EFFECTIVE AND COST-EFFECTIVE MEASURES TO REDUCE ALCOHOL MISUSE IN SCOTLAND: AN UPDATE TO THE LITERATURE REVIEW
SECTION TEN: OTHER ISSUES
This section reviews other issues from the literature that were not categorised by intervention type. The main findings of the previous review were;
one study has produced a ranking of effectiveness evidence across treatment areas;
evidence relating to workplace interventions is mixed;
structured cognitive-behavioural interventions may be the most effective intervention in prison settings but brief interventions may work with problem drinkers;
process of care may be an important factor in addressing specific populations groups, such as women and the elderly;
training needs for general professional groups need to be addressed;
costs for a general treatment programme in Scotland are provided; and
cost-offsets from interventions vary with patient characteristics, such as age and sex.
In this review, studies were identified relating to the needs of teenagers and women. The studies address drinking context and environment for teenagers and barriers to treatment for women.
10.1 This section summarises literature that cuts across the interventions covered in the earlier chapters. The only studies identified related to the needs of teenagers, women and those with a dual diagnosis of mental health and substance abuse disorders.
10.2 A number of reviews have considered the requirements of particular population groups with respect to alcohol misuse.
10.3 Newburn and Shiner (2001) review the problems relating to underage and teenage drinking. A number of areas are recommended for change but not based on a systematic review of the evidence. These mainly relate to structural changes in the drinking environment (e.g. restricting cheap promotions; pricing of low and non-alcoholic drinks and provision of food; plentiful seating and moderate noise levels; door policies) and social or cultural changes in the context in which teenage drinking takes place.
10.4 Zilberman et al (2002) review gender differences relevant to treatment issues. Greater social stigma attached to substance abuse may result in less treatment seeking and deter professionals from asking about substance use. Women with substance use disorders have higher rates of psychiatric co morbidity. Some aspects of self-help groups, such as AA, may be perceived to be male oriented.
10.5 Ashley et al (2003) review the effectiveness of substance abuse programming for women, which they define as services that reduce barriers to women entering treatment or address treatment needs unique to women. The review is not specific to alcohol and of 7 RCTs included only one related to alcohol. This concerned women only outpatient and residential treatment and showed decreased alcohol use and reduced job loss compared with standard care. Thirty-one non-randomised studies were also reviewed, of which 9 make specific reference to alcohol. Overall the components with some evidence of impact on effectiveness were childcare; prenatal care; women only; supplemental services (such as education); mental health services; and comprehensive integration of women's needs into service programming. Some findings may have more relevant to other substances; for example, the finding that women having residential treatment stay in treatment longer if their children are with them may have limited implications for alcohol treatment which is mainly delivered on an outpatient or community basis with any residential stays typically being short.
10.6 Judd et al (2003) report the outcomes and costs of a dual diagnosis project. A before and after study of integrated treatment for 126 patients showed improved outcomes. Increases in mental health and physical health care costs were offset by savings in criminal justice and substance abuse treatment costs. Only 46% of the group studied were considered to be alcohol dependent and separate results are not given for this group.