brief advice for adults Recommendation 11: extended brief interventions for adults Recommendation 12: referral NICE, 2007 Interventions in schools to prevent and reduce alcohol use among children and young people. National Institute for Health and Clinical Excellence Alcohol prevention Children and young adults Prevention and reduction in alcohol use among children and young people There are a number of recommendations in this guideline. This is a summary (refer to full guidance for detail). Recommendation 1 • Ensure alcohol education is an integral part of the curriculum. • Ensure alcohol education is tailored for different age groups and takes different learning needs into account • Introduce a ‘whole school’ approach to alcohol, involving staff, parentsand pupils • Where appropriate, This guidance is based on a series of evidence reviews, supporting evidence statements and economic analysis This intervention is implemented locally in some areas but does not have a consistent national programme or a co-ordinated approach OR is nationally on an ad-hoc basis
education in schools – ensure school interventions on alcohol use are integrated with community activities – find ways to consult with families about initiatives to reduce alcohol use and to involve them in those initiatives – monitor and evaluate partnership working and incorporate good practice into planning. Faggiano F et al, 2005 School-based prevention for illicit drugs' use Cochrane Database of Systematic Outcomes variables (self reported and measured using specific tests): (1) knowledge: (2) attitudes (3) acquirement of personal skills including: Skills based programs appear to be an effective form of school based intervention in deterring early use of alcohol (and other drugs) The pathways of risk and risk factors for alcohol, tobacco and drugs among the young were shown to be the same or similar and the 32 controlled studies were included, of which 29 were randomised, comparing school-based programs aimed at prevention of substance use with the usual curriculum. 46,539 students involved mainly in sixth or seventh grade, mainly in the USA. Programs that focused on knowledge improved knowledge to some degree, in six randomised trials. This intervention is implemented locally in some areas but does not have a consistent national programme or C. There is some evidence supporting the use of this but it is not conclusive
Reviews Substance misuse prevention Children and young adults - self-esteem - peer pressure resistance (4) peers/adults substance use : (5) intention to use substances (6) use of substances: (7) changes in behaviours including: - arrests - school performance review favoured the delivery of a single intervention to prevent the initial use of all the harmful substances. Whilst the review is primarily focused in illicit drugs, the scope of the search included substance use generally, including alcohol and tobacco. Social skills programs were more widely used (25 randomised trials) and effectively increased drug knowledge, decision-making skills, self-esteem, resistance to peer pressure, and drug use including of marijuana (RR 0.8) and hard drugs (heroin) (RR 0.5). Effects of the interventions on assertiveness, attitudes towards substances, and intention to use were not clearly different in any of the trials. a co-ordinated approach OR is nationally on an ad-hoc basis Foxcroft D, Tsertsvadze A, 2011 Universal school based prevention programmes for alcohol misuse in Primary outcomes direct or objective measures of alcohol consumption or problem drinking e.g. Alcohol use, quantity and This review identified studies that showed no effects of preventive interventions, as well as studies that demonstrated statistically significant effects. There was no easily discernible pattern in characteristics that would distinguish trials with positive results from those 53 trials were included, most of which were cluster-randomised. The reporting quality of trials was poor, only 3.8% of them reporting adequate method of randomisation and program allocation concealment. Incomplete data was adequately addressed in 23% of the trials. Due to extensive heterogeneity across interventions, populations, and outcomes, the results were summarized only This intervention is implemented locally in some areas but does not have a consistent D. The evidence is and it is not possible to draw a conclusion but there is some
