Background to the project

A recent report by the WHO entitled ‘Alcohol in the European Region – Consumption, Harm and Policies’ states that Europe has the highest consumption of alcohol in the world. It also has the highest rates of alcohol-related harm, an important European health problem. The consumption of alcoholic beverages is estimated to be responsible for about 9% of the total disease burden in Europe, increasing the risk of liver cirrhosis, certain cancers, raised blood pressure and strokes. Furthermore, excessive alcohol consumption increases the risk of family, work and social problems such as accidents, criminal behaviour, violence, suicide, and road traffic accidents. Between 40% and 60% of all deaths from intentional or unintentional injury are attributed to excessive alcohol consumption. Over 90% of the countries in the European Region have an annual consumption exceeding two litres of absolute alcohol per person. The total societal costs of alcohol are believe to amount to between 1% and 3% of the gross domestic product.

In primary health care, hazardous and harmful drinkers present twice as often as other patients and may constitute 20% of patients on a practice list. However, alcohol problems are responsive to early and brief intervention in primary health care. A number of randomised controlled trials have shown that, in comparison with controls, hazardous and harmful drinkers receiving 5-10 minutes of brief structured advice plus a self-help booklet from primary health care workers will reduce alcohol consumption by an average of 25% (see, e.g., Moyer, A., Finney, J., Swearingen, C., & Vergun, P. (2002). Brief Interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment -seeking and non-treatment seeking populations. Addiction, 97, 279-292.). Primary health care is a particularly valuable point of contact for the delivery of brief interventions because of the large proportion of the population who access their general practitioner (GP) each year, with two thirds of the population consulting their doctor one or more times a year and over 90% at least once in 5 years. Overall, it has been estimated that around 20% of patients identified as hazardous or harmful drinkers who receive a brief intervention will reduce their alcohol consumption.

The WHO Collaborative Project has been concerned with developing, testing and implementing screening and brief alcohol intervention in primary health care settings.

In Phase I of the WHO Project, a reliable and valid screening instrument for detecting hazardous and harmful drinking (the Alcohol Use Disorders Identification Test: AUDIT) was developed.

In Phase II, the effectiveness of brief interventions in primary health care was demonstrated in a cross-national randomised controlled trial.

In Phase III, the practices and perceptions of GPs were assessed, and methods for encouraging the uptake and utilisation of screening and brief interventions by GPs were evaluated in a controlled trial.

Phase IV is concerned with the development and application of strategies for the widespread, routine and enduring implementation of screening and brief alcohol intervention in primary health care throughout participating countries.