MEMBERS SECTION

AGM in Boston

The minutes of the last AGM in Boston include several matters of importance to the network:

  • Niamh Fitzgerald and Richard Saitz have been elected as new members of the Co-ordinating Committee
  • the agreement on the changes in the aims and objectives
  • the agreement to expand to other drugs, and the change of the name to "International Network of Brief Interventions for Alcohol and Other Drugs"

For more information please have a look at the President and Secretariat report

Next conference

The next conference will take place in Barcelona, from the 27th and 28th of September 2012 with a “pre-conference” on the Drink Less project in Catalonia the 26th. The website, with more information on registration, call for abstracts, etc, will be ready by 15th January.

NEWS

Participation of INEBRIA in WHO consultation with NGOs

INEBRIA was invited to participate in a WHO consultation with representatives of nongovernmental organizations and health professionals on ways they could contribute to reducing harmful use of alcohol. Nick Heather and Lidia Segura attended this meeting on 12 December, 2011 in Geneva. A previous meeting in which INEBRIA had been represented by Nick had been held on 24-25 November 2008. The main difference this time was that the WHO Global Strategy to Reduce the Harmful Use of Alcohol  has now been published.  It will be seen there that “supporting initiatives for screening and brief interventions for hazardous and harmful drinking at primary health care and other settings” forms a key element of the WHO strategy.
In a statement prepared for the meeting and in discussions at the time, Nick and Lidia stressed INEBRIA’s strong support for the WHO global strategy, and its willingness to collaborate with other organizations and contribute to the strategy’s success in every way possible. More details on the ways in which INEBRIA’s contribution can be made will be the topic of items in future bulletins.

‘Nick Heather’ President, INEBRIA

Events

Can brief interventions change Scotland's relationship with alcohol? Developing the model for community settings

A one-day conference by Cyrenians in association with INEBRIA, Create Consultancy, Alcohol Research UK and Comic Relief.

27th March 2012 in Edinburgh, Scotland at Murrayfield Stadium.

This conference is co-sponsored by INEBRIA and will discuss evidence and practice in relation to SBI outside of health settings including a specific focus on implementation with vulnerable groups and young people.  Confirmed speakers include: Dr. Richard Saitz, and Dr. Niamh Fitzgerald.  Cyrenians will present an evaluation of their alcohol intervention programme in a homelessness setting.

Reduced rate for INEBRIA members only!

For more information and to register your interest, please contact:

For more information please contact jenny@cyrenians.org.uk
 +44 131 475 2354

Alcohol Screening and Brief Interventions. From research into practice

A one-day conference including findings from the SIPS Alcohol Screening and Brief Intervention Trials and the launch of SIPS Junior.

5th March 2012 at the Institute of Psychiatry, King's College London.

Please note that this conference is free to those invited. However, all participants are required to register for the conference. Due to the limited number of places available we advise the earliest possible registration. Registration will close on 24th February 2012.

Christmas message

HOT TOPIC

Inclusion of hazardous drinking in ICD-11

As INEBRIA members will recall, the network was asked by Professor John Saunders for its view on whether the term ‘hazardous drinking’ should be recommended for inclusion in the International Classification of Diseases – Version 11 (ICD-11) which is now being developed. In ICD-10, which has been in use since 1994, ‘harmful substance use’ is a diagnostic term but ‘hazardous use’ is not.  John is a member of the ICD-11 Substance-Related and Addictive Disorders Work Group but did not contact us in any official WHO capacity.  However, in their individual capacities members of the Work Group were contacting colleagues to encourage discussions and potential input on the issue of hazardous substance use and other matters.  John wondered if this was something INEBRIA might like to discuss. 

