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The effectiveness and cost-effectiveness of a stepped care intervention for alcohol use disorders in primary care: a pilot study

Drummond, Colin, Coulton, Simon, James, Darren, Godfrey, Christine, Parrott, Steve (2009) The effectiveness and cost-effectiveness of a stepped care intervention for alcohol use disorders in primary care: a pilot study. British Journal of Psychiatry, 195 (5). pp. 448-456. ISSN 0007-1250. (doi:10.1192/bjp.bp.108.056697) (KAR id:24382)

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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.


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


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.


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.


Stepped care was feasible to implement in the primary care setting and resulted in greater cost savings compared with minimal intervention.

Item Type: Article
DOI/Identification number: 10.1192/bjp.bp.108.056697
Subjects: H Social Sciences > HV Social pathology. Social and public welfare > HV5001 Alcoholism and intemperance
R Medicine > RA Public aspects of medicine
R Medicine > RT Nursing
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Centre for Health Services Studies
Depositing User: Tony Rees
Date Deposited: 23 Aug 2010 11:03 UTC
Last Modified: 16 Nov 2021 10:02 UTC
Resource URI: (The current URI for this page, for reference purposes)
Coulton, Simon:
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