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EFFECTIVE AND COST-EFFECTIVE MEASURES TO REDUCE ALCOHOL MISUSE IN SCOTLAND: A LITERATURE REVIEW

CHAPTER ONE INTRODUCTION

Background

1.1 Alcohol misuse in Scotland is increasing. Recently published figures show that between 1995 and 1998 there was an increase in alcohol consumption among women aged 16-64, with the proportion exceeding recommended safe drinking limits increasing from 13% to 15%. Whilst there has been little change in drinking patterns for men aged 16-64 over the same time period, there were increases in both alcohol consumption and the proportion exceeding recommended limits in the youngest age group, 16-24 (Scottish Executive, 2000).

1.2 The Scottish Executive has set targets for reducing alcohol misuse and has set up the Scottish Advisory Committee on Alcohol Misuse (SACAM) (The Scottish Office, 1999). SACAM’s remit is "to advise the Scottish Executive on policy, priorities and strategic planning in relation to tackling alcohol misuse in Scotland". SACAM brings together key interests in health, education, social work, the police, health promotion, the voluntary sector and representatives of the licensed trade and drinks industry. The Scottish Executive and SACAM are working together to develop a Plan for Action for Alcohol Misuse. This report has been commissioned by SACAM to provide information on the evidence available about the effectiveness and cost-effectiveness of alternative measures to reduce alcohol misuse and, hence, to inform the Plan for Action for Alcohol Misuse.

Aims

1.3 The aim of this study was to review evidence on the effectiveness and cost-effectiveness of interventions aimed at reducing alcohol misuse. The specification required that the review would:

• identify measures that have been evaluated in terms of their effectiveness and cost-effectiveness;
• categorise these by type of intervention;
• identify whether the interventions were aimed at particular sub-groups within the population;
• assess the quality of the studies;
• summarise the conclusions to be drawn from the available evidence;
• identify the main gaps in the evidence base; and
• provide advice on the lessons to be learned about methods of evaluation in this area.

Structure of the report

1.4 The following two chapters provide details of the methods used in the two reviews carried out to meet the aims of the study. Chapter 2 concerns the review of effectiveness reviews and chapter 3 deals with the review of cost-effectiveness literature. The main findings of the two reviews are then reported by type of intervention in chapters 4 - 10:

Chapter 4 Policy and Legislation
Chapter 5 Enforcement
Chapter 6 Prevention
Chapter 7 Screening and Detection
Chapter 8 Brief Interventions
Chapter 9 Detoxification
Chapter 10 Relapse Prevention

1.5 Chapter 11 of the report presents further results from reviews that dealt with particular population groups, providers or settings rather than types of intervention. This chapter also covers issues such as the educational needs of providers. Chapter 12 reviews some examples of evaluations carried out in Scotland. Finally, chapter 13 summarises the main findings and makes recommendations.

Definition of Intervention Categories

1.6 Tackling alcohol misuse clearly encompasses all the areas of activity set out above. Categorising interventions to particular headings can be difficult because there are a number of grey areas and overlaps between the interventions. For clarification, the approach used in this report is as follows:

policy and legislation refers to measures such as tax policy, advertising controls and legislation on matters such as licensing, legal drinking age and drink driving regulations.

enforcement deals with specific interventions such as random breath testing that are undertaken to increase compliance with legislation.

prevention covers all broad based health education and health promotion interventions

screening and detection examines the evaluation of screening instruments and detection strategies. The use of screening as an integral part of brief interventions, for example, is not included.

brief interventions are the planned or opportunistic counselling of heavy or problem drinkers about their drinking behaviour.

detoxification is the acute treatment of alcohol withdrawal.

relapse prevention is concerned with maintaining patients as either abstinent or controlled drinkers after detoxification.

1.7 Where appropriate, further sub-headings have been used within each chapter. Within each chapter, results are presented in terms of overall conclusions about the effectiveness of the intervention, the population groups covered by the effectiveness evidence, the setting for the intervention (where appropriate), the type of provider (where appropriate) and comments on the quality and relevance of the effectiveness evidence. The relevant cost-effectiveness evidence is presented next and the chapters conclude with a discussion of the main gaps in the evidence requiring further research.

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