Title: A feasibility study of a psychological intervention to address alcohol misuse for people with mild to moderate learning disabilities living in the community
Funder: Department of Health (England)

Abstract: Background: Alcohol is the commonest and most widely available psychoactive substance. With most people with learning disabilities living in the community, there is increasing concern about their exposure to alcohol, increased vulnerability to alcohol misuse, and the ability of services to provide adequate support to those who experience psychological and social difficulties as a result of misuse. Brief intervention and extended brief intervention (EBI) are recommended as first line treatments for the general population who have alcohol use disorders (AUD). EBI has been used in secure in-patient settings but to date EBI has not been evaluated in a community based population with learning disabilities. Aims: The aim of this project is to assess the feasibility of evaluating EBI for adults with mild to moderate learning disabilities through a single-blind, randomised controlled trial (RCT) comparing EBI as an adjunct to usual care versus usual care. Issues including acceptability of the intervention, suitability of outcome measures, compliance, recruitment and retention, will be explored. Qualitative interviews will also be conducted with service users, carers and service providers to examine their perceptions of the intervention and its acceptability. We intend to use this pilot data to prepare for a definitive RCT, with the intention of applying for funding from the HTA. Methods: Based on the MRC guidelines for complex interventions we propose a three stage design: 1. Development of the precise content of the intervention and related materials based on interventions currently available for the general population and from the literature in learning disabilities. This will be piloted and refined in order to carry out a feasibility trial. 2. Fifty people with mild to moderate learning disabilities and alcohol use disorders (AUD; Alcohol Use Disorder Identification Test>8) and their carers, where available, will be recruited to a two-armed RCT and receive either EBI in addition to usual care or usual care only. The EBI, provided by a trained therapist, will involve five half-hour weekly sessions, which will be based on motivational interviewing. A final one hour session, focussed on maintenance, will be delivered at eight weeks. Assessments of the participants and their carers will be conducted at baseline, end of treatment and at 3 months. We will use measures that detect changes in AUD, mental health, physical health status, knowledge and behaviours, and use of services. 3. Service users, carers and service providers (involved in providing usual support to participants, but not involved in providing EBI) will also give their perspectives on the intervention and its acceptability in qualitative interviews at 12 weeks. We will also attempt to conduct interviews with 50% of those who drop out of treatment to ascertain their views and reasons for dropping out. Potential benefits: We will refine the EBI in line with the findings from this study. These materials will be made available to general practices, substance misuse services and learning disabilities services, enabling widespread use by health providers within the NHS. We anticipate that the materials could also be of use to private and third sector providers as they may become involved in delivering treatments to people with mild to moderate learning disabilities within an inclusion agenda. The findings from this study will inform our preparation for a definitive large scale RCT to test the efficacy of EBI in this population. Managing alcohol misuse should lead to improvements in health and quality of life. Costs to the NHS will be reduced through decreased overall service use due to improved health. The programme would also ensure a more equitable service for service users with learning disabilities and fill the current gap in service delivery to this population.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: STROKE;MENTAL HEALTH;CANCER AND NEOPLASMS;CARDIOVASCULAR;ORAL AND GASTROINTESTINAL