young people Cochrane Database of Systematic Reviews Alcohol prevention Children and young adults frequency and incidence of drunkenness Outcome measures related to psychological or awareness were deemed as indirect and therefore were not considered. with no effects. Most commonly observed positive effects across programs were for drunkenness and binge drinking. Current evidence suggests that certain generic psychosocial and developmental prevention programs can be effective and could be considered as policy and practice options. qualitatively. Six of the 11 trials evaluating alcohol-specific interventions showed some evidence of effectiveness compared to a standard curriculum. In 14 of the 39 trials evaluating generic interventions, the program interventions demonstrated significantly greater reductions in alcohol use either through a main or subgroup effect. Gender, baseline alcohol use, and ethnicity modified the effects of interventions. Results from the remaining 3 trials with interventions targeting cannabis, alcohol, and/or tobacco were inconsistent. national programme or a co-ordinated approach OR is nationally on an ad-hoc basis evidence of effect Foxcroft D, Tsertsvadze A, 2011 Universal family-based prevention programs for alcohol misuse in young Primary outcomes direct or objective measures of alcohol consumption or problem drinking e.g. Alcohol use, quantity and Effects of family-based prevention interventions are small but generally consistent and also persistent into the medium- to longer-term. One of the interventions included was the Iowa Strengthening Families programme. This was shown to be significantly better than the control, but 12 parallel-group trials were included. The reporting quality of trials was poor, only 20% of them reporting adequate method of randomisation and program allocation concealment. Incomplete data was adequately addressed in about half of the trials and this information was unclear for about 30% of the trials. Due to extensive heterogeneity, the reported This intervention is implemented locally in some areas but does not have a consistent national programme or C. There is some evidence supporting the use of this but it is not conclusive
people. Cochrane Database of Systematic Reviews Alcohol prevention Children and young adults frequency and incidence of drunkenness Outcome measures related to psychological or awareness were deemed as indirect and therefore were not considered. not significantly different to another programme called Preparing for the Drug-Free Years. results were summarized only qualitatively. 9 of the 12 trials showed some evidence of effectiveness compared to a control or other intervention group, with persistence of effects over the medium and longer-term. Four of these effective interventions were gender-specific, focusing on young females. One study with a small sample size showed positive effects that were not statistically significant, and two studies with larger sample sizes no significant effects of the family-based intervention for reducing alcohol misuse. a co-ordinated approach OR is nationally on an ad-hoc basis Foxcroft D, Tsertsvadze A, 2011 Universal prevention programs for alcohol misuse in young Primary outcomes direct or objective measures of alcohol consumption or problem drinking e.g. Alcohol use, quantity and There is some evidence that multi-component interventions for alcohol misuse prevention in young people can be effective. However, there is little evidence that interventions with multiple components are more effective than interventions with single components. Due to extensive heterogeneity across interventions, populations, and outcomes, the results were summarized only qualitatively. 12 of the 20 trials showed some evidence of effectiveness compared to a control or other intervention group, with persistence of effects ranging from 3 months to 3 years. Of the remaining 8 trials, one trial reported significant effects using Unknown D. The evidence is and it is not possible to draw a conclusion but there is some
Cochrane Database of Systematic Reviews Primary care Children and young adults Working age adults consumption (3) Alcohol related harm to the drinkers or to affected others Secondary outcomes (4) Patient satisfaction (5) quality of life (6) Economic measures including use of health services the normal clinical setting and in research settings with greater resources. Longer counselling had little additional benefit. Future trials should focus on women and on delineating the most effective components of interventions. participants) confirmed the benefit of brief intervention in men (mean difference: -57 grams/week, 95% CI: -89 to -25, I2 = 56%), but not in women (mean difference: -10 grams/week, 95% CI: -48 to 29, I2 = 45%). Boards, but there is some nationally guided delivery. however these are trials and not in a service delivery context. Moreira MT, Smith LA, Foxcroft D, 2009 Social norms interventions to reduce alcohol misuse in University Primary outcomes Alcohol use and misuse as measured by self-reported measures of consumption Secondary outcomes Measures of Web/computer feedback and individual face to face feedback are probably effective in reducing alcohol misuse. The results were not significant for mailed and group feedback and for social norms marketing campaigns. Twenty-two studies were included (7,275 participants). Significant reduction in alcohol related problems (SMD -0.31 95%Cl -0.59 to -0.02), peak blood alcohol content (SMD-0.77 95%Cl -1.25 to drinking frequency (SMD 95%Cl -0.63 to -0.13) and drinking quantity (SMD -0.35 95% Cl -0.51 to -0.18) with web/computer P This intervention is currently being implemented as a trial D. The evidence is and it is not possible to draw a conclusion but there type
