intervention vs. 27% control). In their examination of secondary outcomes (AUDIT subscales and general health), outcomes were either similar or actually favored the control group.
Although brief alcohol interventions can feasibly be implemented in pharmacies, as delivered in the current study (10 minute intervention where pharmacists received 3.5 hours of prior training), they may be unlikely to help more than just handing out a brochure.
There is the possibility that simply being asked about their alcohol use – as was the case in the control group – could lead to reductions in drinking and would make it harder for the intervention to produce an effect over and above that effect of simply being assessed, although that explanation does not seem to account for the interventions lack of advantage.
Next steps are to test whether pharmacists with more training in the assessment of alcohol problems and delivery of brief alcohol interventions may be more effective in reducing individuals’ alcohol use than they were in the current trial.
Dhital, R., Norman, I., Whittlesea, C., Murrells, T., & McCambridge, J. (2015). The effectiveness of brief alcohol interventions delivered by community pharmacists: randomized controlled trial. Addiction, 110(10), 1586-1594. doi:10.1111/add.12994
l
Dhital and colleagues tested whether individuals who received a brief intervention delivered by a pharmacist had better drinking outcomes 3 months later compared to those who received an educational brochure on alcohol related harms.
Dhital et al. used a randomized controlled trial to compare a pharmacist-delivered 10-minute alcohol intervention to an educational brochure among 407 adults in London, United Kingdom (205 vs. 202, respectively) who scored between 8 and 19 on the Alcohol Use Disorders Identification Test (AUDIT). Thus, the study focused on “at-risk” drinkers and excluded individuals with low levels of drinking (< 8) and those reporting more severe drinking (20 or greater), possibly reflective of a moderate-severe alcohol use disorder (AUD).
Pharmacists (N = 17, working at 16 pharmacies) received 3.5 hours of training in how to deliver the intervention, which was based on motivational interviewing (MI). Specifically, patients who were interested in learning more about the study or about alcohol in general, as well as those who purchased an over-the-counter product, received a pharmacy service, or had a prescription for a condition that might be related to, or affected by, alcohol use (e.g., cardiovascular disease, depression, smoking cessation, and sleep difficulties) were asked to participate and initially screened for eligibility.
Those who met eligibility criteria and agreed to participate were assigned to either the intervention or comparison group based on pre-determined random assignment – pharmacists were unaware to which group each person was assigned until they opened a sealed envelope to reveal group assignment. For those in the intervention group, the pharmacist brought the participant into a private room behind the pharmacy counter and asked participants to “talk about how drinking fitted in with their lives, explore any ambivalence and [evaluate] their drinking.” For those in the comparison group, the pharmacists only provided an educational leaflet on alcohol.
Study participants were about 40 years old, on average; 54% were male and approximately 75% were White.
Primary outcomes measured 3 months after receiving the intervention or comparison brochure were:
Controlling for any differences in AUDIT scores when they entered the study and for the pharmacist who delivered the intervention (in case certain pharmacists were more effective than others), there were no differences in AUDIT scores at 3-month follow-up.
Lack of differences persisted even after the authors ran a series of rigorous analyses to see if differences in drop-out or demographics between groups might bias the results in favor of the intervention or the comparison condition.
Also, the proportion who no longer reached the AUDIT risky drinking cut-off of 8 was similar across groups at 3-month follow-up (23% intervention vs. 27% control). In their examination of secondary outcomes (AUDIT subscales and general health), outcomes were either similar or actually favored the control group.
Although brief alcohol interventions can feasibly be implemented in pharmacies, as delivered in the current study (10 minute intervention where pharmacists received 3.5 hours of prior training), they may be unlikely to help more than just handing out a brochure.
There is the possibility that simply being asked about their alcohol use – as was the case in the control group – could lead to reductions in drinking and would make it harder for the intervention to produce an effect over and above that effect of simply being assessed, although that explanation does not seem to account for the interventions lack of advantage.
Next steps are to test whether pharmacists with more training in the assessment of alcohol problems and delivery of brief alcohol interventions may be more effective in reducing individuals’ alcohol use than they were in the current trial.
Dhital, R., Norman, I., Whittlesea, C., Murrells, T., & McCambridge, J. (2015). The effectiveness of brief alcohol interventions delivered by community pharmacists: randomized controlled trial. Addiction, 110(10), 1586-1594. doi:10.1111/add.12994
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