This topic was indeed discussed on the INEBRIA google group and also separately by email between INEBRIA members.  The discussion was lively, interesting and very well-informed. At the end of this period of discussion, the matter was put to the vote in the Co-ordinating Committee with the result that the recommendation for inclusion of hazardous drinking in ICD-11 was endorsed. There were no dissenting votes but there were a few abstentions.  The INEBRIA President then relayed this decision to Professor Saunders in advance of a meeting of the WHO Work Group in mid December.  In order that the full range of views could be represented, Nick also collated all the opinions that had been expressed into a long document and sent that to John too. Just to be absolutely clear about this, the INEBRIA view on this matter does not necessarily mean that hazardous drinking will be included in the ICD revision but it will hopefully receive due consideration by the Work Group. It will be interesting to see how this issue evolves.


SBI: Where there is evidence and where there is not! Digest from  2011 Conference

Boston, MA, USA, September 22.

Richard Saitz discussed the evidence from the peer reviewed literature about screening and brief intervention (SBI) efficacy.  Before citing studies, he set the context by pointing out that screening can identify the spectrum of unhealthy use, from use that increases the risk of harm(s), through to dependence.  As such, interpretation of any data on SBI needs to consider who was excluded from any given research study, bearing in mind that such people cannot normally be excluded in clinical practice.

After showing a graphic of the Boston Red Sox’ unprecedented recent decline in performance, and spilling water on the presentation laptop (from which it did not recover), he made the case that observational data (e.g. 27% decreases in heroin use after a brief intervention) while tantalizing are simply not believable evidence for efficacy as causation cannot be assumed.

Although there has yet to be a randomized controlled trial (RCT) of screening (and BI) versus no screening (the evidence we really need), he pointed to robust RCT evidence in support of SBI versus screening only, for nondependent unhealthy alcohol use in primary care settings.

Dr. Saitz then spent some time reviewing the lack of data to support efficacy of brief intervention for those identified by screening who: are in emergency departments and trauma centers (more negative than positive trials); are hospital inpatients; have dependence; use other drugs; are adolescents; or are given a very brief intervention.  He also raised questions about the effectiveness of brief intervention when it is done outside tightly controlled circumstances. 

Some researchers believe that some studies don’t show efficacy of brief intervention because comparison groups who do not get brief intervention receive assessments that make them think about their drinking and then cut down.  But Dr. Saitz concluded that this explanation was unlikely for at least 2 reasons: 1) studies in primary care have found efficacy despite assessments having been done in control groups, and 2) large negative trials in emergency departments included not only BI and no BI groups but also no BI/no assessment groups and found no differences in outcomes across the three groups.

Might SBI not work in those cases (e.g. emergency departments)?  It is plausible, said Saitz, and one could hypothesise a whole range of potential reasons e.g. the lack of a longitudinal patient-clinician relationship, if the alcohol (or drug) problem is more severe, or if the patient was going to change their behavior anyway.  The burden of proof is therefore on those who believe SBI has efficacy in a wide range of circumstances to demonstrate whether in fact it does.

His full presentation and all the Boston ones have been posted here


The WHO ASSIST project - Alcohol, Smoking and Substance Involvement Screening Test

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was developed for the World Health Organization (WHO) by an international group of substance abuse researchers to detect and manage substance use and related problems in primary and general medical care settings. Primary health care professionals are well-positioned to provide interventions targeted to all substances irrespective of their legal status.

The ASSIST has undergone significant testing in three sequential phases (I, II and III) to ensure that it is feasible, reliable, valid, flexible, comprehensive and cross-culturally relevant, and able to be linked to brief interventions. The results of Phase III study have been recently accepted for publication in Addiction. 

ASSIST is currently in its fourth Phase aimed at world wide dissemination.

Within the project, the ASSIST package is developed to help the primary health professionals to detect and manage substance use and related problems in primary and general medical care settings. It includes the ASSIST screening and feedback card and three different manuals:

 The package (screening tool and brief intervention manual) has been recently translated into Spanish by Pan American Health Organization(PAHO).

For more information:
Vladimir Poznyak
Coordinator
Management of Substance Abuse
Department of Mental Health and Substance Abuse
World Health Organization
E-mail: poznyakv@who.int
http://www.who.int/substance_abuse/activities/assist/en/index.html