or College students. Cochrane Database of Systematic Reviews Alcohol reduction Children and young adults, alcohol related problems e.g. Adverse legal events as a consequence of alcohol i.e. violence, driving offences; Inappropriate risky behaviours; and Alcohol related injuries (Social norms refers to our perceptions and beliefs of what is ’normal’ behaviour in the people close to us, and these beliefs are influential on behaviour e.g. perceptions of how much peers drink. Interventions involved web based, individual face-to-face, mailed and group social norms interventions) feedback is some evidence of effect Stade BC et al, 2009 Psychological and/or educational interventions for reducing alcohol consumption in pregnant women and This systematic review aims to examine all trials including pregnant women or women planning for pregnancy which compare psychological and/or educational interventions No meta-analyses performed as the interventions and outcomes measured in the studies were not sufficiently similar. Results from individual studies suggest that interventions may encourage women to abstain from alcohol in pregnancy. There was very little Four studies met the inclusion criteria (715 pregnant women), The studies involved women Who were less than 28 weeks pregnant and consuming some alcohol. All were carried out in the USA and reported on at least one of the outcomes of interest. The main conclusion of this review is that overall there is very little evidence about the effects of educational and psychological interventions aiming to reduce Services for pregnant women tend to focus on drugs, rather than alcohol and safeguarding, rather than general harm to health issues. D. The evidence is and it is not possible to draw a conclusion but there is some evidence
women planning pregnancy. Cochrane Database of Systematic Reviews Alcohol reduction Women: young adults, working age adults versus no intervention (or usual care) for reducing the consumption of alcohol during pregnancy. Outcomes – alcohol intake plus health outcomes for mother and baby information provided on the effects of interventions on the health of mothers and babies although some. alcohol consumption in pregnancy, and in particular, on the effect of such interventions on the health of women and babies. of effect Thomas RE, Lorenzetti D, Spragins W, 2011 Mentoring adolescents to prevent drug and alcohol use. To assess the effectiveness of mentoring on: 1)Abstinence 2)Use of alcohol or drugs 3)Reduction in consumption of drugs and or Two out of the four included RCTs found that mentoring reduced rates of initiation of use of alcohol, and one reduced initiation of use of drugs. No adverse effects were identified. All four RCTs were in the US, and included “deprived” and mostly minority 4 RCTs (1,194 adolescents) were identified. No RCT reported enough detail to assess whether a strong randomisation method was used or allocation was concealed. Blinding was not possible as the intervention was mentoring. Three RCTs provided complete data. Three RCTs provided evidence about mentoring and preventing ASSIST may include some elements of this, but it is a single point in time intervention delivered in a limited number of schools. Alcohol concern may offer this D. The evidence is and it is not possible to draw a conclusion but there
Cochrane Database of Systematic Reviews Alcohol prevention Children and young people alcohol 4)Not being involved in alcohol or aggression or accidents adolescents. Participants were young (in two studies age 12, and in two others 9-16). All students at baseline were non-users of alcohol and drugs. The studies assessed structured programmes and not informal mentors. alcohol use. Two RCTs were pooled(RR for mentoring compared to no intervention = 0.71 (95% CI = 0.57 to 0.90, P value = 0.005). A third RCT found no significant differences. Three RCTs provided evidence about mentoring and preventing drug use, but could not be pooled. One found significantly less use of “illegal“ drugs,” one did not, and one assessed only marijuana use and found no significant differences. One RCT measured “substance use” without separating alcohol and drugs, and found no difference for mentoring. of programme. is some evidence of effect The Community Guide Recommendations
The Community Guide is a product of the Community Preventative Task Force in the US. The Community Preventive Services Task Force was established by the U.S. Department of Health and Human Services (DHHS) in 1996 to develop guidance on which community-based health promotion and disease prevention interventions work and which do not work, based on available scientific evidence. The Centers for Disease Control and Prevention (CDC) is the DHHS agency that provides the Task Force with technical and administrative support following a systematic review process. These recommendations are made in a US policy and services context and may not apply fully to the UK. In the field of substance misuse, alcohol, the following recommendations have been made (terms in the brackets relate to the terminology used in this review) Interventions Directed to the General Population Recommended March 2010 Recommended August 2012 Recommended June 2007 Recommended June 2008 Recommended February 2009 Insufficient Evidence March 2010